Kawasaki like illness in COVID versus Kawasaki disease in pre-COVID era
DOI:
https://doi.org/10.18203/2349-3291.ijcp20230723Keywords:
KD, COVID-19, KDSS, IgG, RT-PCRAbstract
Background: In children and adolescents, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is mostly responsible for mild respiratory symptoms, in contrast with severe forms reported in adults. An association between the disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), and late manifestations of vasculitis has been increasingly suspected.
Method: All children and adolescents (aged ≤18 years) who were diagnosed with Kawasaki disease (KD) and KD shock syndrome (KDSS) as per AHA and Kanegaye et al criteria. From each patient we obtained at least two nasopharyngeal swabs to test for SARS-CoV-2 using reverse transcription- polymerase chain reaction (RT-PCR). We also took blood samples to test for IgG antibodies against SARS-CoV-2.
Results: Leucocytosis was found in majority with median leucocyte count of 10100 predominant neutrophila. Inflammatory markers D dimer, serum ferritin and fibrinogen level were raised. The 43% patients had coronary artery aneurysm. The 75% patient had some form of Left ventricular systolic dysfunction. All patients received IVIG while 13 patients received both IVIG and methyl predinisolone. Ionotropes were used in 68%. Two patients received tocluzumab.
Conclusions: In this study we found increased incidence of Kawasaki like illness temporally associated with COVID-19. Older age of presentation with more atypical presentation.
Metrics
References
Jindal AK, Pilania RK, Prithvi A, Guleria S, Singh S. Kawasaki disease: characteristics, diagnosis, and unusual presentations. Expert Rev Clin Immunol. 2019;15(10):1089-104.
Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771-8.
Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 2020;79(8):999-1006.
Ouldali N, Pouletty M, Mariani P, Beyler C, Blachier A, Bonacorsi S et al. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. Lancet Child Adolesc Health. 2020;4(9):662-8.
Belot A, Antona D, Renolleau S, Javouhey E, Hentgen V, Angoulvant F et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study. Euro Surveill. 2020;25(22):2001010.
Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al. Multisystem inflammatory syndrome in US Children and adolescents. N Engl J Med. 2020;383(4):334-6.
Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-71.
Panupattanapong S, Elizabeth B. Brooks Center for Pediatric Rheumatology and Immunology, Cleveland Clinic Children’s New spectrum of COVID-19 manifestations in children: Kawasaki-like syndrome and hyperinflammatory response. 2020.
Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG et al. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital. Pediatr Cardiol. 2020;41:1391-401.
Hedrich CM, Schnabel A, Hospach T. Kawasaki disease. Front Pediatr. 2018;6:198.
Son MB, Sundel RP. Chapter 35-Kawasaki disease. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn LR, editors. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, PA: W.B. Saunders. 2016;467-83.
Rowley AH. Kawasaki disease: novel insights into etiology and genetic susceptibility. Ann Rev Med. 2011;62:69-77.
Kanegaye JT, Wilder MS, Molkara D, Frazer JR, Pancheri J, Tremoulet AH et al. Recognition of a Kawasaki Disease Shock Syndrome. Pediatrics. 2009;123(5):e783-9.
Downloads
Published
How to Cite
Issue
Section
