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Severe Kawasaki in Children After COVID-19

May 25, 2020

Written by Clay Smith

Spoon Feed
An increased incidence of severe Kawasaki disease has been recognized in association with COVID-19 infection in children. It is now called multisystem inflammatory syndrome in children, MIS-C.

Why does this matter?
Children have lower mortality from COVID-19, but this rare illness is a unique way that children are negatively impacted. Be sure to read the newly released CDC case definition for MIS-C. This article describes the Italian experience with this illness.

File this under MIS-C
Using a before and after design, they found that Kawasaki-like illness is occurring more often in this region of Italy after COVID-19: 10 cases per month vs. 0.3 cases per month. Affected children are older, 7.5 vs. 3 years. It has also been more severe, 60% with cardiac involvement after COVID-19 vs. 10.5% before; 50% had Kawasaki Disease shock syndrome* as well as macrophage activation syndrome** after COVID vs. 0% before; 80% vs 16% needed steroids after vs. before. Out of the ten children, 8 had either positive SARS-CoV-2 RT-PCR or positive IgM or IgG. Two of the ten children were symptomatic but had negative RT-PCR and serologies. All cases at that point had responded to usual treatment with IVIG, aspirin, and 80% were treated with adjunctive steroids.

*Kawasaki disease shock syndrome – “systolic hypotension for age, a sustained decrease in systolic blood pressure from baseline of ≥20%, or clinical signs of poor perfusion.”
Macrophage activation syndrome, also known as secondary hemophagocytic lymphohistiocytosis, is characterized by, “persistence of fever with splenomegaly, hyperferritinemia, thrombocytopenia, and elevated aspartate aminotransferase (AST).”

Another Spoonful
Here are several more recent articles on this syndrome.

An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020 May 13. doi: 10.1016/S0140-6736(20)31103-X. [Epub ahead of print]

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