Cases of PIMS-TS - a novel post-infectious systemic hyperinflammatory syndrome - have been reported in children in Victoria.
Advice for clinicians
- Advise paediatric and emergency staff to consider PIMS-TS in a child with fever, abdominal pain, rash and tachycardia.
- If you have a patient with PIMS-TS, contact the on-call paediatric infectious diseases service at the Royal Children's or Monash Children's hospitals.
- Transfer to a tertiary centre may be required. Contact PIPER on 1300 137 650.
The syndrome is named paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 in the UK, and multisystem inflammatory syndrome in children (MIS-C) in the US.
PIMS-TS has been described in children in areas with high incidence of SARS-CoV-2 infection. Case incidence has been noted to increase in the months after COVID-19 peaks.
There are likely to be further - albeit rare - cases of PIMS-TS in Australia in areas with higher SARS-CoV-2 transmission.
PIMS-TS occurs two to six weeks after infection with SARS-CoV-2. The initial infection may be asymptomatic.
The median age is nine years and it is more common in boys, those of ethnicities other than Anglo-European, and obese children.
Signs and symptoms
PIMS-TS is characterised by:
- gastrointestinal symptoms (abdominal pain, diarrhoea and vomiting)
- conjunctival injection
Myocardial dysfunction requiring ICU admission occurs in at least half the patients.
Coronary artery aneurysms occur in about 15 per cent.
ECMO has been needed in some cases and occasional deaths have been reported overseas.
PIMS-TS case definition as developed by the developed by the Paediatric Active Enhanced Disease Surveillance (PAEDS) network.
Children and adolescents (up to 18 years of age) with fever ≥3 days
AND two of the following:
a) Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet)
b) Age specific hypotension or 'shock' within first 24 hours of presentation
c) Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP)
d) Evidence of coagulopathy (by PT, PTT, elevated d-Dimers)
e) Acute gastrointestinal problems (diarrhoea, vomiting or abdominal pain).
AND Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin.
AND Exclusion of other infectious causes of inflammation, including bacterial sepsis, staphylococcal or streptococcal toxic shock syndromes.
AND Evidence of COVID-19 (RT-PCR) on antigen test, or confirmed contact with COVID-19 case, or confirmed positive SARS-CoV-2 serology (noting testing may be delayed, particularly serology. If all other criteria are met, collect data pending results.
Differential diagnoses include:
- staphylococcal and streptococcal toxic shock syndrome
- Kawasaki disease (from which it appears distinct)
- Kawasaki shock syndrome
- bacterial sepsis.
Refer to statewide paediatric clinical guidelines for more information.
Dufort EM et al, N Engl J Med 2020, Multisystem Inflammatory Syndrome in Children in New York State
Goldfred-Cato S et al MMWR 2020, COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020
Singh-Grewal D et al, J Paeds Child Health 2020, Update on the COVID‐19‐associated inflammatory syndrome in children and adolescents; paediatric inflammatory multisystem syndrome‐temporally associated with SARS‐CoV‐2