KAWASAKI DISEASE AND COVID-19

A rare multisystem inflammatory syndrome believed to be linked to coronavirus had been reported in 73 hospitalized children in and around New York City as of Friday, May 8, and the illness has also sickened children in Boston, Los Angeles, and other cities in the U.S. and Europe.

In his Friday afternoon press conference, New York Governor Andrew Cuomo confirmed that the death of a 5-year-old boy at a Manhattan hospital on Thursday was being investigated as possibly related to Covid-19 and the condition, which has been labeled "pediatric multisystem inflammatory syndrome."

Cuomo said if the condition is related to previous or acute infection with SARS-CoV-2, it shows that the virus can be life threatening in children, even if serious complications are very rare in young patients.

"So, this is every parent’s nightmare that your child may actually be affected by this virus, but it is something we have to consider seriously now," he said.

The syndrome, which closely resembles the coronary artery condition Kawasaki disease, is characterized by inflammation, fever, and rash. It can become life threatening when dramatic blood pressure drops and toxic shock occur.

Palo Alto, California pediatrician Venna Jones, MD, and colleagues described a case of classic Kawasaki disease in a 6-month-old infant with concurrent confirmed Covid-19 infection in a paper published this week in the journal Hospital Pediatrics.

On Friday, an official with Children’s Hospital Los Angeles confirmed to BreakingMED that the center has experienced an "increase in cases of typical and atypical Kawasaki Disease," in 2020, compared to 2019 and 2018.

Preliminary data identified 3 patients treated at the hospital with symptoms consistent with pediatric multisystem inflammatory syndrome who all tested positive for SARS-Cov-2 antibodies but negative for the active virus, indicating that their conditions may have been a late response to a recent infection with the novel virus.

Public relations officer Lauren Song said specialists in Kawasaki disease are currently following up with recent patients to test them for antibodies to the novel virus and all new patients with signs of Kawasaki disease are being evaluated for Covid-19.

According to news reports, at least 10 children have been treated at Children’s Hospital of Philadelphia and four at Boston Children’s Hospital for suspected PMIS in recent weeks.

In an interview with BreakingMED, Mary Beth Son, MD, who directs the rheumatology program at Boston Children’s Hospital, said there appears to be a spectrum of clinical phenotypes associated with the syndrome, with some children presenting with all the classic symptoms of Kawasaki disease and others presenting with very few.

Son would not say how many pediatric patients have been treated for the Kawasaki-like syndrome at the hospital, but she did confirm that some have exhibited serious symptoms requiring treatment in the ICU.

She added that, while some children have presented with acute infections, others have tested negative for infectious SARS-CoV-2 at presentation.

Her message to clinicians is that kids who present with persistent fever and tachycardia or signs of Kawasaki disease should be quickly referred to a tertiary care center with pediatric sub-specialists.

"Treating this takes a team," she said.

"The other thing we are seeing in a lot of these kids, but not all, is signs of cytokine storm, with high ferritin levels and D-dimer levels," she added. "It is important to look for this, because prompt treatment can make a big difference in outcomes."

Jane Newburger, MD, who directs the Kawasaki program at Boston Children’s Hospital, said while Kawasaki disease can cause permanent heart or vascular damage in children, this complication is rare.

"We want to reassure parents — this appears to be uncommon," Newburger noted in a press release issued this week by the American Heart Association (AHA).

"While Kawasaki disease can damage the heart of blood vessels, the heart problems usually go away in five or six weeks, and most children fully recover," she noted. "Rarely, but sometimes, the coronary artery damage persists. Because of this, Kawasaki disease is the most common cause of acquired heart disease in children in developed countries."

Newburger agreed that prompt evaluation and appropriate treatment of children with symptoms of pediatric multisystem inflammatory syndrome is key to preventing permanent injury.

Due to the "small but increasing number of children" who exhibit fever and evidence of inflammation who are not severely ill, the AHA is calling for all children with unexplained fever and elevated C-reactive protein or white blood cell counts to be carefully monitored," she said.

The AHA’s Young Hearts Council is also calling on children to be enrolled, "whenever possible," in Covid-19 research projects that involve obtaining serum or plasma samples, DNA, and RNA studies for biobanking.

The group also called for clinical trials and data integration across existing and planned registries of children who have been sickened by Covid-19.