Coronavirus disease 2019 (COVID‐19): A systematic review of 133 Children that presented with Kawasaki‐like multisystem inflammatory syndrome

Abstract

Kawasaki‐like disease (KLD) and multisystem inflammatory syndrome in children (MIS‐C) are considered as challenges for pediatric patients under the age of 18 infected with coronavirus disease 2019 (COVID‐19). A systematic search was performed on July 2, 2020, and updated on December 1, 2020, to identify studies on KLD/MIS‐C associated with COVID‐19. The databases of Scopus, PubMed, Web of Science, Embase, and Scholar were searched. The hospitalized children with a presentation of Kawasaki disease (KD), KLD, MIS‐C, or inflammatory shock syndromes were included. A total number of 133 children in 45 studies were reviewed. A total of 74 (55.6%) cases had been admitted to pediatric intensive care units (PICUs). Also, 49 (36.8%) patients had required respiratory support, of whom 31 (23.3%) cases had required mechanical ventilation/intubation, 18 (13.5%) cases had required other oxygen therapies. In total, 79 (59.4%) cases had been discharged from hospitals, 3 (2.2%) had been readmitted, 9 (6.7%) had been hospitalized at the time of the study, and 9 (6.7%) patients had expired due to the severe heart failure, shock, brain infarction. Similar outcomes had not been reported in other patients. Approximately two‐thirds of the children with KLD associated with COVID‐19 had been admitted to PICUs, around one‐fourth of them had required mechanical ventilation/intubation, and even some of them had been required readmissions. Therefore, physicians are strongly recommended to monitor children that present with the characteristics of KD during the pandemic as they can be the dominant manifestations in children with COVID‐19.

Multisystem Inflammatory Syndrome Associated With COVID-19 in Children (MIS-C): A Systematic Review of Studies From India

“…Owing to severe heart failure, cardiac arrest, and refractory hypotension, a higher number of deaths (6.7%) were observed in another study of children with COVID-19. KD-like features were more commonly associated with male gender [14]. A poor prognosis in males could be explained by ACE2 expression, the transmembrane protease, serinetype 2 (TMPRSS2) gene, and hyper-inflammatory immunological response in general in males [15].…”

Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis

“…The mortality of patients with K-lD associated with COVID-19 is 6.7% due to severe heart failure, cardiac arrest, and refractory hypotension. In these cases, no myocardial infarction was mentioned as a cause for death, but only brain infarction [31]. As can be seen from the same meta-analysis of over 688 patients with MIS-C, there are important differentiating features in the long-term prognosis between Kawasaki disease and MIS-C patients.…”

Identification of Torquetenovirus Species in Patients with Kawasaki Disease Using a Newly Developed Species-Specific PCR Method

“…Although it has been widely assumed that KD is of an infectious origin, the etiological agent has yet to be identified. During the global outbreak of COVID-19, SARS-CoV-2 was reported to cause a pediatric illness clinically similar to KD [23][24][25]. This news renewed interest in the possible viral involvement in KD.…”