Doctors are investigating the case of a Winnipeg toddler with symptoms suggesting a rare, inflammatory illness potentially linked to COVID-19, the girl’s mother says.
And the child is fighting to recover, even after she no longer tested positive for the disease.
The mother says health-care providers treating her daughter are concerned the girl may have developed Kawasaki disease, or multi-system inflammatory syndrome in children, also called MIS-C.
The inflammatory syndromes can result from the body’s reaction to new viruses — not just the new coronavirus. But doctors in Canada, and scientists around the world, are investigating cases for a link to COVID-19.
Public health officials in Manitoba say no cases of the conditions connected with COVID-19 have been confirmed in the province so far.
“Honestly, it’s just terrifying. I don’t have the answers. Doctors don’t have the answers,” said the girl’s mother, who CBC is not naming due to concern about stigma.
“We’re just trying to do anything we can.”
It’s been more than a month since the one-year-old girl tested positive for COVID-19 in late April, the mother said. She believes her daughter was infected after her husband was exposed to a co-worker who later tested positive.
At first, her parents didn’t know what to make of the little girl’s symptoms. She had a red, puffy rash, vomiting and diarrhea, a tender abdomen and a recurring fever that spiked to 102 F.
“She refused to eat, barely had anything to drink,” said her mother.
Before they knew about her husband’s COVID-19 exposure, pediatricians contacted via Zoom were cautious about sending the child to a hospital, and told the mother to try Tylenol, thinking the girl had a flu.
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The family learned of the workplace exposure on April 28, two days after the symptoms arose, and went for testing immediately. Blood work done at the Children’s Hospital at the Health Sciences Centre confirmed the toddler had COVID-19.
At that point, Manitoba had fewer than 25 active cases of the disease caused by the new coronavirus. The province was already announcing plans for reopening.
“It was absolutely devastating,” the mother said.
“You see your child kind of deteriorating, and you kind of think, it could be something different,” she said. “How could it possibly be COVID … with the cases being so low?”
Wish to take the pain away
Hospitals in Ontario, Quebec, B.C. and Alberta are examining possible cases of MIS-C. Experts say the illness is difficult to diagnose and many cases remain ill-defined.
“There are way more unknowns than knowns,” said Dr. Rae Yeung, a professor of pediatrics, immunology and medical sciences at the University of Toronto, and staff pediatrician and rheumatologist at the Hospital for Sick Children.
“Right now, the big challenge is that there is not one diagnostic test … that can actually tell us whether a child has MIS-C or Kawasaki disease, [which are] all one hyper-inflammatory syndrome,” said Yeung, who is also a senior scientist in cell biology research.
“As we’re learning, the one common denominator is that they have massive immune activation. But many things can cause massive immune activation.”
When she’s not sick, the Winnipeg 21-month-old is “very chatty. She’s energetic, running around,” said her mother. “She’s your typical toddler. She is always happy — except for when she’s teething, of course.”
COVID-19 sucked that energy away.
“She started sleeping more and more, to the point where she was only awake approximately three hours in a 24-hour period,” her mother said.
After she tested positive, doctors admitted the toddler to the hospital and put her on IV fluids and antibiotics. Medical staff did X-rays, ultrasounds, urinalysis and blood work, trying to rule out anything else that may have been making her sicker.
Initially, doctors hoped her body could fight off the disease on its own, her mother said. But the family has been in and out of the hospital for weeks as her condition remained serious.
Last week, the toddler’s condition took a turn for the worse. Her mother said it was like being “back to Square 1” — but when she brought her back to the hospital, on May 28, tests showed her daughter is now negative for COVID-19, and fighting a new medical battle.
That was the day doctors first raised the possibility of MIS-C or Kawasaki, the mother said. The toddler was also diagnosed with sepsis and a severe urinary tract infection, and prescribed a strong antibiotic — but on Thursday, one week into a 10-day prescription, there was little improvement.
Now, the mother said doctors will begin further tests to help understand exactly what is making her daughter so ill.
“You just kind of feel helpless because you can’t make [your children] feel better — and that’s kind of your job as a mother,” she said.
“You don’t want to see them sick, especially with something so serious as a pandemic. You just wish you could take their pain away.”
The syndrome with many names
Yeung calls MIS-C “the syndrome with many different names,” because depending on where you are in the world, it might be called different things.
“I think this is part of the reason why it’s led to some confusion and a lot of anxiety, in fact, among not only families, but also caregivers and health-care professionals,” she said.
Much of what’s known so far about the disease remains hypothetical, she said, and research is needed to understand more. At its core, the syndrome — and Kawasaki disease, which is part and parcel of the same family of illnesses — can be characterized by inflammation, especially in blood vessels, caused by a hyperactivation of the immune system.
“What we’re seeing in all of these syndromes is hyper inflammation — just an overactive immune system that’s gone into overdrive, affecting multiple organs in the body,” she said.
The illnesses in that family are triggered by a “tickle” to the immune system, Yeung said, which can be anything from strep throat to the novel coronavirus. Canada documents roughly 100 to 150 cases of Kawasaki disease a year, for example, she said.
But epidemiology in Europe, the U.S. and Canada has suggested a pattern, as cases of inflammatory syndromes in children emerge roughly four to six weeks following the peak coronavirus outbreak in each population.
Many, even most, of the children diagnosed with these illnesses don’t initially test positive when swabbed for COVID-19, Yeung said, but bloodwork often shows the children had the disease previously.
It’s still not clear exactly how many cases of the inflammatory illness there are in Canada, Yeung said. At the Sick Kids hospital in Toronto, where she works, she said they’re seeing roughly three to four times the volume of these illnesses over normal years.
She’s helping lead research, in partnership with the Canadian Paediatric Society and the Public Health Agency of Canada, to work with doctors across the country to determine where cases are and help understand them better.
“I think sharing knowledge and alerting the public is a very important component of this, so that people are alert and aren’t afraid to come to the hospital,” Yeung said. “I don’t want people to avoid coming to the hospital if their child is sick and has prolonged fever. They need to seek appropriate medical attention.”
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