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Abstract
Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain.Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1–May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV–) to those from the same period during 2018 and 2019 (PreCoV).Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period.Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.
Highlights
COVID-19 has a less severe course in children
We looked at the SARS-CoV-2-positive patients to see if they fulfilled the World Health Organization (WHO) definition of multisystem inflammatory syndrome in children (MIS-C) [8] and/or the Royal College of Pediatrics and Child Health definition of PIMS-TS [9]
Nationwide, 124 cases were collected during the periods March 1–May 30, 2018/19/20 with 23 (19%) requiring pediatric intensive care unit (PICU); the diagnosis of Kawasaki disease (KD) was confirmed for all patients after individual data review
Summary
COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). In April, some children presented critically ill with fever, shock, and signs of multisystem inflammation most of them requiring admission to the pediatric intensive care unit (PICU) They presented clinical signs overlapping with Kawasaki disease (KD) [4, 5] triggering alerts to pediatricians. The World Health Organization (WHO) [6], the European Centre for Disease Prevention and Control [7], the US Centers for Disease Control and Prevention [8], and the Royal Collage of Paediatrics and Child Health [9] have all produced definitions for this new entity It was called pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) [9] or multisystem inflammatory syndrome in children (MIS-C) [8] and case definition and guidance on clinical management was published
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