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.
Highlights
INTRODUCTIONKawasaki disease (KD) reported in 1967 is an acute, self-limiting vasculitis of the medium caliber vessels in children.[1,2] Coronavirus disease 2019 (COVID-19) is increasingly reported in children.[3,4] There is a concern for the hyperinflammatory state of COVID-19 and KD in multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS).[5,6,7,8] Kawasaki-like disease with cardiac involvement and macrophage activation syndrome (MAS) has been reported from COVID-19 affected areas.[9,10,11] Acute stage of KD may present with hemodynamic instability of KD shock syndrome (KDSS).[12]
We briefly review the clinical features of Kawasaki disease (KD) and possible associations with COVID-19 in children and timely management to prevent cardiovascular complications
We performed an extensive review of Kawasaki Disease (KD), and Kawasaki-like disease which have been increasingly reported in children in association with COVID-19, and posing difficulties in the timely management of KD
Summary
Kawasaki disease (KD) reported in 1967 is an acute, self-limiting vasculitis of the medium caliber vessels in children.[1,2] Coronavirus disease 2019 (COVID-19) is increasingly reported in children.[3,4] There is a concern for the hyperinflammatory state of COVID-19 and KD in multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS).[5,6,7,8] Kawasaki-like disease with cardiac involvement and macrophage activation syndrome (MAS) has been reported from COVID-19 affected areas.[9,10,11] Acute stage of KD may present with hemodynamic instability of KD shock syndrome (KDSS).[12]. The novel coronavirus (2019-nCoV) pneumonia reported from Wuhan, China in December 2019, was later renamed COVID-19 by the WHO.[13] Association between viral infections and CIVID-19 have been reported in KD children.[14,15] Management of KD is complicated due to the overlap of COVID-19 and MIS-C.5,7,9,16-19. We briefly review the clinical features of KD and possible associations with COVID-19 in children and timely management to prevent cardiovascular complications
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