More Evidence Of A Causal Link Between COVID-19 And Kawasaki-Like Illness In Kids

A study from France strengthens the connection between SARS-CoV-2 infection and Kawasaki-like multisystem inflammatory syndrome in children, and suggests that black children are at greater risk than whites.

The study also suggests that the syndrome likely represents a post-viral immunological reaction to the novel coronavirus.

In an article in The BMJ, Dr. Julie Toubiana of the University of Paris and colleagues describe the clinical and demographic characteristics of 21 children and adolescents (median age, 7.9 years) with features of Kawasaki disease who were admitted to Necker Hospital for Sick Children in Paris over a 2-week period in April and May.

Twelve patients (57%) were of African ancestry. "The observation of a higher proportion of patients of African ancestry is consistent with recent findings, suggesting an effect of either social and living conditions or genetic susceptibility," the authors say.

They caution that "African countries where the SARS-CoV-2 pandemic has spread might face a potentially large number of children with Kawasaki disease, and supply shortages of intravenous immunoglobulin should be anticipated in such settings."

Twelve of the children (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis; 17 (81%) required intensive care. All 21 children had noticeable gastrointestinal symptoms, leukocytosis and highly elevated levels of inflammatory markers, including C-reactive protein and serum interleukin 6.

Two children developed electrocardiographic changes and arrhythmias, notes the author of a linked editorial, "an emerging phenomenon indicative of extensive cardiac involvement beyond coronary artery abnormalities and myocardial involvement" in children and adolescents with pediatric inflammatory multisystem syndrome (PIMS).

Nineteen of the 21 children had laboratory evidence of SARS-CoV-2 infection; eight (38%) were positive by RT-PCR and 19 (90%) had positive IgG antibody tests. Two children were negative for both.

On presentation to the hospital, only one child had symptoms suggestive of acute COVID-19 and 90% had positive serum test results for IgG antibodies, suggesting that Kawasaki disease may represent a post-viral immunological reaction, the authors say.

All of the children were treated with intravenous immunoglobulin and 10 (48%) also received corticosteroids. "The clinical outcome was favorable in all patients," the researchers report. After a median hospital stay of eight days, all were discharged home, with no deaths.

Editorialist Dr. Mary Beth Son of Boston Children's Hospital and Harvard Medical School says this cohort study has "added an important layer to the growing knowledge of this disorder, strengthening the connection between SARS-CoV-2 infection and this condition."

"It seems highly likely that more reports will appear from around the globe as recent peaks of SARS-CoV-2 infections in new regions result in waves of PIMS in children and adolescents. Urgent issues that will be best tackled by an international, multidisciplinary pediatric community include determination of the incidence and spectrum of mild to severe PIMS through systematic surveillance; best treatment strategies; the incidence and clinical course of coronary artery dilation, aneurysms, and other cardiac complications and their association with risk factors such as severity of presenting illness; and non-cardiac long term health sequelae. The rapid release of publications about PIMS, such as that of Toubiana and colleagues, is the first step in this critical process," Dr. Son concludes.

—Reuters Staff

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