Characteristics of Children With Kawasaki Disease-Like Signs in COVID-19 Pandemic: A Systematic Review

Abstract

Recent studies have shown that several children diagnosed with COVID-19 have developed Kawasaki Disease (KD)-like symptoms. This systematic review aims to assess the demographic, laboratory, and clinical characteristics of children with KD-like syndrome during the COVID-19 pandemic and evaluate efficacy of treatments and patients' outcome. A comprehensive search was carried out systematically through PubMed, Scopus, and Web of Science (WoS), medRxiv, and bioRxiv by two reviewers independently for all studies or preprints data on the demographic, laboratory, and clinical characteristics of children with K.D-like signs during the COVID-19 outbreak. Overall, 378 studies were identified by the systematic search, of which 25 studies were included in the study. The included studies involved 599 patients in total. Thirteen studies (52%) were case reports or case series, and the rest (48%) were cohort studies. In 19 studies, patients were diagnosed with Multisystem inflammatory syndrome in children (MIS-C). In 16 studies COVID-19 was diagnosed in all patients based on their polymerase chain reaction result, serological findings, and computed tomography results. Higher C-reactive protein and erythrocyte sedimentation rate level were the most prevalent laboratory findings. In most studies, patients had leucopenia with marked lymphopenia, hypoalbuminemia, and increased ferritin, as well as hyponatremia. Abnormal echocardiography and respiratory outcomes were the most common clinical outcomes. In 11 studies, all patients required intensive care unit admission. Findings of the present systematic review show that the incidence of KD-like syndrome in the COVID-19 pandemic increased significantly. Moreover, this study offers new insights in the KD-like syndrome pathogenesis and clinical spectrum during COVID-19 pandemic.

Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study

“…However, high inappropriate prescribing will increase antimicrobial resistance (AMR) rates, increasing morbidity, mortality and costs [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], with high rates of AMR already a concern in Bangladesh [ 33 , 34 , 35 , 36 ]. Children with COVID-19 can also develop Kawasaki Disease (KD)-like symptoms/hyperinflammatory syndromes [ 8 , 37 , 38 , 39 ] as well as experience leucopoenia with marked lymphopenia, hyponatremia, hypoalbuminemia, gastrointestinal and respiratory changes [ 37 ], potentially increasing ICU admissions.…”

Pilot Study on the Current Management of Children with COVID-19 In Hospitals in Bangladesh; Findings and Implications

“…We see though that children diagnosed with COVID-19 do develop Kawasaki Disease (KD)like symptoms/ hyperinflammatory syndromes 41,81-83 , which is reflected by higher C-reactive protein and erythrocyte sedimentation rates and children experiencing leucopoenia with marked lymphopenia, hypoalbuminemia, and hyponatremia along with gastrointestinal changes, abnormal electrocardiogram (ECG) and respiratory changes 81 , which can result in the need for intensive care 81 . This is important as we know from research with adults with COVID-19 in ICUs in Bangladesh that over 50% died whilst in ICU 84 .…”

Prevalence of paediatric hyperinflammatory conditions in paediatric and adolescent hospitalized COVID‐19 patients: a systematic review and meta‐analysis

“…Our meta‐analysis showed that patients in the PHICs group had a slight male preponderance, as seen in previous studies, for all 3 conditions. However, the prevalence of PHICs with younger age was less conclusive; as patients in the PHICs group were reported to be younger, however, this group had a higher mean age [28–31] upon exclusion of Feldstein et al. [8] study.…”