Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Abstract

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain.Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1–May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV–) to those from the same period during 2018 and 2019 (PreCoV).Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period.Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.

Distinct characteristics of multisystem inflammatory syndrome in children in Poland

“…The exact pre-pandemic incidence of KD in Poland was not known (there had been no national reporting effort before the pandemic), though it was not likely to substantially differ from other European countries 21 . Similarly as in other countries 7 , 22 , 23 , we have observed a sharp increase in KD cases following COVID-19 wave. The data limited to two reporting sites supporting these observations are presented in Supplementary Table 6 .…”

“…In previous studies which included both clinical variants, KD prevalence was two times more common than in those in which only typical KD definition was used 15 – 17 , 27 . Moreover, the comparison of patients with KD from pre-pandemic and pandemic periods in Spain revealed more frequent atypical presentation (71%) among patients with documented SARS-CoV-2 history 23 . Secondly, KD/aKD phenotype could have been over-represented due to our inclusion criteria and the fact, that the cases were identified and reported by pediatricians, who were more familiar with recognising KD than either TSS, MAS or new inflammatory syndrome.…”

“…The data limited to two reporting sites supporting these observations are presented in Supplementary Table 6 . Despite being initially reported as Kawasaki-like disease, MIS-C appeared to be a distinct entity soon after 8 , 9 , 23 – 25 . Children in our cohort, more frequently than in others, fulfilled KD/aKD diagnostic criteria but concomitantly presented unique features typical for MIS-C 7 , 15 – 17 , 26 , 27 .…”

Differences and similarities of multisystem inflammatory syndrome in children, Kawasaki disease and macrophage activating syndrome due to systemic juvenile idiopathic arthritis: a comparative study

“…KDSS usually presents in older ages with a higher rate of myocarditis and elevated levels of inflammatory markers compared to KD [ 23 , 30 ]. According to the literature, KDSS was more frequently observed in MIS-C patients than classic KD patients (7% vs. 45.8%) [ 5 , 6 , 14 – 17 ]. Similarly, in the present study, no KDSS cases were presented among the classic KD patients, while the rate of KDSS was 43% in MIS-C patients.…”

“…Apart from clinical improvement, it is a matter of interest when laboratory findings will improve. The study of Lee et al showed that the mean time to 50% decrease in CRP and ferritin levels were 5.3 days and 13.4 days, respectively [ 17 ]. Correspondingly, CRP levels returned to normal levels at 10 days in our cohort.…”