Kawasaki aumenta en épocas de COVID-19

Kawasaki-Like Disease

By Amy Orciari Herman

Edited by Richard Saitz, MD, MPH, FACP, DFASAM

The province of Bergamo, Italy, experienced a 30-fold increase in Kawasaki-like disease during the region's novel coronavirus (COVID-19) outbreak, according to a Lancet study. The finding adds to mounting evidence linking COVID-19 to what some are calling "pediatric multisystem inflammatory syndrome."

Ten children who developed Kawasaki-like disease during the COVID-19 epidemic were compared with 19 patients diagnosed with the illness during the prior 5 years. Eight of the ten patients during the epidemic tested positive for SARS-CoV-2 antibodies.

The incidence of Kawasaki-like disease was 10 per month during COVID-19, versus just 0.3 per month previously. Additionally, the epidemic cohort was older (mean age, 7.5 vs. 3.0 years) and had a more severe disease course: they were more likely to have abnormal echocardiography (60% vs. 10%), Kawasaki disease shock syndrome (50% vs. 0%), and macrophage activation syndrome (50% vs. 0%). The epidemic cohort was also more likely to require steroids in addition to intravenous immunoglobulin (80% vs. 16%).

The researchers write, "The association between SARS-CoV-2 and Kawasaki-like disease should be taken into account when it comes to considering social reintegration policies for the paediatric population. However, the Kawasaki-like disease described here remains a rare condition, probably affecting no more than one in 1000 children exposed to SARS-CoV-2."

Separately, the authors of a Hospital Pediatrics editorial discuss whether the association between COVID-19 and Kawasaki disease is causal and conclude that while "promoting awareness is crucial ... we must tread carefully and objectively."

Lancet article (Free)

Lancet comment (Free)

Hospital Pediatrics editorial (Free PDF)

NEJM Journal Watch COVID-19 page (Free)

NEJM COVID-19 page (Free)