Kawasaki-like Syndrome Research Articles

Unravel the Enigma of Kawasaki Disease: Groping in the Dark

Kawasaki disease is one of the leading causes of acquired cardiac disease in childhood especially in Asian countries. Research efforts are extensive and focus on finding the molecular origin of Kawasaki disease. Kawasaki disease shows initially typical symptoms followed by coronary artery lesions in a few percentage of cases. Some patients develop coronary artery lesions, some do not. Research focus on finding biomarkers to predict the development of coronary artery lesions in a child with Kawasaki disease. Kawasaki-like features of the disease are known like MIS-C or Kawasaki-like syndrome, not clearly showing the classical clinical picture of Kawasaki disease. From that point, Kawasaki is not Kawasaki. This manuscript attempts to unravel the molecular and immunological enigma of a rare pediatric disease with to date, unknown etiology.

PIMS-TS Complicating SARS-CoV-2 Infection: A Report of 10 Pediatric Cases

SARS-CoV-2, or COVID-19, is a betacoronavirus identified by the WHO as the cause of the 2020 pandemic. Unlike most respiratory virus, children exhibit lower susceptibility to COVID-19 and generally develop milder disease courses, with reduced mortality rates. Recently, there have been reports of clustered cases characterized by shock states associated with elevated cardiac biomarkers and vasoplegia, necessitating treatment with inotropes, vasopressors, and fluid resuscitation. This clinical presentation has been linked to the emergence of Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), also known as Kawasaki-like syndrome. This study is a retrospective analysis of 10 pediatric patients diagnosed with PIMS-TS secondary to COVID-19 infection, who were admitted to Mohammed VI International University Hospital in Casablanca, Morocco, from January 2021 to October 2023. The cohort's ages ranged from 2 to 13 years, with a mean age of 6 years, and demonstrated a male predominance (sex ratio 9M:1F). Clinical manifestations included prolonged fever, gastrointestinal disturbances, rash, conjunctivitis, and cheilitis. Laboratory findings revealed elevated levels of CRP, PCT, and ferritin, indicative of an atypical Kawasaki syndrome. These patients responded to intravenous immunoglobulin therapy, with adjunctive corticosteroids administered as needed. All patients experienced favorable outcomes, with resolution of systemic involvement and normalization of inflammatory markers, and no relapses or fatalities were recorded. The risk factors for PIMS-TS complicating COVID-19 infection remain unclear. However, there are noted parallels between PIMS-TS and Kawasaki syndrome diagnostic criteria, suggesting possible pathophysiological overlap. In conclusion, a novel multisystem inflammatory syndrome associated with COVID-19 infection, resembling Kawasaki syndrome, has been identified in pediatric patients. This emerging syndrome enhances our understanding of the complex pathophysiology associated with COVID-19 and underscores the need for continued research into its etiology and optimal management strategies.

Are the New Kawasaki-like Syndromes in the Children Associated with COVID-19?

COVID-19 pandemic is severe acute respiratory syndrome is still ongoing since December in almost every countries and cities. This syndrome was first reported in December 2019 in Wuhan, China than first case was seen in Thailand and many COVID-19 cases are detected in all populations, and most of them recovered and age, comorbidities, gender, of COVID-19 deaths and the severity of the infection were changed according to the patients’ additional health risk parameters. Elderly population and people with chronic diseases have been categorized as major risk group, however some COVID-19 positive children have showed Kawasaki disease-like syndromes such as hyper-inflammatory state according to the current state same as adult patients infected by COVID-19. We suggested that glucose-6-phosphate dehydrogenase (G6PD) deficiency can make some children more vulnerable against COVID-19 infection same as adults, since this virus attacks hemoglobin and heme metabolism leading to the increased hemolysis and impaired oxygen transport to the tissues. G6PD deficiency is most affects males. Thus, possible correlation between COVID-19 infection and Kawasaki disease like syndromes in the especially male children should be further investigated and maybe children may be categorized as risk group in the future.

E45 Kawasaki syndrome-related heart disease before and during the COVID-19 pandemic

Abstract Introduction Kawasaki disease (kDa) is an acute febrile systemic panvascularitis that affects medium-caliber arteries with a strong predilection for the coronary arteries. It is the leading cause of acquired heart disease in children under 5 years of age. However, after the COVID-19 pandemic, we see a change in the profile of cardiac involvement. Objective To describe the clinical, paraclinical, and evolutionary characteristics of cardiac damage in children managed for Kawasaki or Kawasaki-Like syndrome before and during the Covid19 pandemic. Materials and Methods This is a retrospective, descriptive study conducted over a period of five years (1st January 2017 to 31st December 2021). Result We collected 30 cases of patients hospitalized with Kawasaki disease, between January 2017 and December 2021: 11 cases with Kawasaki syndrome before COVID-19; and 19 cases with Kawasaki syndrome after COVID-19. The mean age and standard deviation (SD) at diagnosis was 42 (±37.8) months before the pandemic vs 81 (±34.7) months after the pandemic. The sex ratio was 0.5 (4 girls and 7 boys) before the pandemic vs 0.7 (8 girls and 11 boys) after the pandemic. Heart damage was found in 2 cases before the pandemic (coronary aneurysm type) vs 3 cases after the pandemic, mainly cardiogenic shock. The mean time from the first transthoracic ultrasound to fever was 11.3 days before the pandemic, vs 5.8 days after the pandemic. Transthoracic ultrasound showed 2 cases of coronary aneurysm before the pandemic, with a Z score exceeding 2.5SD; vs 7 cases of heart failure after the pandemic with a decrease in left ventricular ejection fraction. The ASAI score (a score that assesses the risk of coronary artery disease) was >6 in 1 case before the pandemic vs in 0 cases after the pandemic. The average predictive score for cardiac involvement was 4.2 (±1.4) before the pandemic, vs 3.5 (±1.5) after the pandemic. The outcome was favorable in all cases despite a more severe picture after the COVID-19 pandemic. Conclusion The change in the pattern of cardiac involvement in Kawasaki disease following the emergence of COVID-19 must be taken into account in order to manage an influx of patients with severe Kawasaki disease.

E68 Kawasaki Disease before and during COVID-19

Abstract Introduction Kawasaki disease is a febrile systemic vasculitis of children, which is suspected to be triggered by respiratory viral infections. We further note, with the outbreak of COVID 19, an increase in incidence with a change in the profile of Kawasaki disease. Objective To describe the epidemiological, clinical and evolutionary characteristics of children managed for Kawasaki or Kawasaki-Like syndrome before and during the Covid pandemic19. Materials and Methods This is a retrospective, descriptive study conducted in the PUC department of the Béchir Hamza children's hospital in Tunis, over a period of 05 years from 1 January 2017–31 December 2021. Results We collected 30 cases of patients hospitalized with Kawasaki disease, between January 2017 and December 2021: 11 cases with Kawasaki syndrome before COVID-19; and 19 cases with Kawasaki syndrome after COVID-19. The mean age of diagnosis was 42 months before the pandemic vs 81 months after the pandemic. The sex ratio was 0.5 before the pandemic vs 0.7 after the pandemic. Viral disease was reported in 0 cases before the pandemic vs 4 cases with confirmed COVID contacts after the pandemic. Fever was the main symptom in both periods, with a mean maximum temperature of 39.7°C before the pandemic vs 39.5°C after the pandemic. The delay of fever from diagnosis was 7.8 days before the pandemic vs 5 days after the pandemic. Cheilitis was reported in 10 cases before the pandemic vs 16 case after the pandemic. Palmoplantarerythema was reported in 1 case before the pandemic vs 7 cases after the pandemic. Scaling was found in 8 cases before the pandemic vs 2 cases after the pandemic. The rash was reported in 9 cases mainly purpuric before the pandemic vs 17 cases after the pandemic, maculopapular. Abdominal involvement was found in 2 cases before the pandemic vs 14 cases after the pandemic. Clinical cardiac involvement was found in 2 cases before the pandemic vs 3 cases after the pandemic. The TTE was pathological in 2 cases before the pandemic, with coronary aneurysm vs 7 cases after the pandemic, with heart failure. All cases received immunoglobulin with a mean time to apyrexia of 26 h before the pandemic vs 25 h after the pandemic. The mean time to hospitalization was 8 days before the pandemic vs 7.3 days after the pandemic. No deaths occurred. Conclusion The change in the profile and incidence of Kawasaki disease following the emergence of COVID-19 must be taken into account in order to manage an influx of patients with severe Kawasaki disease.

Мультисистемный воспалительный синдром, ассоциированный с СOVID-19 (Кавасаки-подобный синдром), у детей (cлучай из практики)

The article presents a clinical case: Kawasaki-like syndrome against the background of a new coronavirus infection developed in a 15 years old child with a favorable outcome. Diagnostic signs of multisystem inflammatory syndrome associated with SOVID-19 (Kawasaki-like syndrome) are given

Cytokine cascade in Kawasaki disease versus Kawasaki-like syndrome.

Kawasaki disease (KD) is a medium vessel systemic vasculitis that predominantly occurs in children below five years of age. It is an acute febrile condition in which coronary artery aneurysms and myocarditis are the most common cardiovascular complications. It is most often characterized by hypercytokinemia. The etiopathogenesis of KD is not fully understood. The present review synthesizes the recent advances in the pathophysiology and treatment options of KD. According to different studies, the genetic, infections and autoimmunity factors play a major role in pathogenesis. Several susceptibility genes (e.g. caspase 3) and cytokines (e.g. IL-2, IL-4, IL-6, IL-10, IFN-gamma and TNF-alpha) have been identified in KD. Patients with high cytokine levels are predisposed to KD shock syndrome. The importance of respiratory viruses in the pathogenesis of the disease is unclear. Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce in children and adults an abnormal systemic inflammatory response. This syndrome shares characteristics with KD. It has been called by many terms like MIS-C (Multisystem Inflammatory Syndrome in Children), PIMS-TS (pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2), hyperinflammatory shock syndrome, cytokine storm (cytokine release syndrome) or simply, Kawasaki-like syndrome. The cytokine's role in the development of KD or Kawasaki-like syndrome being triggered by COVID-19 is controversial. The presences of the antiendothelial cell autoantibodies (AECAs) together with the newly developed hypothesis of immunothrombosis are considered potential pathogenic mechanisms for KD. In consequence, the diagnosis and treatment of KD and Kawasaki-like syndrome, one of the most common causes of acquired heart disease in developed countries, are challenging without a clearly defined protocol.

МУЛЬТИСИСТЕМНЫЙ ВОСПАЛИТЕЛЬНЫЙ СИНДРОМ У ДЕТЕЙ, АССОЦИИРОВАННЫЙ С НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ (COVID-19)

10 histories of cases of children hospitalized in a District clinical Hospital with a COVID-19 associated multisystem inflammatory syndrome and Kawasaki-like syndrome were analyzed

P082 Appendicular syndrome revealing Kawasaki-like syndrome: a case report

BackgroundWith the wide spread of the current SARS-CoV-2, It was found that about 2% of children was affected according to several studies, However, a small number of children with Covid-19 develop a significant systemic inflammatory response similar to Kawasaki disease, a new disease entity called multisystem inflammatory syndrome.MethodsA 12-year-old child, without a notable pathological history, who presented to the emergency, during the SARS-CoV-2 pandemic, for management of a pseudo-appendicular syndrome. Our patient was initially assessed by the surgical team due to his query acute abdomen. The pain had been evolving for 3 days associated with several episodes of bilious vomiting in a context of fever at 38.5°. Abdominal examination noted abdominal tenderness and defence. Extradigestive signs were not reported, The Lab Testing objectified a CRP at 235, elevated white blood cells at 18 180, an abdominal ultrasound was requested returning without particularities. Faced with the persistence of bilious vomiting, surgical exploration was indicated objectifying a catarrhal appendix. A pediatric opinion was requested, the clinical examination shows conscious child who presents infra cervical lymphadenopathy with a fever at 38 associated with an erythematous skin rash on the back and aseptic conjunctivitis. The Lab Testing objectified an important inflammatory syndrome, a acute kidney and heart failure a Covid 19 serology was requested with positive IGG, négative IGM, PCR covid test was negative, given the unavailability of In immunoglobulins, the treatment was based on corticosteroid bolus then relay by oral corticosteroid associated with an anti-inflammatory treatment, gastric protection by proton pump inhibitors, treatment of heart and acute kidney failure. The evolution was marked by clinical and biological improvementDiscussionCoronavirus 2 (SARS-CoV-2) infection among children and adolescents, is mainly responsible for mild respiratory symptoms, in contrast to the severe forms reported in adults [7]. A systemic inflammatory syndrome mimicking kDa, temporally associated with infection with SARS-CoV-2 (Kawa-COVID-19) has recently been described as a serious illness sometimes requiring intensive care (44%). The median age is older (> 5 years), the frequency and severity of myocarditis are very different from classic kDa, abdominal pain and/or diarrhea were more frequently (81%) reported than in classic kDa, heart failure, pneumonia, neurological and renal impairment, associated with elevated CRP, hyperferritinemia are more common in Kawasaki-Like syndrome [10]. Some investigations must be systematically realized urgently to diagnose potentially fatal complications. These include testing for myocarditis, patients should benefit from careful monitoring and treatment with IV Ig 2 g/kg should be administered rapidly and seems to be effective in the majority of cases, associated anti-inflammatory therapy, such as steroids is necessaryConclusionPediatricians should be aware of these atypical presentations of COVID-19 infection for early diagnosis.

P089 Meningeal syndrome revealing Kawasaki like syndrome: a case report

BackgroundMultisystemic inflammatory syndrome in children is a new and rare hyperinflammatory disorder with a temporal link to the current coronavirus 2019 (COVID-19) pandemic; its main clinical signs are prolonged fever, typical features of Kawasaki disease; cardiac dysfunction; as well as gastrointestinal, renal, and/or neurological symptoms. However, the association between meningeal syndrome and the pediatric multisystemic inflammatory syndrome is poorly described in the literature. We will report the case of a boy who presented with meningeal syndrome revealing a Kawasaki-like syndrome. The objective of our work is to provide an update on this pathology which is very little known by clinicians.ObservationOur patient is a male child aged 8 years, from a 2nd degree consanguineous marriage, with a history of the influenza-like syndrome in all family members one month before admission, He was admitted for the management of a febrile meningeal syndrome, the history of which goes back to seven days before his admission, with the onset of a non-calculated fever resistant to antipyretics, associated with peri-umbilical pain and stiffness of the neck with the notion of photophobia and constipation. The clinical examination revealed a conscious child, GCS 15/15, very asthenic, fever 39.3 degrees. The neurological examination revealed a stiff neck with a negative brudzinski and kerning sign and no sensory-motor deficit. The skin examination reveals a morbilliform exanthema with an interval of healthy skin made up of non-infiltrated erythematous macules, which fade away within vitro pressure, on the lower and upper limbs and the trunk, sparing the face, the palms, the soles, and the external genitals, associated with the presence of bilateral palmoplantar oedema without desquamation. The mucous membrane examination showed bilateral conjunctivitis, not purulent, and cheilitis with left cervical adenopathy measuring 2 cm, with an inflammatory appearance on ganglionic examination. The rest of the examination was unremarkable. In front of the meningeal syndrome, a lumbar puncture was performed and came back negative. The biological workup revealed a major inflammatory syndrome: the white blood cells were 25 000 with a predominance of PNN at 23 500, the lymphocytes at 1,000, the platelets at 278 000, the sedimentation rate at 100 and the CRP at 272, the ferritinemia at 725.12, the Pro-BNP was elevated at 1,834, the liver and kidney biological results were normal. Echocardiography revealed myocarditis with mitral leakage, slight hypokinesia of the left ventricle, ejection fraction at 50%, VGTG 40MM, dilated coronary arteries, left common trunk at 4 mm, and IVA at 3 mm with minimal pericardial effusion. Given the current epidemiological context of the clinical symptomatology in our child, the multisystemic inflammatory syndrome was strongly suspected, so a covid19 serology was performed: negative IgM, positive IgG.ConclusionsSeveral recent studies have shown the presence of neurological signs in children with multisystemic inflammatory syndrome related to Covid 19 hence the interest in screening to have recommendations based on sound clinical data for better management of patients with this syndrome during this pandemic.

Multisystem Inflammatory Syndrome in Children in the Critical Care Setting.

Multisystem inflammatory syndrome in children is a new syndrome that has been hypothesized to be connected with the COVID-19 pandemic. Children are presenting-likely after SARS-CoV-2 infection or exposure-with vague symptoms including fever, gastrointestinal distress, and/or rash. To review what is currently known about multisystem inflammatory syndrome in children, including physiology, signs and symptoms, laboratory and imaging findings, treatment options, and nursing considerations in critical care settings. This integrative review was conducted using the keywords multisystem inflammatory syndrome in children, Kawasaki-like syndrome, COVID, COVID-19, and SARS-CoV-2. Initially, 324 articles were found. All were screened, and 34 were included. Eight articles were added after hand-searching and weekly literature searches were conducted. Multisystem inflammatory syndrome in children is a newly identified syndrome, thus information on diagnosis, treatment, and outcomes is available but evolving. Many aspects of nursing care are important to consider with regard to this illness, including COVID precautions, physical assessments, medication administration, and timing of blood sampling for laboratory testing as well as other standard intensive care unit considerations. Providing anticipatory guidance and support to patients and their families is also important. Critical care nurses must remain informed about advances in the care of patients with multisystem inflammatory syndrome in children, as these patients are often seen in critical care environments because of their high risk of cardiovascular failure.

COVID-19-related oral mucosa lesions among confirmed SARS-CoV-2 patients: a systematic review.

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is the virus responsible for coronavirus disease 2019 (COVID‐19), which manifests as a flu‐like respiratory infection affecting multiple organ systems, including the gastrointestinal system, central nervous system, cardiovascular system, skin, and mucosa. In this review, we investigated the literature on specific manifestations of COVID‐19 in the oral mucosa. An online literature search in PubMed, Scopus, Google Scholar, and Medline was conducted to retrieve relevant studies on confirmed COVID‐19 patients with oral mucosa findings published between December 31, 2019, and April 07, 2021. After an independent review by two authors, 39 articles considering 59 laboratory‐confirmed cases of SARS‐CoV‐2 infection were included in the final analysis. The most common finding, reported in 29 patients (43.9%), was Kawasaki‐like syndrome. In addition, oral ulcers including aphthous, hemorrhagic, and necrotic ulcers were reported in 24 patients (36.3%). Other lesions reported included pustules, macules, bullae, maculopapular enanthema, and erythema multiforme‐like lesions. Concomitant skin lesions were present in 60.6% of patients. Fever was reported in 86.2% of patients. Forty‐eight patients (76.1%) were hospitalized. Loss of taste and smell was present in 30.8% of the patients. A comprehensive understanding of the dermatologic manifestations of COVID‐19 can improve and facilitate patient management and referrals.

Clinical Features of Kawasaki Disease during SARS-CoV-2 Epidemic: A Single-Center Retrospective Study

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, causing coronavirus disease 2019 (COVID-19), has rapidly spread worldwide. Recently, cases of Kawasaki-like syndrome associated with COVID-19 (MIS‐C/PIMS) have been reported in the USA and Europe. However, the clinical features of Kawasaki disease (KD) in Japan during the SARS-CoV-2 epidemic remain unclear. Therefore, this retrospective study aimed to evaluate the clinical features of KD in our department during the year of the COVID-19 pandemic (2020). Data were obtained from 45 KD patients who underwent acute-phase treatment from January 2018 to December 2020. The patients were divided into three groups: (1) 2018 group, in which 18 patients receiving acute-phase treatment during 2018; (2) 2019 group, in which 17 patients receiving acute-phase treatment during 2019; and (3) 2020 group, in which 10 patients receiving acute-phase treatment during 2020. The comparison of the clinical findings, treatments, and outcomes among the three groups (2018 vs. 2019 vs. 2020 group) revealed a significant difference in the rate of the male gender (72.2% vs. 41.2% vs. 10.0%, P < 0.010), recurrence (0.0% vs. 0.0% vs. 25.0%, P = 0.015), and coronary artery lesions (16.7% vs. 0.0% vs. 0.0%, P = 0.044). No patients required ventilation assistance or inotropic agents and met the diagnostic criteria of MIS‐C/PIMS. Further studies are warranted to elucidate the clinical features of KD during the SARS-CoV-2 epidemic.

Coronary Vasculitis.

The term coronary “artery vasculitis” is used for a diverse group of diseases with a wide spectrum of manifestations and severity. Clinical manifestations may include pericarditis or myocarditis due to involvement of the coronary microvasculature, stenosis, aneurysm, or spontaneous dissection of large coronaries, or vascular thrombosis. As compared to common atherosclerosis, patients with coronary artery vasculitis are younger and often have a more rapid disease progression. Several clinical entities have been associated with coronary artery vasculitis, including Kawasaki’s disease, Takayasu’s arteritis, polyarteritis nodosa, ANCA-associated vasculitis, giant-cell arteritis, and more recently a Kawasaki-like syndrome associated with SARS-COV-2 infection. This review will provide a short description of these conditions, their diagnosis and therapy for use by the practicing cardiologist.

The clinical epidemiology of coronavirus disease 2019 in children and adolescents mirrors the widening gap in healthcare disparities.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has exacerbated the longstanding racial/ethnic health disparities in the USA, with a disproportionately negative effect on children of color. This review summarizes recently published studies that describe the clinical epidemiology and racial/ethnic disparities associated with SARS-CoV-2 in children. Children with SARS-CoV-2 infections manifest with a wide spectrum of disease. Most are either asymptomatic or mildly symptomatic with fever, gastrointestinal, and/or upper respiratory disease. Some children can progress to develop severe lower respiratory disease or a hyper-inflammatory, Kawasaki-like syndrome leading to cardiovascular shock. Although SARS-CoV-2-related deaths in children are rare, more children died within the first nine months of the pandemic than have died during any influenza season over the last decade.Black and Hispanic children represent less than 41% of the US population but account for three out of every four SARS-CoV-2-related hospitalizations and deaths in the USA. The drivers of these disparities in children are complex and likely a combination of societal, biological, and behavioral influences. This pandemic brought to light longstanding health disparities in historically marginalized populations, and minority children have suffered tremendously. It provides an opportunity to understand how a virus hijacked deep-rooted inequities, address these inequities, and work to prevent this outcome in future pandemics/epidemics.

Мультисистемный воспалительный синдром, ассоциированный с SARS-CoV-2, у ребенка

The COVID-19 infection occurs much less commonly in children than in adults, presumably due to the predominance of asymptomatic variants. Nevertheless, single deaths by the COVID-19 were reported in children worldwide. Some of these deaths result from multisystem inflammatory syndrome (MIS) that develops at late stages or after the COVID-19. MIS is characterized by acute onset, steady fever, skin and mucosal damage, and multiorgan failure. Unlike the classic variant of Kawasaki disease, MIS is associated with more frequent shocks and a more severe course. This paper addresses a case report of MIS with a favorable course and outcome in a 7-year-old boy. Practitioners should be aware that severe intoxication and inflammation with increased inflammatory markers emerging at late stages or after respiratory infections are potential manifestations of MIS. In these cases, tests for the COVID-19 should be timely performed; if found, pathogenic therapy is promptly initiated. Taking into account the insufficient knowledge of the pathogenesis and the knowledge of the consequences of MIS associated with SARS-CoV-2, long-term follow-up monitoring is required. KEYWORDS: coronavirus infection, COVID-19, SARS-СoV-2, multisystem inflammatory syndrome, Kawasaki-like syndrome, Kawasaki-like disease. FOR CITATION: Nagovitsyna N.M. SARS-CoV-2-associated multisystem inflammatory syndrome in a child. Russian Journal of Woman and Child Health. 2021;4(4):375–377 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-375-377.

COVID-19 CHALLENGE, IN WHICH A THREE-YEAR-OLD GIRL WON

Since March 11, coronavirus infection has become an intercontinental problem – a pandemic has developed.Ukraine (until December 2019) ranks 17th in the world in the number of Covid-19 cases. Although according to statistics, the children are the least vulnerable group for coronavirus infection, unfortunately, severe and serious complications such as pneumonia, Kawasaki disease and Kawasaki-like syndrome, Multisystem inflammatory syndrome in children, toxic shock syndrome, myocarditis occur in children, too. As of the end of November, according to the Ministry of Health in Ukraine, 732,625 cases of coronavirus were laboratory- confirmed, including 13,720 children. According to the Lviv Regional Laboratory Center of the Ministry of Health, in the Lviv region since the beginning of the Covid-19 pandemic, among 46078 of all infected were about 5-6% of children. To analyze clinical, laboratory features of severe coronavirus infection complicated by bilateral pneumonia with acute respiratory distress syndrome (ARDS) in a three-year-old girl who was on V-V ECMO for one week and mechanical ventilation of the lungs for 28 days. The diagnosis was confirmed by detection of SARS-CoV-2 virus RNA by PCR, X-ray and ultrasound examination of the lungs. The disease had a dramatic course but a successful outcome. Life-threatening conditions associated with COVID-19 in children are much less common than in adult patients. However, in some cases, when critical hypoxemia is not eliminated by traditional methods of respiratory support, ECMO can become a life-saving technology and with its timely usage in pediatric patients.

CLINICAL AND LABORATORY CHARACTERISTICS OF SARS-COV-2 INFECTION IN CHILDREN AND ADOLESCENTS.

ABSTRACTObjective: To present the current evidence on clinical and laboratory characteristics of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during childhood and adolescence.Data source: This is a narrative review conducted in the databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Latin American and Caribbean Health Sciences Literature in the Virtual Health Library (LILACS/VHL), Scopus, Web of Science, Cochrane Library, portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The terms used were SARS-CoV-2, COVID-19, novel coronavirus, child, newborn, and adolescent.Data synthesis: Unlike adults, most children infected by SARS-CoV-2 have mild or asymptomatic clinical presentations. Symptomatic children mainly have low fever and cough, with some associated gastrointestinal symptoms. Severe cases are rare and occur especially in infants under one year of age. Detection of viral particles in feces seems to be more persistent in children and can be used as a tool for diagnosis and control of the quarantine period. Different from adults, children can present distinct inflammatory responses, as has happened in new cases of Kawasaki-like syndrome associated with SARS-CoV-2 infection.Conclusions: Most children have asymptomatic or mild presentations, with a prevalence of fever, cough, and gastrointestinal symptoms. New cases with different systemic inflammatory reactions in children have been reported, with clinical manifestations distinct from those typically found in adults.

Kawasaki-like syndrome in children from Greater Poland during the first wave of COVID-19 pandemic

Kawasaki disease is an acute disease caused by systemic vasculitis, which predominantly affects children younger than 5 years of age. It is the leading cause of acquired coronary artery disease in childhood in developed countries. Currently, in the era of COVID-19, an increased number of cases, most likely related to SARS-CoV-2, are being observed. Our study aimed to describe the incidence and course of Kawasaki-like syndrome in patients admitted to the Polish department of infectious diseases during the first wave of COVID-19 pandemic. We identified 6 children with Kawasaki disease within almost 6 weeks of the pandemic. Medical history of 3 children showed contact with a person suspected of SARS-CoV-2 infection. One patient had confirmed SARS-CoV-2 serology (a female patient who lived in the epidemic centre). We did not confirm any bacterial or viral aetiology in 3 patients. Conclusions: Based on the conducted analysis comparing the number of cases during the “spring wave” of SARS-CoV-2 pandemic compared to previous years, an increased incidence of Kawasaki syndrome among children from the Greater Poland was found, similar to that reported by doctors from various European countries. The mean age of patients with Kawasaki disease was higher than previously reported. Analysis of clinical forms in our patients showed the entire spectrum from incomplete Kawasaki disease to full blown Kawasaki disease shock syndrome and multisystem inflammatory syndrome in children. The risk assessment of immunoglobulin resistance using the Kobayashi and Egami scores had no predictive value in patients with Kawasaki disease during the COVID-19 period.

БОЛЕЗНЬ КАВАСАКИ И МУЛЬТИСИСТЕМНЫЙ ВОСПАЛИТЕЛЬНЫЙ СИНДРОМ ПРИ ИНФЕКЦИИ COVID-19 У ДЕТЕЙ

During the COVD-19 pandemic, some pediatric patients in many countries around the world experienced a syndrome resembling a severe Kawasaki disease (KD), often accompanied by shock. Due to the incomplete signs of the classic KD in the era before the present pandemic, in many publications from European countries and the United States, this condition was called «multisystem inflammatory syndrome in children – MIS-C» or «hyperinflammatory shock» or «Kawasaki-like syndrome». This syndrome with a new coronavirus infection is characterized by refractory fever, frequent gastrointestinal symptoms, heart damage (including coronary dilation in some patients, and acute left ventricular failure in the majority), increased ESR and CRP levels, neutrophilia, extremely high troponin levels, increased ferritin, AST, ALT, lactate dehydrogenase, creatine phosphate kinase, interleukin-6 and interleukin-10, coagulopathy with an increase in D-dimer and fibrinogen, thrombocytopenia, sometimes procalcitonin increase. The manifestations of a cytokine storm may meet the criteria for secondary hemophagocytic syndrome. The mechanism of myocardial damage remains unclear. Treatment with high-dose intravenous immunoglobulin is effective, and in the presence of signs of hemophagocytic syndrome, dexamethasone or methylprednisolone. Further research is needed to understand the pathogenesis, resemblance and differences of this syndrome with classic KD, understanding of heart injuiry and early recognition for the need of urgent care.