Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study

Abstract

Objectives To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design Prospective observational study. Setting General paediatric department of a university hospital in Paris, France. Participants 21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020. Main outcome measures The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus. Results 21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home. Conclusions The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

“…The median age of children was 7 years (range between 10 months and 17 years). Similar to previous reports, patients with MIS-C tend to be older than 5 years old [3,5,6,10,17,26] and it is in contrast to the epidemiology of Kawasaki disease that approximately 80% of cases occurring in children <5 years of age [4]. Median time from the onset of symptoms prior to hospitalisation was 5 days that was similar to previous reports [15,26].…”

“…According to the French surveillance study, MIS-C might occur in fewer than two per 10 000 children [10]. Although case series of MIS-C have now been reported from the United States [5,11,12] and Europe including the UK [2,13], Spain [14], Italy [6], France [10,[15][16][17] and Switzerland [18], only a few cases have been reported from Asia [19,20]. The aim of this study was to describe the clinical and laboratory characteristics of 45 patients who met criteria for MIS-C in Iran.…”

Echocardiographic patterns in critically ill COVID-19 patients.

“…In our population, LV systolic dysfunction, when present, did not involve LV dilatation, suggesting an acute injury. The second is related to the Kawasaki-like syndrome described in children and adolescents [22]. In our population, we had 2 young women, respectively 17 and 24 years of age, who developed such a syndrome with shock and severe LV failure.…”

“…BMI: body mass index, COPD: chronic obstructive pulmonary disease ACP was much more pronounced during D 3-7 where ACP was the most frequent pattern. CCE was in the normal ranges in the 26 patients who did not require catecholamine infusion (median LVEF of 66% [56-74], RV/LVEDA of 0.56 [0.50-0.56] and VTI of 20 cm[18][19][20][21][22][23]).…”

Unusual Presentation of Kawasaki Disease with Multisystem Inflammation and Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2: A Case Report

“…However, since mid-April 2020, clusters of children with multisystem in ammatory disease similar to Kawasaki disease shock syndrome (KDSS) have been reported in Europe (3) and North America (4), and some cases appeared to be associated with COVID-19. In these cases, the clinical presentations varied and were consistent with complete or incomplete Kawasaki disease (KD), toxic shock syndrome (TSS), multisystemic hyperin ammation, gastrointestinal symptoms (such as abdominal pain and diarrhea), or pleural/pericardial effusion (5).…”