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World How a Kawasaki-like syndrome left this 6-year-old fighting for his life on a ventilator

14:14  25 may  2020
14:14  25 may  2020 Source:   cnn.com

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"The doctors were shocked. They said they had never seen anything like this," says Valentina Vigilante, recalling the terrifying day her 6-year-old son Nicolò was rushed into intensive care in Bergamo, northern Italy, as he struggled to breathe.

a young boy in a yellow shirt and green bushes: Nicolo poses with his mother Valentina after his recovery. © Valentina Vigilante Nicolo poses with his mother Valentina after his recovery.

"I feared he was going to die. Then, they intubated my child."

This was the moment that doctors finally diagnosed Nicolò with a rare condition, known as multisystem inflammatory syndrome in children, or MIS-C.

Britain's National Health Service, the World Health Organization and the US Centers for Disease Control and Prevention (CDC) are now issuing alerts to pediatricians to be on the lookout for cases. While not all affected children test positive for the coronavirus, the CDC and physicians in Britain believe the syndrome comes as a result of the body's reaction to infection with Covid-19.

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Kawasaki - like condition is believed to be caused by infection with SARS-CoV-2. It remains unknown why the syndrome develops weeks after infection, but scientists believe it may be due He modelled the protein's surface spikes and this has allowed his team to produce an almost exact copy of the spike.

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Nicolo relaxes at home after his return from hospital. © Valentina Vigilante Nicolo relaxes at home after his return from hospital.

Parents must also understand the dangers, says Vigilante, a 35-year-old nurse. "We must exchange information about what is going on in our countries because my pediatrician did not even know what was happening at first."

"Today a child can't be seen easily because of Covid. I couldn't bring him because the doctor's office was closed. A doctor could not come to the house and treat him."

Vigilante, who worked in a hospital in Milan, northern Italy, the epicenter of the disease in Europe, contracted the coronavirus in March. Her husband did too. "I had been working up until then, and I started having a hard time breathing," she said.

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After the couple recovered, one of their twin sons became sick and was admitted to hospital. Nicolò was found to have been infected with the coronavirus, but had shown no symptoms. Doctors initially believed he had Kawasaki disease, an inflammatory condition that usually involves the major arteries and the heart.

As Nicolò struggled to breathe, Vigilante begged doctors to do a CT scan, which eventually revealed that he had MIS-C. "I was losing it. They continued to say he had Kawasaki."

She was unable to stay with her young son overnight. "The hospital doesn't allow parents to stay because of Covid, so I had to calm him down, help him fall asleep before I left.

"I had to tell him he was going to be safe. My son begged me to not leave, he didn't want to be left alone," she recalled.

Danger for children

On the first day of his treatment, Nicolò was given immunoglobulin but his condition deteriorated so much that doctors were forced to place him on a ventilator for 24 hours. After this he was treated with standard Kawasaki therapy -- immunoglobulin and aspirin -- and because of his MIS-C diagnosis, cortisone.

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Dr. Lucio Verdoni, a pediatrician at Bergamo's Hospital Papa Giovanni XXIII where Nicolò was treated, said that in his experience, treating patients with this therapy often achieved rapid results: "After 24 hours, the patients treated were already improving. We did not have to do a secondary treatment after this." Doctors in Britain and the US have had similar success with this treatment cocktail.

The CDC and physicians in Britain believe MIS-C is a result of the body's reaction to Covid-19 infection. "There is no doubt that this form of Kawasaki is connected with Covid," Verdoni tells CNN.

The danger for young children, according to Dr. Alberto Villani, President of Italy's National Association of Pediatricians, is the difficulty in diagnosing MIS-C, because its symptoms can be similar to those of both conditions.

"What is happening now is that this disease creates acute inflammation. It has a lot of similarities with Kawasaki. These children often have had contact with Covid and it appears a lot like Kawasaki. If a child is very sick, he must be treated right away."

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Luckily, Vigilante knew that her son needed urgent treatment. "Thankfully I am a nurse and mother, and have an eye to recognize something was wrong," she recalled.

"Kawasaki is not so serious, but Covid provokes this type of Kawasaki, and I know this is worse because I lived it."

Nicolò came home last week after an 18-day stay in hospital. Finally, the little boy was able to play with his twin brother Massimo again.


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