Kawasaki Disease- Management Strategies Given Symptoms Overlap to COVID-19: A Review

Abstract

Kawasaki disease is an acute, self-limiting vasculitis in children. Early treatment is necessary to prevent cardiovascular complications. The acute phase of Kawasaki disease may present with hemodynamic instability. An association between viral respiratory infections and Kawasaki disease has been reported. Studies have shown that Kawasaki and Kawasaki-like disease may be associated with and have symptoms overlapping COVID-19. Children with COVID-19 may present as Kawasaki-like disease with pediatric inflammatory multisystem syndrome, or macrophage activation syndrome. Clinicians need to be aware of the early diagnosis and management of Kawasaki disease to prevent the development of coronary artery aneurysms. The symptoms overlap of multisystem inflammatory disease seen in COVID-19 adds to the difficulties in timely diagnosis and treatment. Children with Kawasaki disease require regular follow-up plans for coronary artery aneurysms. This adds to the difficulties during the changed environment of COVID-19 for control and prevention. Missed diagnosis and early treatment of Kawasaki disease with immunoglobulin and aspirin results in the development of coronary artery aneurysm in up to 25% of cases, with grave consequences. Here, we briefly review the management of typical and atypical Kawasaki disease which has symptoms overlapping with the multisystem inflammatory disease as seen in COVID-19.

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

“…Clearly, the blockage of a blood vessel by a microclot is likely to exert pressure on the vessel's walls, potentially weakening it, and so it is reasonable that aneurysms might be expected to accompany diseases involving microclots. This turns out to be the case in rheumatoid arthritis [ 490 ], acute COVID [ 491 , 492 ] (which bears similarities to Kawasaki disease [ 493 ]) and Long COVID [ 17 ]. The association with ME/chronic fatigue syndrome is seemingly weaker, and is usually seen as an association of fatigue, for example, driven by a subarachnoid haemorrhage [ 494 , 495 ].…”

The effect of vitamin D status on the occurrence of Kawasaki Disease: a meta-analysis

“…Consequently, researchers have sought to understand the development process of the coronary artery and its influencing factors to intercept or reduce the risk of CAL in KD patients. Some studies have revealed a notable association between low levels of serum 25(OH)D in KD patients with CAL when compared to those without CAL and control groups [ 22 , 27 , 53 ]. Additionally, vitamin D supplementation and adjuvant treatment have been found to effectively mitigate the risk of CAL and improve IVIG treatment response [ 14 ].…”

MiR‐223‐3p affects the proliferation and apoptosis of HCAECs in Kawasaki disease by regulating the expression of FOXP3

“…KD can be treated with intravenous immunoglobulin (IVIG), oral aspirin, or anti‐inflammatory agents such as TNF‐α blockers and IL‐1 receptor antagonist 5‐7 . Particularly, early and proper use of IVIG is very important for preventing cardiovascular complications 8 …”

“… 5 , 6 , 7 Particularly, early and proper use of IVIG is very important for preventing cardiovascular complications. 8 …”

“…[5][6][7] Particularly, early and proper use of IVIG is very important for preventing cardiovascular complications. 8 miRNAs can participate in various biological processes such as cell apoptosis, angiogenesis, and differentiation. 9,10 miR-223 is a blood-forming lineage miRNA that is exported in cells such as blood platelets and leukocytes of the bone marrow.…”