Spanish girl, 11, dies of organ failure after testing positive for Covid-19 in rare suspected case of Kawasaki-like inflammatory syndrome

  • Child died at Joan XXIII University Hospital of Tarragona in Catalonia yesterday
  • Girl's condition had all hallmarks of Covid-linked condition dubbed PIMS-TS
  • Two British children have died from it and hundreds have been hospitalised

By RITA SOBOT FOR MAILONLINE

Published: | Updated:

An eleven-year-old girl has died from organ failure in Spain after suffering from a rare immune complication linked to the coronavirus, according to local media.

The child, who had no known underlying health conditions, passed away at the Joan XXIII University Hospital in Tarragona, Catalonia, yesterday after previously testing positive for Covid-19. 

Catalonia's public health secretary claimed it was too early to say Covid-19 was definitely the cause of death, adding that it was 'a very sad case'.

But the girl's case had all of the hallmarks of the Covid-linked syndrome likened to Kawasaki disease, which has been dubbed Paediatric Inflammatory Multisystem Syndrome Temporally (PIMS-TS).  

The condition appears to strike children around the age of 10, on average, typically causing stomach pains, vomiting, diarrhoea, fevers, rashes, red eyes and swollen feet. 

Fatal complications of the illness appear to be related to the strain it puts on the heart - but the exact details of how the condition kills remain unclear.

Doctors are almost certain the illness is being caused by the coronavirus but they haven't yet been able to prove it yet.

Reports of children dying of the condition - or of Covid-19 at all - are rare, but at least two British children have died from PIMS-TS and hundreds have been hospitalised. 

The child, who had no underlying health conditions, passed away at the Joan XXIII University Hospital of Tarragona in Catalonia (pictured) yesterday after testing positive for Covid-19

The child, who had no underlying health conditions, passed away at the Joan XXIII University Hospital of Tarragona in Catalonia (pictured) yesterday after testing positive for Covid-19

In the largest study of its kind yet, paediatricians detailed the course of the mystery inflammatory illness in 78 hospitalised youngsters. The most common symptoms were fever, shock, abdominal pain, vomiting and diarrhoea. Other reported symptoms by other doctors are a rash (see bottom right, in different skin colours), red eyes, a headache, swollen hands and feet and confusion

In the largest study of its kind yet, paediatricians detailed the course of the mystery inflammatory illness in 78 hospitalised youngsters. The most common symptoms were fever, shock, abdominal pain, vomiting and diarrhoea. Other reported symptoms by other doctors are a rash (see bottom right, in different skin colours), red eyes, a headache, swollen hands and feet and confusion

The Spanish girl was initially admitted to the Verge de la Cinta Hospital in Tortosa over the weekend, according to regional newspaper Diario de Tarragona.

It's unclear what her initial symptoms were, but her condition is said to have deteriorated rapidly.

The child was then transferred 50 miles to the Joan XXIII early on Monday morning when her organs started to fail.

Secretary General of Public Health, Mr Argimon, said the girl had been diagnosed with Covid-19, but, for the moment, it was not possible to know if the virus was the cause of the death.

'You have to differentiate the two things well,' said Mr Argimon. 'It it is a very sad case.'

WHAT DO WE KNOW ABOUT PIMS-TS?

WHAT IS IT CALLED?

The illness has been likened to Kawasaki disease, which mainly affects children under the age of five.

But it has been named Paediatric Inflammatory Multisystem Syndrome Temporally (PIMS-TS) because it is new and distinct from Kawasaki.

WHAT SYMPTOMS DOES IT CAUSE?  

The majority of the children being hospitalised with the condition have suffered from a high fever for a number of days, severe abdominal pain and diarrhoea.

Some develop a rash and red eyes or red lips, while a very small group go into shock, in which the heart is affected and they may get cold hands and feet and have rapid breathing. 

The symptoms are similar to those caused by Kawasaki disease, a rare but treatable condition that affects around eight in every 100,000 children each year in the UK. 

WHO DOES IT AFFECT?

PIMS-TS appears to be more likely to affect older children than Kawasaki disease (average nine years old versus four years old respectively), British researchers recently wrote in the Journal of the American Medical Association. 

Up to 80 per cent of affected children in a study of 78 children by the Royal College of Paediatrics and Child Health were from black, Asian and minority ethnic backgrounds (BAME). 

Similarly, more than half (57 per cent) of 21 youngsters diagnosed in a Paris hospital were of African heritage, compared to 29 per cent of European descent.

Dr Sara Hanna, medical director at Evelina London Children's Hospital, said 70 to 80 per cent of children seen in London hospitals have been BAME.

WHEN DID OFFICIALS FIRST START TO SEE CASES?

The NHS sent an alert to doctors on April 27, warning them to look out for signs of the syndrome. 

At the time they said cases had been appearing in tiny numbers in London for about three weeks. Since then they have spread further across the country.

There have been less than 200 cases of PIMS-TS reported in England so far, according to researchers at the Imperial College Academic Health Science Centre. Figures for the UK are not clear.

IS IT CAUSED BY SARS-COV-2, THE CORONAVIRUS?

Doctors are almost certain the illness is being caused by the coronavirus but they haven't yet been able to prove it. 

Cases began appearing as the UK's coronavirus outbreak hit its peak and similar conditions have been reported in China and Italy during the pandemic.

However, not all children with the Kawasaki-like syndrome test positive for the virus. Swab testing has suggested some of the children have not been infected with COVID-19 at the time they were ill.

But all patients have tested positive for antibodies, doctors said, meaning they have had the coronavirus in the past.

They said this suggests it is a 'post-infectious phenomenon' which is caused by a delayed overreaction of the immune system, which may happen weeks or even up to a month after the child was infected with Covid-19. 

IS IT TREATABLE? 

Yes. But there have been some reported deaths - at least two, according to the RCPCH.

The only child known to have died with it, a 14-year-old boy, died of a stroke that was triggered by the life support machine he was on.

Doctors are currently treating the condition by using medications to calm down the immune system and dampen the overreaction.

Dr Liz Whittaker, a paediatrician at Imperial College Healthcare in London, said the sickest children are usually very ill for four to five days and begin to recover a couple of days after starting treatment.

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There have been fewer than 200 cases of PIMS-TS reported in England so far, with a range of symptoms and severity. Most children have already recovered. 

Nearly 300 cases the life-threatening syndrome have been identified in the US, in two studies published in The New England Journal of Medicine.  

The illness has been likened to Kawasaki disease, which mainly affects under-fives and causes blood vessels throughout the body to swell. 

Children appear to fall sick with PIMS-TS several weeks after being infected by the coronavirus, called SARS-CoV-2. 

In April, clinicians in the UK were alerted to a cluster of children with unexplained inflammation requiring admission to intensive care units.

A major study was carried out over 40 days and 78 cases of PIMS-TS were reported by 21 of 23 intensive care units in the UK. Two of the chidren died.

The full findings were published in the medical journal, The Lancet, last month. 

The study said hospital admissions to paediatric intensive care between April 1 and May 10 was at least 11-fold higher than historical trends for similar inflammatory conditions.   

Dr Patrick Davies, consultant paediatric intensive care specialist at Nottingham Children's Hospital, published the findings of 78 children across 21 of 23 UK paediatric intensive care units during that time period.

They each fulfilled the condition definition newly outlined by the Royal College of Paediatrics and Child Health to help both doctors and parents spot the signs. 

A fever was present in all cases studied, and children also suffered with shock, abdominal pain, diarrhoea and vomiting. 

They received a varied range of treatments, and one child was given the antiviral remdesivir - which became the first medication to get approval for use on the NHS to treat Covid-19 in May.

A third of patients were found to have coronary artery abnormalities. These included coronary aneurysms - the abnormal dilation of a artery supplying the heart. 

Four per cent of patients had significant blood clotting that was affecting the blood flow in vessels.

Doctors believe the survival rate is high because three per cent (two) of children in the study died. 

Dr Padmanabhan Ramnarayan, senior author of the research, told MailOnline: 'While it is difficult to comment about the cause of death in individual cases, potential mechanisms for a poor outcome might include blood clots in the brain, excessive bleeding and severe heart failure. 

'However, this study shows that the condition is rare and has affected few children overall, and that outcomes for those who have needed ICU care is generally very good.'

He added that PIMS-TS is an inflammatory condition and causes a similar phenomenon to the 'cytokine storm' described in adults with Covid-19.

A cytokine stormy, potentially fatal, is when the immune response goes into overdrive and immune cells start attacking healthy tissue as well.  

Dr Ramnarayan, a consultant in paediatric intensive care retrieval at Great Ormond Street Hospital, said: '[It] may lead to multiple organs being affected, mainly the heart, kidneys and blood vessels.' 

Academics did not reveal who the children who died in the study cohort were. It is not clear they are two previously reported UK fatalities linked to Kawasaki and Covid - a 14-year-old boy and an eight month old baby.

The death of the unnamed 14-year-old boy, treated at Evelina London Children’s Hospital in May, was reported on May 13. He had been part of a cluster of cases of PIMTS at the hospital. 

The baby, Alexander Parsons, who had no underlying health conditions, passed away after being admitted to Plymouth's Derriford Hospital on April 6.

He had been diagnosed with Kawasaki disease the day of his death and suffered a ruptured aneurysm, but it is not clear if his case was linked with Covid-19, his parents said.

Dr Ramnarayan said clinicians across the world have already made tremendous progress in understanding PIMS-TS, The Sun reports.  

'However, many aspects of the condition remain unclear, such as why it only affects some children or what the long-term implications of having this condition are,' he added.

Dr Barney Scholefield, senior author, said a wealth of information to help treat cases has been uncovered so far.

'A large group of children's intensive care clinicians from across the NHS have rapidly worked together to help understand this condition,' the paediatric intensive care consultant at Birmingham Women's and Children's NHS Foundation Trust and researcher at the University of Birmingham said.

Lead researcher on the paper and consultant paediatric intensive care specialist at Nottingham Children's Hospital, Dr Patrick Davies said the key to successful treatment is 'close collaboration with many specialists'.

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