Family Transmission of COVID-19 Including a Child with MIS-C and Acute Pancreatitis

Abstract

Introduction Spread of the novel coronavirus SARS-CoV-2, since at least December 2019, has caused a pandemic. SARS-CoV-2 causes the disease COVID-19, which can affect several human organs. Abdominal pain is one of the known symptoms, but little is known about acute pancreatitis as a complication. As well, knowledge about viral transmission in families is limited. This case report describes MIS-C and acalculous acute pancreatitis in a child who was a member of a family in which four of five members had COVID-19. Case Report A previously healthy family was infected by SARS-CoV-2 from an unknown source. The 13-year-old daughter was infected by SARS-CoV-2 and symptomatic during two periods, with an asymptomatic interval in-between. During the first period, she had transient and mild upper respiratory symptoms which was followed four weeks later by a secondary severe illness. At that point, there was inflammation in multiple organs and signs of Multisystem Inflammatory Syndrome in Children (MIS-C) and a Kawasaki-like disease with skin rash, scalded skin in hands and conjunctivitis. Myocarditis, bronchopneumonia, pancreatitis, and hepatopathy without encephalopathy were noted. She required assisted ventilation for 5 days. There were laboratory signs of disseminated intravascular coagulopathy. The multisystem inflammation was treated with intravenous immunoglobulin (IVIG) once a day for four days and immunotherapy (high dose methylprednisolone (IV) once a day, for 12 days, then tapered over 4 weeks, anakinra (IV) four times daily for 12 days), low molecular weight heparin for 22 days and salicylates for 6 weeks leading to full restoration of health. The two brothers and mother in the family had mild to moderate COVID-19 infections. The father was not affected despite close contact with his children. The household transmission and clinical course and outcome are described. No further known COVID-19 infection occurred in the neighborhood during or immediately after the family cluster was discovered. Conclusion Penetrance and severity of COVID-19 can vary in family clusters. One adolescent showed a two-phase course with severe infection. This case report highlights MIS-C and acute pancreatitis as a complication associated with COVID-19 in children.

International Survey on Severe Acute Respiratory Syndrome Coronavirus 2 and Acute Pancreatitis Co-occurrence in Children

“…In examining the pancreatitis course in our cohort, we found a median time to pancreatitis symptomatic recovery that was longer than the previously reported median length of hospitalization stays for non-COVID-19 pediatric AP (7 [IQR, 5-15] vs 4 [IQR, 2-7] days, respectively) (Fig. 2A) 18,19 and more similar to what has been reported for children with systemic inflammatory response syndrome (8 [IQR, [4][5][6][7][8][9][10][11][12][13]). 20 As the ability to take oral feeds may be related to one's pancreatitis recovery, we examined relative length of nil per os (NPO) status in those with COVID-19 + AP.…”

Child transmission of SARS-CoV-2: a systematic review and meta-analysis

“…Of the 40 articles included, 13 studies were conducted in the North America [ 13 – 25 ], 14 in Europe [ 4 , 10 , 26 – 37 ], 12 from Asia [ 38 – 49 ], and 1 from Australia [ 50 ]. Of the 40 articles, 23 identified household child-to-adult or child-to-child transmission [ 10 , 13 – 15 , 18 , 19 , 24 – 27 , 29 , 32 – 34 , 38 – 42 , 45 – 48 ]. Seventeen articles documented transmission at a school [ 4 , 17 – 23 , 28 – 30 , 35 – 37 , 43 , 44 , 50 ], 6 in a childcare setting, [ 19 , 28 , 29 , 31 , 49 , 50 ] and 5 from other social gatherings [ 16 , 17 , 23 , 24 , 47 ] (Table 1 ).…”

A systematic review on outbreaks of COVID-19 among children within households in the European region

“…The highest SAR was found in the study ofAbbas et al (2021) (29), tracing a family cluster residing in Sweden. Among the four family contacts of the paediatric index case, three secondary infections occurred, with the SAR being estimated at 75%.…”