Kawasaki like illness in COVID versus Kawasaki disease in pre-COVID era

Abstract

Background: In children and adolescents, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is mostly responsible for mild respiratory symptoms, in contrast with severe forms reported in adults. An association between the disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), and late manifestations of vasculitis has been increasingly suspected. Method: All children and adolescents (aged ≤18 years) who were diagnosed with Kawasaki disease (KD) and KD shock syndrome (KDSS) as per AHA and Kanegaye et al criteria. From each patient we obtained at least two nasopharyngeal swabs to test for SARS-CoV-2 using reverse transcription- polymerase chain reaction (RT-PCR). We also took blood samples to test for IgG antibodies against SARS-CoV-2. Results: Leucocytosis was found in majority with median leucocyte count of 10100 predominant neutrophila. Inflammatory markers D dimer, serum ferritin and fibrinogen level were raised. The 43% patients had coronary artery aneurysm. The 75% patient had some form of Left ventricular systolic dysfunction. All patients received IVIG while 13 patients received both IVIG and methyl predinisolone. Ionotropes were used in 68%. Two patients received tocluzumab. Conclusions: In this study we found increased incidence of Kawasaki like illness temporally associated with COVID-19. Older age of presentation with more atypical presentation.