Teens develop septic shock due to COVID-19

By Angela Betsaida B. Laguipo, BSNMay 24 2020

Since the emergence of the novel coronavirus disease (COVID-19), most people who develop severe illness are older adults, those with underlying medical conditions, and those who are immunocompromised. Though children are mostly spared, some adolescents developed septic shock due to COVID-19, a new study has found.

A team of researchers from Children's Hospital of Geneva revealed the case of three adolescents who developed septic shock secondary to the coronavirus infection.

A team of researchers performed a literature search that revealed reports of complications seen in children affected with COVID-19. The study covered 57 children who had a positive coronavirus test result in Geneva, Switzerland. The study, published in The Lancet, highlights the clinical characteristics of three adolescents between the age of 10 and 12 years old.

What is septic shock?

The team revealed that the three adolescents with coronavirus infection manifested with septic shock, which is a life-threatening condition that occurs when the blood pressure drops to dangerously low levels after infection. The condition can be caused by either a bacterial or viral infection.

When the body has an ongoing infection, it causes a condition called sepsis, which develops when the body has an overwhelming response to an infection. If it is left untreated, the toxins produced by the pathogen damage the small blood vessels, causing the fluid in the blood vessel to leak into the surrounding tissues.

As a result, it affects the heart's ability to pump blood to the viral organs effectively, lowering the blood pressure. The most common symptoms of septic shock include decreased urination, changes in mental ability, patches of discolored skin, the difficulty of breathing, abnormal heart functions, chills, low platelet count, and unconsciousness. Septic shock also causes low blood pressure, rapid heart rate, and increased breathing.

Adolescents with septic shock

The team studied three cases of septic shock in adolescents.

The first case was a 12-year-old Hispanic male with mild asthma and obesity. The patient has reported symptoms such as fever for one day, cough, the difficulty of breathing, headache, and sore throat.

Upon assessment, the teen did not respond to salbutamol to ease his symptoms. Further, the chest X-ray revealed mild bibasilar hypoventilation without wheezing and a slightly increased inspiration to expiration ratio. Despite just mild symptoms, the patient suddenly experienced a high heart rate of up to 170 beats per minute, showing signs of compensated shock with cold, clammy skin and delayed capillary refill.

He was admitted and treated with crystalloid boluses. The patient responded to the treatments and eventually recovered. Upon testing, he was positive with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Novel Coronavirus SARS-CoV-2 This scanning electron microscope image shows SARS-CoV-2 (yellow)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (pink) cultured in the lab. Image captured and colorized at NIAID's Rocky Mountain Laboratories (RML) in Hamilton, Montana. Credit: NIAID

The second patient was a 10-year-old male with obesity. He went to the emergency department presenting with fever for five days, sore throat, cough, abdominal pain, and vomiting. Upon assessment, the adolescent had low blood pressure, rapid heart rate, and an increased respiratory rate.

With signs of impending septic shock, the patient was also treated with crystalloid buses, antibiotics, and inotropic support. The patient recovered has been discharged from the hospital.

The third patient is a previously healthy 10-year-old male with obesity who had a hypotensive shock after one week of fever, severe abdominal pain, and vomiting. Upon examination, he presented with rapid breathing, fast heart rate, and low blood pressure, the significant hallmarks of shock.

The patient received crystalloid boluses, and his test for SARS-CoV-2 turned out positive. The patient was admitted to the intensive care unit with a renal injury that required hemodialysis. He has since been transferred out of the ICU but remains in the hospital during the study period.

The pediatric multisystem inflammatory syndrome

When the coronavirus outbreak started in Wuhan City, Hubei Province in China in December 2019, most of the patients who experienced severe COVID-19 disease were the elderly and those with comorbidities.

In recent months, however, cases of severe pediatric disease have been reported. A recently published report tackled about pediatric multisystem inflammatory syndrome tied to COVID-19—the patients presented with fever, inflammation, and organ failure. The condition shares common features with known pediatric inflammatory conditions such as toxic shock syndrome, Kawasaki disease, bacterial sepsis, and macrophage activation syndrome.

Obesity as a risk factor

All the pediatric patients who manifested septic shock in the study group were obese, with a body mass index (BMI) higher than the 97^th percentile for age. This raises the question of obesity as a risk factor for severe disease, just like in adults.

The results of the study show that clinicians should be observant when it comes to assessing children presenting with sepsis symptoms. Since pediatric multisystem inflammatory syndrome and septic shock have been tied to COVID-19, prompt treatment is crucial to prevent potentially fatal consequences.