{"id":37907,"date":"2020-05-14T08:22:09","date_gmt":"2020-05-14T08:22:09","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=37907"},"modified":"2020-05-18T15:14:57","modified_gmt":"2020-05-18T15:14:57","slug":"reports-of-kawasaki-like-disease-in-children-after-the-start-of-the-sars-cov-2-epidemic-in-italy","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/37907","title":{"rendered":"Reports of Kawasaki-like disease in children after the start of the SARS-CoV-2 epidemic in Italy\u00a0"},"content":{"rendered":"

Polly Clayden, HIV i-Base<\/span><\/strong><\/p>\n

A paediatric hospital in the Bergamo province, Italy reported a 30-fold increased incidence of Kawasaki-like disease after the start of the SARS-CoV-2 epidemic. [1] <\/span><\/strong><\/p>\n

These findings were described in a retrospective review, published online in The Lancet 13 May 2020.<\/span><\/p>\n

In children, the respiratory symptoms that are typical in adults appear to be more benign, with almost no deaths reported in this age group.<\/span><\/p>\n

Kawasaki disease causes swelling of the blood vessels, which can lead to complications in the coronary arteries and almost exclusively affects children. The study authors noted that <\/span>despite half a century having passed since Tomisaku Kawasaki first reported 50 cases in Japan,<\/span>the cause of the disease remains unknown. The generally accepted hypothesis supports an abnormal response of the immune system to one or more unidentified pathogens in genetically predisposed patients.<\/span><\/p>\n

The Bergamo province, has been hugely affected by the SARS-CoV-2 epidemic \u2013 the City of Bergamo has the highest rates of deaths from COVID-19 in Italy.<\/span><\/p>\n

The authors retrospectively reviewed the notes of children diagnosed with Kawasaki disease admitted to the General Paediatric Unit of Hospital Papa Giovanni XXIII between 1 January 2015 and 20 April 2020. <\/span><\/p>\n

The aim of the study was to describe the incidence and characteristics of new cases of Kawasaki-like presentations admitted to the unit during the SARS-CoV-2 epidemic. <\/span><\/p>\n

All children diagnosed with a Kawasaki-like disease over the study period were stratified by symptoms before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. <\/span><\/p>\n

Kawasaki disease shock syndrome (KDSS) was defined by presence of circulatory dysfunction. Macrophage activation syndrome (MAS) was defined according to the Paediatric Rheumatology International Trials Organisation criteria. <\/span><\/p>\n

Current or previous infection was diagnosed using reverse-transcriptase quantitative PCR in nasopharyngeal and oropharyngeal swabs, and by serological qualitative test detecting SARS-CoV-2 IgM and IgG, respectively. <\/span><\/p>\n

Group 1 included 19 children: 7 boys and 12 girls, mean aged 3 years (SD 2\u00b75), diagnosed between 1 January\u00a0 2015 and 17 February 17 2020. Group 2 included 10 children: 7 boys and 3 girls, mean age 7\u00b75 years (SD 3\u00b75), diagnosed between 18 February and 20 April 2020; 8 of 10 were positive for IgG or IgM, or both. <\/span><\/p>\n

The authors reported the following differences among children in group 1 vs group 2, respectively:\u00a0 disease incidence, 0\u00b73 vs 10 per month; mean age, 3 vs\u00a0<\/i>7\u00b75 years;\u00a0 <\/span>abnormal echocardiogram, 2\/19 vs\u00a0<\/i>6\/10, <\/span>p=0\u00b7<\/i>0089; met criteria for KDSS and MAS, 0\/19 vs 5\/10, <\/span>p=0\u00b7<\/i>02; <\/span>Kobayashi score of 5 or more, 2\/19 vs 7\/10, p=0\u00b7<\/i>0021; and need for adjunctive steroid treatment, 4\/19 vs<\/i>8\/10, <\/span>p=0\u00b7<\/i>0045.<\/span><\/p>\n

The authors suggest that the <\/span>association between SARS-CoV-2 and Kawasaki-like disease should be taken into account in the paediatric population. But, they added, the Kawasaki-like disease described here remains a rare condition, probably affecting no more than one in 1000 children exposed to SARS-CoV-2. And this estimate is based on the limited data from the case series in this region.<\/span><\/p>\n

Comment<\/span><\/h3>\n

In an accompanying commentary, the authors explain that although\u00a0<\/span><\/b>studies from several countries have confirmed that severe illness and death due to COVID-19 among children are rare, attention has now shifted in the understanding of the role of the disease in children. [2]<\/span><\/b><\/b><\/p>\n

First, as the degree to which children transmit COVID-19 is key to how countries resume activities after lockdown. Second, the new concerns about a novel severe Kawasaki-like disease in children related to COVID-19, including that described in the Bergamo region above.<\/span><\/b><\/p>\n

Experts in the UK have formulated a case definition for what is provisionally called Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). This has been published by the Royal College of Paediatrics and Child Health. [3]<\/span><\/b><\/p>\n

Correspondence in The Lancet\u00a0<\/i>on 6 May 2020, describing nine children with PIMS-TS needing critical care in south London highlights the severe end of this disease. [4]<\/span><\/b><\/p>\n

As that correspondence went to press, one week after the initial submission, the Evelina London Children\u2019s Hospital paediatric intensive care unit had managed more than 20 children with similar symptoms.<\/b><\/p>\n

References<\/span><\/p>\n

    \n
  1. Verdoni L et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. The Lancet. Published online. 13 May 2020.<\/span>
    \nhttps:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(20)31103-X\/fulltext<\/a><\/span><\/li>\n
  2. Viner RM and Whittaker E. Kawasaki-like disease: emerging complication during the COVID-19 pandemic. Published online 13 May 2020. <\/span>https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(20)31129-6\/fulltext<\/a><\/span><\/li>\n
  3. Royal College of Paediatrics and Child Health Guidance \u2013Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. 5 May 2020.
    \n    https:\/\/www.rcpch.ac.uk\/resources\/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19<\/a><\/span><\/li>\n
  4. Shelley Riphagen et al. Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet. Published online 6 May 2020.
    \n<\/span>    https:\/\/www.thelancet.com\/pdfs\/journals\/lancet\/PIIS0140-6736(20)31094-1.pdf<\/a> (PDF)<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Polly Clayden, HIV i-Base A paediatric hospital in the Bergamo province, Italy reported a 30-fold increased incidence of Kawasaki-like disease after the start of the SARS-CoV-2 epidemic. [1] These findings were described in a retrospective review, published online in The …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[293,278],"tags":[],"class_list":["post-37907","post","type-post","status-publish","format-standard","hentry","category-covid-19-paediatrics","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37907","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=37907"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37907\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=37907"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=37907"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=37907"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}