PIMS – pocovid syndrome in children

PIMS - pocovid syndrome in children

In the context of contracting COVID-19, there is increasing talk of the so-called PIMS pocovid syndrome. It primarily affects children who contract coronavirus asymptomatically or have few symptoms of infection. What is PIMS, how does it progress and how is it treated?

Pocovid syndrome – what is it and how to deal with it?

Pocovid syndrome is a multisystem inflammatory syndrome that occurs most often in school-aged children (up to 9 years old) who have contracted coronavirus, even if the infection was asymptomatic. The syndrome is abbreviated as PIMS, PIMS-TS from pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 or MIS-C from multisystem inflammatory syndrome in children. Simply put, PIMS is a complication after COVID-19, with the first symptoms observed 2-4 weeks after infection.

The disease cannot be unequivocally detected – so far no tests have been created to confirm or exclude Pocovid syndrome. The only things that can be relied on are the characteristic symptoms and abnormalities in laboratory tests, including an increase in inflammatory exponents with a concomitant decrease in lymphocytes, abnormal results of markers of cardiac damage, and abnormal levels of ions and proteins.

What are the symptoms of PIMS pocovid syndrome?

Symptoms of pocovid syndrome include high fever, abdominal pain, neck pain, headache and/or sore throat, diarrhea, vomiting, red macular or papular rash usually in the shape of rings, conjunctivitis without discharge, enlargement of cervical lymph nodes, weakness, fatigue, sluggishness, swelling of the hands and feet, chapped lips and a rash on the tongue – the tongue looks like the surface of a strawberry.

Importantly, PIMS is not contagious. It is a pathological reaction of the body to a recent infection. Pocovid syndrome can take different courses. Some children undergo PIMS mildly, others severely.

What is the course?

Symptoms of pocovid syndrome appear suddenly and affect various systems, hence it is said to be a multisystem inflammatory syndrome. The primary symptom of PIMS is a temperature above 38.5 degrees Celsius that persists for a minimum of 3 days.

In addition, discomforts are observed concerning:

  • gastrointestinal system – diarrhea, severe abdominal pain, vomiting;
  • nervous system – headache, apathy, excessive sleepiness, lack of appetite, paresis, unusual behavior;
  • Respiratory system – cough, shortness of breath, chest pain;
  • excretory system – abnormal urination;
  • cardiovascular system – blood pressure too low or too high, abnormal heart rhythm, fainting, bleeding without prior injury;
  • skin – rash, strawberry tongue, dry lips, swelling of the hands and feet.

Importantly, symptoms usually do not occur all at once, but the appearance of single symptoms does not always indicate PIMS. If pocovid syndrome is suspected in a child, hospitalization is recommended, due to the fact that some patients experience a sudden deterioration in condition 5 or 6 days after the onset of fever. Some children may develop shock and multi-organ failure. The most common permanent complication of PIMS is coronary artery aneurysms. The mortality rate for PIMS is 1.5-2%, so worrying symptoms should not be ignored.

How is pocovid syndrome treated?

The sooner pocovid syndrome is diagnosed and treatment is started, the better the prognosis. With PIMS, intravenous immunoglobulins (IVIG) are administered, and if these do not reduce symptoms, glucocorticosteroids and immunomodulatory biologic drugs such as anakinra, tocilizumab or infliximab are used. In addition, anticoagulant treatment is implemented, using acetylsalicylic acid or heparin. Painkillers, antipyretics and shielding drugs are also administered on an ad hoc basis.

Successful treatment allows full recovery after just a few days. Nonetheless, for a minimum of six weeks you should attend medical checks and avoid sports activities.


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