Kawasaki Disease Shock Syndrome in Japan and Comparison With Multisystem Inflammatory Syndrome in Children in European countries

Suzuki, Junko; Abe, Kota; Matsui, Takuya; Honda, Takafumi; Yasukawa, Kumi; Takanashi, Jun‐ichi; Hamada, Hiromichi

doi:10.3389/fped.2021.625456

Cited by 20 publications

(30 citation statements)

References 27 publications

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“…The patient's current medical history, symptoms (fever, abdominal pain, nausea, and manifestations of Kawasaki disease), and responses to treatment were also consistent with reports from Europe and the United States ( 1 , 2 , 4 ). Although it is difficult to clearly differentiate MIS-C from Kawasaki shock syndrome, the clinical picture of this case is closer to that of MIS-C because of the obvious preceding SARS-CoV-2 infection, the older age, the strong abdominal pain and vomiting, and the thrombocytopenia and lymphopenia ( 10 ). This patient's cardiac function was reduced after fever resolution and required cardiovascular intervention.…”

Section: Discussionmentioning

confidence: 80%

“…Because cardiac function, vascular permeability, and volume overload due to treatment would all contribute to the patient's disease state, we presumed that reduced cardiac function would occur after the initiation of treatment for MIS-C. In a previous report regarding Kawasaki disease shock syndrome ( 10 ), which comprises vasculitis due to hypercytokinemia (similar to MIS-C), hypotension occurred either during or after IVIG administration in three of six patients.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

et al. 2021

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Multisystem inflammatory syndrome in children (MIS-C) is a severe disease that is reportedly linked to coronavirus disease 2019. Affected patients present with gastrointestinal symptoms and cardiovascular dysfunction, in addition to Kawasaki disease-like features, suggesting the potential for overlapping disease mechanisms. Kawasaki disease has been reported among individuals of East Asian ethnicities, whereas there is minimal clinical literature regarding the occurrence of MIS-C among individuals of Asian ethnicities. A few reports thus far have described changes in cytokine kinetics during the course of disease in patients with MIS-C. We followed the temporal cytokine kinetics in a 9-year-old Japanese girl who exhibited a classical trajectory of MIS-C. The patient exhibited right cervical swelling and pain, abdominal pain, vomiting, and lip reddening, which developed 31 days after she was diagnosed with severe acute respiratory syndrome coronavirus-2 infection. The patient was diagnosed with Kawasaki disease on her fifth day of illness; because she fulfilled the criteria for MIS-C, she was also diagnosed with this disease on her fifth day of illness. Her fever rapidly resolved upon administration of intravenous immunoglobulin, aspirin, and prednisolone. On the patient's sixth day of illness, she developed acute myocarditis, which was treated with two diuretics and one vasodilator; the myocarditis ameliorated within a few days. Analyses of temporal kinetics for 71 serum cytokines revealed several patterns of cytokine changes that were consistent with the patient's clinical course of disease. Importantly, there was a clear distinction between cytokines that did and did not decrease rapidly following post-treatment fever resolution. These findings may be useful for the assessment of disease status and selection of therapy in patients with similar symptoms; they may also provide insights for basic and clinical research regarding MIS-C.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

et al. 2021

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“…The outcomes of subgroup analysis indicated that the WBC count (×10 9 /L) was lower in MIS‐C patients than in KD patients [WMD (95% CI): −4.47 (−6.98, −1.96), p < .001; heterogeneity: p = .067, I 2 = 51.5%] with REM, but there were no significant differences in the WBC counts (×10 9 /L) between MIS‐C and KDSS patients [WMD (95% CI): −2.81 (−6.90, 1.28), p = .178; heterogeneity: p = .132, I 2 = 50.6%] with REM (Table 2 and Figure 1). 10–16,18–20 …”

Section: Resultsmentioning

confidence: 99%

Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease

Zhou

Zhao

Wang

et al. 2021

Pediatric Pulmonology

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Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been described to partially overlap with Kawasaki disease (KD) with regard to clinical symptoms, but they are unlikely to share the same disease entity. We conducted a systematic review and meta-analysis to characterize the laboratory parameters of MIS-C compared with those of KD and Kawasaki disease shock syndrome (KDSS). Databases were searched for studies on laboratory parameters of MIS-C (hematology, inflammatory markers, cardiac markers, and biochemistry) through May 31, 2021. Twelve studies with 3073 participants yielded 969 MIS-C patients. In terms of hematology, MIS-C patients had lower levels of leukocytes, absolute lymphocyte count and platelet count (PLT) than KD patients and had similar absolute neutrophil count (ANC) and hemoglobin (Hb) levels.In terms of inflammatory markers, MIS-C patients had higher levels of C-reactive protein, D-dimer and ferritin than KD patients and had similar levels of procalcitonin and erythrocyte sedimentation rate (ESR). In terms of cardiac markers, MIS-C patients had higher CPK levels than KD patients. The levels of N-terminal pro-brain natriuretic peptide, troponin and aspartate aminotransferase were not significantly different between MIS-C and KD patients. In terms of biochemistry, MIS-C patients had lower levels of albumin, sodium and alanine aminotransferase and higher levels of creatinine than KD patients. In addition, MIS-C patients had lower levels of PLT, Hb and ESR and higher levels of ANC than KDSS patients. Measurement of laboratory parameters might assist clinicians with accurate evaluation of MIS-C and further mechanistic research.

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“…Our data stand in contrast to findings published from East Asian countries where, despite having historically higher rates of KD compared with Europe and the United States in the years before the pandemic, there was no observed significant increase in KD-like cases after their initial COVID waves. 34 , 35 Hara et al 36 reported no significant change in age or severity of KD cases in Japan. Although we found an overrepresentation of subjects who identified as Asian during the study period, the proportion of subjects admitted for KD who identified as Asian decreased in 2020 compared with the 2016–2019 cohort.…”

Section: Discussionmentioning

confidence: 99%

Kawasaki Disease Hospitalizations in the United States 2016–2020: A Comparison of Before and During the Coronavirus Disease 2019 Era

Pham-Duy

Smith

Herbst

et al. 2021

Pediatric Infectious Disease Journal

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Background: Kawasaki disease (KD) is an acute vasculitis of young children. A comparison of US hospitalization rates and epidemiologic features of KD in 2020 to those of precoronavirus disease years has yet to be reported. Methods: Using a large, inpatient database, we conducted a retrospective cohort study and analyzed data for patients with (1) diagnosis coding for KD, (2) IV immunoglobulin treatment administered during hospitalization and (3) discharge date between January 1, 2016, and December 30, 2020. Severe cases were defined as those requiring adjunctive therapy or IV immunoglobulin–resistant therapy. Results: The annual number of KD hospitalizations were stable from 2016 to 2019 (n = 1652, 1796, 1748, 1692, respectively) but decreased in 2020 (n = 1383). KD hospitalizations demonstrated seasonal variation with an annual peak between December and April. A second peak of KD admissions was observed in May 2020. The proportion of KD cases classified as severe increased to 40% in 2020 from 33% during the years 2016–2019 ( P < 0.01). Median age in years increased from 2.9 in subjects hospitalized from 2016 to 2019 to 3.2 in 2020 ( P = 0.002). Conclusions: Compared with the previous 4 years, the annual number of pediatric KD admissions decreased, and children discharged with diagnostic codes for KD in 2020 were generally older and more likely to have severe morbidity possibly reflective of misdiagnosed multisystem inflammatory syndrome in children. Clinicians should be wary of a possible rise in KD rates in the postcoronavirus disease 2019 era as social distancing policies are lifted and other viruses associated with KD return.

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Kawasaki Disease Shock Syndrome in Japan and Comparison With Multisystem Inflammatory Syndrome in Children in European countries

Cited by 20 publications

References 27 publications

Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease

Kawasaki Disease Hospitalizations in the United States 2016–2020: A Comparison of Before and During the Coronavirus Disease 2019 Era

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