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Infectious Diseases

Updated 15 June 2020

Kawasaki-like disease affecting children is a new condition – and may be linked to Covid-19

Researchers have identified the main symptoms of a new syndrome, named PIMS-TS, but concluded that it is extremely rare.

  • A multi-inflammatory syndrome affecting children has emerged during the Covid-19 crisis
  • Named PIMS-TS, researchers say it is distinct from Kawasaki disease
  • A recent study shows a possible link between PIMS-TS and Covid-19


Amid the Covid-19 crisis, researchers in the UK and several European countries recently picked up on a new inflammatory syndrome in children that is similar to Kawasaki disease, a rare inflammatory disease known to affect infants and young children. 

This new disease has been named Paediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS) and is a mysterious condition that only surfaced after the Covid-19 outbreak. 

Their research, published in the Journal of the American Medical Association, identified the main symptoms and clinical markers of the new syndrome after studying 58 children who were admitted to eight hospitals in England.

PMIS-TS and Covid-19

Led by Imperial College Academic Health Science Centre (AHSC) researchers, the analysis showed that if left untreated, the new condition presents a risk of severe complications in seriously ill children.

Although PIMS-TS is believed to be extremely rare (fewer than 200 cases have been reported in England), the researchers expressed concerns about long-lasting coronary damage. However, with early identification and treatment, the outcome is positive as the children studied remained completely well after being discharged.

While the research team cannot say for certain that PIMS-TS is caused by Covid-19, their findings show that the majority of children who were infected with the new inflammatory disease also had antibodies for the new coronavirus. This suggests that PIMS-TS happens after infection, which they think is the result of an immune system overreaction.

The emergency of a new inflammatory condition during this time is unlikely to be a coincidence, they wrote. 

Kawasaki vs PIMS-TS: what’s the difference?

According to the US Centers for Diseases Control (CDC), Kawasaki disease occurs worldwide (the highest incidence in Japan) and tends to affect younger children. Although not much is currently known about PIMS-TS, the team noticed that the newer disease appears to affect older children (average nine years old), whereas Kawasaki disease – also known as mucocutaneous lymph node syndrome – mainly affects children under the age of five.

Symptoms of PIMS-TS include abdominal pains and diarrhoea, alongside common features such as a sustained fever. According to the study, it also appears to affect a higher number of Black and Asian patients. Cases of Kawasaki, however, have occurred in children across various races and ethnicities, notes academic healthcare organisation Cedars Sinai.

Blood tests also revealed that PIMS-TS patients have more indications of inflammation and cardiac enzymes, suggesting that the heart is under strain. Kawasaki disease, on the other hand, is known to damage the coronary artery in young children, making the disease a leading cause of acquired heart disease in children.

Immune therapy has been used on PIMS-TS patients as it is known to alleviate the problems caused by Kawasaki disease, but the team mentioned that the new disease and treatment need further investigation.

"The new condition, PIMS-TS, is extremely rare but it can make a child very ill, so it's important to characterise the disease properly so we can provide close monitoring and the best treatment,” lead author Dr Elizabeth Whittaker, from the Department of Infectious Disease at Imperial College London told EurekAlert.

Collaboration with European and US teams

Since PIMS-TS has so far demonstrated serious complications, the researchers mention that the more is known about it, the better-prepared healthcare workers can be to intervene and prevent worse outcomes.

“For example, patients who develop shock and cardiac failure have a different pattern of blood tests that may help to identify the at-risk group for targeted treatment," said lead researcher, Professor Michael Levin, from the Department of Infectious Disease at Imperial College London.

The team is currently collaborating with teams across Europe and the US that are also studying the new condition and aim to better understand it and its link to Covid-19. This is especially relevant and will need to be considered in vaccine development, since PIMS-TS is brought about by an immune system overreaction, they said.

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