Death of child infected with Covid-19 and two other viruses a rare case, say S'pore doctors

SINGAPORE – The death of a 1½-year-old baby boy from encephalitis, or brain inflammation, after being infected with Covid-19 and two other viruses is extremely rare, doctors said.

The Ministry of Health (MOH) said in a statement on Monday (June 27) 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 and enterovirus infections, it said.

Respiratory syncytial virus is a common respiratory virus that may cause mild, cold-like symptoms.

“While most cases are mild, severe respiratory syncytial virus 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, infectious disease service at the paediatrics department in KK Women’s and Children’s Hospital (KKH).

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

Dr Yeo Tong Hong, a senior consultant and the head of neurology service at KKH, said that encephalitis may initially present with flu-like symptoms such as fever, general lethargy or headache. These flu-like 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),” he said.

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

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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 baby had no past medical history. He was taken to the emergency department at KKH 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 on June 22, and was diagnosed with severe meningoencephalitis.

The United Nations Children’s Fund cited data that showed that 0.4 per cent of the 4.4 million reported Covid-19 deaths occurred in children and adolescents below the age of 20.