Children With Kawasaki-Like Disease Positive for COVID-19

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MAY 08, 2020 -- Since April 15, France has seen — like Italy, the UK, Spain, and Belgium — the arrival in intensive care of a surprisingly high number of children with symptoms similar to Kawasaki disease.

Medscape's French Edition has learned around 20 cases have been reported in the Île-de-France region around Paris, although others have been recorded in Reims, Nancy, Bordeaux, Montpellier, Chambéry, and Lyon.

It is a highly unusual incidence rate that suggests a link with the COVID-19 pandemic.

During an online press conference on April 30 organized by Assistance publique – Hôpitaux de Paris (AP-HP), the university hospital trust in the region, several doctors from Necker Hospital in Paris described the profile of these patients and the possible link with COVID-19.

"There are very few inflammatory diseases in which we see damage to the heart muscle. It was easy to label these patients with Kawasaki disease, as the pathophysiology is similar," commented Sylvain Renolleau, MD, PhD, of intensive care and medico-surgical monitoring at Necker Hospital.

The Profile of Young Patients in Intensive Care

Concerning the age and risk factors of these patients, the doctors indicated that there was not one who had a notable history, such as obesity or cardiovascular disease. The median age was 9.5 years, and ranged from 3 to 17 years.

Setting out the symptomatology of the patients during their hospitalization, Renolleau said the children arrived in the emergency room after several days of fever and abdominal pain or vomiting. Sometimes they had a very fleeting rash and presented with cardiac and circulatory failure, in the context of severe inflammation.

"All the children needed ventilatory support, even if they did not have pulmonary disease, due to their hemodynamic problems. Almost all of them needed medical support to aid cardiac function and normalize arterial function," he added.

All of the children progressed favorably after 3 or 4 days in intensive care, with complete restoration of cardiac function.

What Is the Link With COVID-19?

While there were doubts a few days ago, it is now clear that "the children were all in contact at some point with the virus," confirmed Renolleau.

Continued

The patients had either a PCR test, "still positive but weak," or a positive serological test (antibody) that showed contact with the virus dated from 3 or 4 weeks previously.

"In the adult form of COVID-19, a cytokine storm arrives at the start of the second week. In children, this exaggerated inflammatory response comes later, in the third or fourth week," Renolleau reported.

"From what we understand of the timing in these children, it acts in a different way from the start of the epidemic in adults, probably as a post-infectious disease, with immunological mechanisms that follow the COVID-19 infection," explained Damien Bonnet, MD, PhD, head of pediatric medical cardiology at Necker Hospital. "Even if today we cannot say that there is a direct causal link," he added.

How Will These Cases Be Recorded?

To find out more about the prevalence of this Kawasaki-like syndrome, a data collection sheet for potential cases will be offered, in collaboration with the various academic institutions, to be able to report reliable epidemiological data to the health authorities.

In addition to examining these serious cases, Bonnet wondered about children with less serious forms, not hospitalized in intensive care but in pediatric care, for example.

"We need to know if we count only children hospitalized in intensive care or also those who present in other services," he said. And finally, there is the question of potential "adult" cases.

Fever in a Child: What to Do

According to the specialists at Necker Hospital, a doctor should be consulted when a significant fever (39-40ºC) persists for more than 72 hours and if it is unexplained or poorly tolerated, the child is drowsy, refuses to eat, does not move as usual, or complains of abdominal pain or vomits.

When a child presents with unexplained fever, the recommendation is to order lab tests, including blood counts and C-reactive protein (CRP) levels. The CRP level may lead to a referral to pediatric cardiology.

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