Kawasaki-Like Disease, a New Phenotype in Sars-CoV-2?

Abstract

The coronavirus disease , that assumed pandemic proportions in March 2020, mainly affects the respiratory tract, causing severe interstitial pneumonia in adults. Worldwide data indicate that COVID-19 tends to be more benign in children, which is evidenced by a high incidence of asymptomatic or mild upper airways' infection cases in this population. However, recent studies have been associating Kawasaki-like symptoms as a nonclassical presentation of coronavirus disease in pediatrics. It is suggested that the intense cytokine cascade, promoted by the SARS-CoV-2 infection, can trigger a multisystem inflammatory response as an atypical Kawasaki form in genetically predisposed individuals. In this context, patients may develop more severe clinical features with a greater predisposition to myocardial involvement, Macrophage Activation Syndrome, and Kawasaki Disease Shock Syndrome. Despite critical conditions, patients usually respond to conventional treatment of Kawasaki Disease with intravenous immunoglobulin. This article intends to provide an approach to the association between Kawasaki-Like Syndrome and COVID-19. BackgroundThe Sars-CoV-2 virus was initially isolated in the city of Wuhan, China, during a pneumonia outbreak of unknown cause in December 2019, a disease then named COVID-19. Due to its progressive worldwide spread, the World Health Organization decreed, three months later, the state of pandemic. 1 Sars-CoV-2 usually affects the respiratory tract, causing severe interstitial pneumonia in adults. In children, however, it tends to be more benign, manifesting asymptomatically or as a mild infection of upper airways. A systematic review that assessed a 12-case series of children from China found that 39%-82% of the patients with COVID-19 developed a moderate course of the disease. 2 A minority of pediatric cases presented severity, with respiratory failure, shock, coagulation dysfunction, and renal injury. 3,4 Data from many countries indicate that the rate of Sars-CoV-2 infection in the population under 18 is low, ranging from 1%-2%. Among the cases, the occurrence of unfavorable outcomes is even rarer. A cohort study by DeBiasi et al., 5 with 177 young patients diagnosed with coronavirus disease found that 44 (24.8%) patients needed hospitalization, among these, only 9 (2.8%) were critically ill. 5 Interestingly, one of them developed hypotension and myocardial depression associated with signs of hyperinflammatory state, a Kawasaki-like presentation. Despite being an unusual manifestation, the increase in the number of reported associations between Kawasaki Disease (KD) and COVID-19 in children raises new concerns about its consequences. 5,6 Search Methods: In order to develop a nonsystematic narrative review, we executed literature searches in multiple databases (Google Scholar, PubMed, SciELO, and Medscape) with no time restriction for articles published in English. Search terms included the keywords: "Sars-CoV-2", "COVID-19", "Kawasaki-like", "MIS-C", "PIMS-TS" and "Autoimmune disease". We emphasized i...

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What have we Learned about the Different COVID-19 Phenotypes in the Pediatric Population so Far?

“…The scientific paper "Kawasaki-like disease, a new phenotype in Sars-CoV-2?" 9 brings interesting information about SARS-CoV-2 in childhood and adolescence and its association with the Kawasaki-like disease and MIS-C, 9 and highlights different clinical and laboratory aspects that stand out in cases of Kawasaki-like disease. For example, a higher frequency of gastrointestinal manifestations (abdominal pain, mesenteric lymphadenopathy, vomiting, diarrhea, and in some cases an acute abdomen requiring exploratory surgery), lymphopenia, elevation of inflammatory markers and myocardial injury (C-reactive protein, interleukins, procalcitonin, D-dimer, N-terminal prohormone of brain natriuretic peptide [NT-proBNP], troponin, lactate, transaminases, etc.…”