Kawasaki-like disease in children with COVID-19

Akça, Ümmüşen Kaya; Kesici, Selman; Özsürekçi, Yasemin; Aykan, Hayrettin Hakan; Batu, Ezgi Deniz; Atalay, Erdal; Demir, Selcan; Sağ, Erdal; Vurallı, Doğuş; Bayrakçı, Benan; Bilginer, Yelda; Özen, Seza

doi:10.1007/s00296-020-04701-6

Cited by 77 publications

(79 citation statements)

References 71 publications

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“…One of the challenges of us was to differentiate children with MIS-C and Kawasaki disease (KD) as reported from many centers [ 9 , 10 ] because of the possibility of an association between KD and positive testing for SARS-CoV-2 [ 11 ]. In our hospital, 129 pediatric cases with KD were diagnosed between 2007 and 2019, and approximately, a 3.7-fold increase in the incidence of KD cases was observed in the beginning of pandemic [ 12 ]. Subsequently, this fold-increase had a steep rise.…”

Section: Introductionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children during the COVID-19 pandemic in Turkey: first report from the Eastern Mediterranean

et al. 2021

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Objective We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with multisystem inflammatory syndrome in children (MIS-C) and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country. Methods Children (aged <18 years) who diagnosed with MIS-C and severe/critical pediatric cases with COVID-19 and were admitted to hospital between March 26 and November 3, 2020 were enrolled in the study. Results A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C, were included in the study. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only three deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral. Conclusion Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count are reliable diagnostic parameters for MIS-C cases. Keywords Kawasaki disease. Pediatrics. Hyperinflammation. Multisystem inflammatory syndrome in children (MIS-C). Multisystem inflammatory syndrome in adults (MIS-A) Key Points • MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe/critical pediatric cases with COVID-19. • Higher CRP and low total WBC count are the independent predictors for the diagnosis of MIS-C. • MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19.

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Section: Introductionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children during the COVID-19 pandemic in Turkey: first report from the Eastern Mediterranean

et al. 2021

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“…-Gamma globulins: Their effectiveness is not clear. They can be attempted in particularly severe forms of COVID-19 and in those with symptoms similar to Kawasaki disease at the dose of 2 g/kg/day for one day, 1 g/kg/day for two days or 400 mg/kg/day for five days (67,68). -Tocilizumab: This human anti-IL-6 monoclonal antibody appeared to be effective in the treatment in adults with extensive and bilateral lung involvement (60).…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Section: Management and Treatment Of Covid-19 Pneumoniamentioning

confidence: 99%

COVID-19 Pneumonia in Children: From Etiology to Management

et al. 2020

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COVID-19 is less serious in children than in adults. However, respiratory management dominates the clinical picture of hospitalized COVID-19 even in children. In some case series, deterioration of the clinical picture wherein dyspnea, cyanosis, and the onset of acute respiratory distress syndrome (ARDS) emerged ~8–10 days after the onset of SARS-CoV-2 infection, which could rapidly progress to multiple organ failure and death. This review aimed to evaluate the characteristics of COVID-19 pneumonia in pediatric populations, beginning from its etiology and pathological mechanisms and closing with its clinical management.

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“…In line with this, children with MIS-C had elevated NT-proBNP and troponins values in comparison with the normal values described in paediatrics [ 23 – 25 ], probably because these biomarkers are related to cardiac dysfunction. The paediatric patients had a good evolution overall, but one of them developed coronary aneurysms, which is suggestive of the Kawasaki-like disease [ 26 ], that has been described to be related to COVID-19 in children [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The different manifestations of COVID-19 in adults and children: a cohort study in an intensive care unit

et al. 2021

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Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has collapsed health systems worldwide. In adults, the virus causes severe acute respiratory distress syndrome (ARDS), while in children the disease seems to be milder, although a severe multisystem inflammatory syndrome (MIS-C) has been described. The aim was to describe and compare the characteristics of the severe COVID-19 disease in adults and children. Methods This prospective observational cohort study included the young adults and children infected with SARS-CoV-2 between March–June 2020 and admitted to the paediatric intensive care unit. The two populations were analysed and compared focusing on their clinical and analytical characteristics and outcomes. Results Twenty patients were included. There were 16 adults (80%) and 4 children (20%). No mortality was recorded. All the adults were admitted due to ARDS. The median age was 32 years (IQR 23.3–41.5) and the most relevant previous pathology was obesity (n = 7, 43.7%). Thirteen (81.3%) needed mechanical ventilation, with a median PEEP of 13 (IQR 10.5–14.5). Six (37.5%) needed inotropic support due to the sedation. Eight (50%) developed a healthcare-associated infection, the most frequent of which was central line-associated bloodstream infection (n = 7, 71.4%). One patient developed a partial pulmonary thromboembolism, despite him being treated with heparin. All the children were admitted due to MIS-C. Two (50%) required mechanical ventilation. All needed inotropic support, with a median vasoactive-inotropic score of 27.5 (IQR 17.5–30). The difference in the inotropic requirements between the two populations was statistically significant (37.5% vs. 100%, p < 0.001). The biomarker values were higher in children than in adults: mid-regional pro-adrenomedullin 1.72 vs. 0.78 nmol/L (p = 0.017), procalcitonin 5.7 vs. 0.19 ng/mL (p = 0.023), and C-reactive protein 328.2 vs. 146.9 mg/L (p = 0.005). N-terminal pro-B-type natriuretic peptide and troponins were higher in children than in adults (p = 0.034 and p = 0.039, respectively). Conclusions Adults and children had different clinical manifestations. Adults developed severe ARDS requiring increased respiratory support, whereas children presented MIS-C with greater inotropic requirements. Biomarkers could be helpful in identifying susceptible patients, since they might change depending on the clinical features.

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Kawasaki-like disease in children with COVID-19

Cited by 77 publications

References 71 publications

Multisystem inflammatory syndrome in children during the COVID-19 pandemic in Turkey: first report from the Eastern Mediterranean

Multisystem inflammatory syndrome in children during the COVID-19 pandemic in Turkey: first report from the Eastern Mediterranean

COVID-19 Pneumonia in Children: From Etiology to Management

The different manifestations of COVID-19 in adults and children: a cohort study in an intensive care unit

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