Regarding outcomes for the entire cohort, none of the children had significant pre-existing conditions and most fared well with COVID-19 and were either normal or had some mild residual neurological deficits at last follow-up, the researchers report.

However, four previously healthy children developed atypical central nervous system (CNS) co-infections, leading to death despite aggressive treatment.

Two of these four children developed fulminant Mycobacterium tuberculosis infections of the CNS and had no known tuberculosis exposure. The third case involved a child who was co-infected with methicillin-resistant Staph aureus (MRSA) and varicella zoster virus. The fourth case involved a child co-infected with Fusobacterium necrophorum and Streptococcus constellatus who developed meningitis and vasculitis and died from multifocal cerebral infarctions.

“These four cases emphasise the potential for SARS-CoV-2 to impede the host’s normal immune responses such that co-infections can work synergistically, contributing to a more severe clinical evolution of infection,” the researchers caution.

Summing up, they say, “Knowledge of the neuroimaging patterns of COVID-19 is important, as these patterns could be the first indication of SARS-CoV-2 infection in children with neurological abnormalities.”