Kawasaki disease following SARS-CoV-2 infection: Stronger inflammation with no increase in cardiac complications

Abstract

BackgroundHerein we investigate the difference between Kawasaki disease (KD) with and without a recent history of SARS-CoV-2 infection.MethodsWe compared the clinical characteristics of patients with KD during the SARS-CoV-2 pandemic in a single children's hospital in Korea. Fifty-two patients were enrolled and divided into group 1 (with a history of COVID-19, n = 26) and group 2 (without a history of COVID-19, n = 26) according to whether or not they contracted COVID-19 within the 8 weeks before hospitalization. Data, including clinical features and laboratory results, were analyzed and compared between groups.ResultsThe median age of patients was significantly higher in group 1 than in group 2 (53 months [IQR, 24–81] vs. 15 months [IQR, 6–33], p = 0.001). The incidence of cervical lymphadenopathy was significantly higher (p = 0.017), while that of BCGitis was significantly lower in group 1 (p = 0.023), and patients had a significantly longer hospital stay (5 days [IQR, 3–8] vs. 3 days [IQR, 3–4], p = 0.008). In group 1, platelet count was significantly lower (p = 0.006), and hemoglobin and ferritin levels were significantly higher (p = 0.013 and p = 0.001, respectively) on the first admission day. Following treatment with intravenous immunoglobulin (IVIG), the platelet count was significantly lower (p = 0.015), and the percentage of neutrophils and neutrophil-to-lymphocyte ratio were significantly higher in group 1 (p = 0.037 and p = 0.012). Although there was no statistical difference, patients requiring infliximab treatment due to prolonged fever was only in group 1. The incidence of cardiovascular complications did not differ between the groups.ConclusionsPost-COVID KD showed a stronger inflammatory response than KD-alone, with no differences in cardiac complications.

Risk factors and scores for prediction of coronary artery aneurysms in Kawasaki disease: a European monocentric study

“…All the patients included in the present study were discharged with a diagnosis of KD, moreover, four expert clinicians, two paediatric immunologists and two paediatric cardiologists, analysed the cases to include to better discriminate between the two diagnoses. A Korean study did not find differences in cardiac complications between patients with KD with and without a recent COVID-19 infection [27]. Since in our sample, only five patients had recent or concurrent SARS-CoV-2 infection, we did not evaluate the differences between the two groups.…”

Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review

“…Roh et al. ( 70 ) found that the number of KD patients with COVID-19 receiving IFX was higher than those KD patients without a history of COVID-19 (two patients vs none), but it was not statistically significant. Therefore, the exact roles of IFX in treating KD patients with COVID-19 and patients with MIS-C still need further investigation.…”

“…Due to IFX is a TNF-a antagonist, patients with MIS-C might be successfully treated with IFX (69). For the KD patients with SARS-CoV-2 infection, Roh et al (70) reported that post-COVID KD showing a stronger inflammatory response than KD-alone, but with no differences in cardiac complications. Limited studies have shown the efficacy of IFX in treating KD patients with SARS-CoV-2 infection.…”

Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children

“… 53 , 78 It is possible that some of the decrease in KD may be related to misclassification of KD patients as having MIS-C, although this is more likely related to decrease exposure to possible infectious/environmental triggers. 79 , 80 A case series from Korea, where the incidence of MIS-C during the pandemic has been very low, compared 19 KD patients with a history of prior COVID-19 with 26 KD patients without, and noted few differences, although patients with prior COVID were older with more severe disease, which may suggest some similiarities with MIS-C. 81 The association of prior COVID-19 and vaccination with the risk of subsequent KD is largely unknown. In contrast, a report from Seattle noted that patients with a prior history of KD did not have adverse outcomes when either infected with SARS-CoV-2 or vaccinated with mRNA COVID-19 vaccines.…”