Symptoms

Since the beginning of the COVID-19 pandemic, children have been the least affected group, but doctors around the world are warning healthcare professionals that they can suffer from a multi-system inflammatory state requiring intensive care. In fact, the clinical presentation can share similarities with toxic shock syndrome or Kawasaki disease. Not all of the children in this state were confirmed to have COVID-19. Also, children can present with abdominal pain and gastrointestinal symptoms that can lead to shock or heart problems according to Spain’s Association of Pediatrics.

Maria Cheng. European doctors warn rare kids’ syndrome may have coronavirus tie. USA Today. April 28, 2020.

Original article: https://www.usatoday.com/story/news/world/2020/04/28/coronavirus-doctors-warn-kawasaki-disease-may-have-covid-19-tie/3038537001/

The Canadian Paediatric Surveillance Program (CPSP) is warning doctors and parents that skin manifestations, looking like pernio, can be a common presentation among children, even without respiratory symptoms. These are blueish-red lesions that can be painful and warm. They affect mostly the top and the underside of the foot, the toes and can be accompanied by cracked or dry skin. Unfortunately, there is no specific treatment in these cases.

Doctors should therefore suspect COVID-19 when these manifestations occur, and report all cases of COVID-19 positive children with skin lesions to the CPSP. 

Brooklyn Neustaeter. Pediatricians warned about ‘COVID toes’ in children infected with COVID-19. CTV News. April 27, 2020.

Original article: https://www.ctvnews.ca/health/coronavirus/pediatricians-warned-about-covid-toes-in-children-infected-with-covid-19-1.4913770

The National Health Service (NHS) in England is warning doctors that the pediatric population testing positive for COVID-19 can have presentations similar to toxic shock syndrome and atypical Kawasaki disease. Manifestations such as abdominal pain, other gastrointestinal symptoms and cardiac inflammation have been reported. A disproportionate inflammatory response could be responsible for these symptoms.

Amy Woodyatt and Jacqueline Howard. Coronavirus could be tied to a rare but serious illness in children: U.K. doctors. CTV News. April 27, 2020.

Original article: https://www.ctvnews.ca/health/coronavirus/coronavirus-could-be-tied-to-a-rare-but-serious-illness-in-children-u-k-doctors-1.4913764

Deep vein thrombosis and pulmonary embolism have been described in many patients affected by COVID-19, including young adults without any risk factors. Many doctors have reported that the coagulation abnormalities were atypical, and that heparin wasn’t working in these patients.

In these situations, amputation may sometimes be the only way to treat ischemia. Also, artificial ventilation can be inefficient with pulmonary embolism because of the shunt created by the blood clots.

Ivan Couronne, Issam Ahmed. Blood Clots: Another Bad Surprise From COVID-19. La Presse. April 27, 2020.

Original article: https://www.lapresse.ca/covid-19/202004/27/01-5271122-une-autre-mauvaise-surprise-de-la-covid-19-des-caillots-de-sang.php

Alarming cases of large vessel occlusions have been reported among adults in their 30s and 40s. At Mount Sinai Hospital, Manhattan, a 44 year old man, without any pre-existing conditions, was admitted with a severe stroke and no evidence of respiratory symptoms, even though he tested positive for COVID-19.

Dr. Thomas Oxley, vascular and interventional neurologist, noted that the brain imaging of the patient looked “like a can of spaghetti”, something he had never seen before. New clots were forming around the area of the stroke as he was removing the clot.

Ariana Eunjung Cha. Young And Middle-Aged People, Barely Sick With Covid-19, Are Dying Of Strokes. Washington Post. April 25, 2020.

Original article: https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients/

Different complications affecting multiple organs are being described with COVID-19. In fact, there is a higher risk of blood clotting when a patient has the virus. Other manifestations include arrhythmias, unsteady blood pressure, liver and kidney infections, and skin manifestations, especially on the fingers and toes. Also, severe cases can ultimately require ventilators, dialysis and even extracorporeal membrane oxygenation (ECMO), devices that can potentially cause infections.

Victoria Ahearn. Amputations, organ failure, blood clotting: The range of complications in COVID-19 cases. CTV News. April 22, 2020.

Original article: https://www.ctvnews.ca/health/coronavirus/amputations-organ-failure-blood-clotting-the-range-of-complications-in-covid-19-cases-1.4907290