Death of child infected with Covid-19, 2 other viruses a rare case: Docs

The death of an 18-month-old boy from encephalitis or brain inflammation after being infected with Covid-19 and two other viruses was an extremely rare event, doctors said.

The Ministry of Health (MOH) said in a statement on Monday that it was Singapore's first Covid-19 death of a patient below the age of 12. The cause of death was encephalitis due to Covid-19, respiratory syncytial virus (RSV) and enterovirus infections, it said.

RSV is a common respiratory virus that may cause mild cold-like symptoms.

"While most cases are mild, severe RSV can cause bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in younger children," said Associate Professor Thoon Koh Cheng, a senior consultant of the infectious disease service at the paediatrics department of KK Women's and Children's Hospital (KKH).

Enterovirus is a common childhood illness which may cause fever, mild respiratory symptoms, flu-like symptoms and gastrointestinal symptoms. "In some rare cases, complications such as inflammation of the brain, spinal cord or heart may occur," he said.

Dr Yeo Tong Hong, a senior consultant and head of the neurology service at KKH's paediatrics department, said that encephalitis may initially present with flu-like symptoms. These symptoms can become more severe in some cases, which can lead to confusion, drowsiness, seizures or problems with breathing and heart muscle function.

"Encephalitis can be caused either by an infection invading the brain (infectious encephalitis) or through the immune system attacking the brain (autoimmune or post-infectious encephalitis).

"Viruses are the most common cause of infectious encephalitis, which has also been reported to occur as a complication of Covid-19 infection. However, this is rare."

Professor Paul Tambyah, speaking as president of the Asia Pacific Society of Clinical Microbiology and Infection, said: "There have been isolated, extremely rare cases of encephalitis with Sars-CoV-2 in adults mainly but also in children. In contrast, the enteroviruses are well known as episodic causes of encephalitis."

He added: "The chances of being infected with three viruses at the same time are very low and suggest that there may be some rare immunological problem which might have predisposed this unfortunate infant to severe complications."

MOH said the boy was taken to KKH's emergency department on the night of June 21, with a high fever and recurrent seizures, and subsequently began to lose consciousness.

He was then admitted to the Children's Intensive Care Unit in critical condition the next day, and was diagnosed with severe meningoencephalitis.

Dr Lim Yang Chern, a paediatrician from Thomson Paediatric Centre, said the death was unlikely the "fault" of Covid-19 alone. Without having details of the case, he said he felt that it was likely due to the combination of multiple viral infections (the biggest suspects being the enterovirus and the coronavirus) and the resultant immune response that contributed or caused severe encephalitis that then led to death.

Prof Thoon said: "Complications among paediatric Covid-19 cases are rare. Some examples include pneumonia, myocarditis (heart muscle inflammation) and inflammation of brain and spine."