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

##plugins.themes.bootstrap3.article.main##

  •   Toshimasa Nakada

Abstract

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.


Keywords: COVID-19, Kawasaki disease, male, recurrence, SARS-CoV-2

References

Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 1974; 54: 271–6.

Fukazawa R, Kobayashi J, Ayusawa M, Hamada H, Miura M, Mitani Y, et al. JCS/JSCS 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease. Circ J 2020; 84: 1348–407. doi:10.1253/circj.CJ-19-1094.

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395: 1771–78. https://doi.org/10.1016/S0140-6736(20)31103-X.

LR Feldstein, EB Rose, SM Horwitz, JP Collins, MM Newhams, MBF Son, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N. Engl. J. Med. 2020; 383: 334–46. DOI: 10.1056/NEJMoa2021680.

Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324(3):259. doi:10.1001/jama.2020.10369.

Ouldali N, Pouletty M, Mariani P, Beyler C, Blachier A, Bonacorsi S, et al. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. Lancet Child Adolesc Health 2020; 4: 662–68. https://doi.org/10.1016/S2352-4642(20)30175-9.

The Centers for Disease Control and Prevention. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). https://emergenc y.cdc.gov/han/2020/han00432.asp. (Accessed on July 19, 2020).

Royal College of Paediatrics and Child Health. Guidance-Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-ultisystem-%20inflammatory%20syndrome-20200501.pdf. (Accessed on July 19,2020).

Uda K, Okita K, Soneda K, Taniguchi K, Horikoshi Y. Kawasaki disease following coronavirus disease 2019 with prolonged fecal viral shedding. Pediatr Int (2020) 0, 1–3 doi: 10.1111/ped.14452.

Iio K, Uda K, Hataya H, Yasui F, Honda T, Sanada T, et al. Kawasaki disease or Kawasaki-like disease: Influence of SARSCoV-2 infections in Japan. Acta Paediatrica. 2021; 110:600–1. DOI: 10.1111/apa.15535.

Yasuhara J, Watanabe K, Takagi H, Sumitomo N, Kuno T. COVID‐19 and multisystem inflammatory syndrome in children: A systematic review and meta‐analysis. Pediatric Pulmonology. 2020;1–12. DOI: 10.1002/ppul.25245.

Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int 2005; 47: 232–4. https://doi.org/10.1111/j.1442-200x.2005.02033.

Rearch Committee of the Japanese Society of Pediatric Cardiology; Cardiac Surgery Committee for Development of Guidelines for Medical Treatment of Acute Kawasaki Disease. Guidelines for medical treatment of acute Kawasaki disease: report of the Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version). Pediatr Int 2014; 56: 135–58. https://doi.org/10.1111/ped.12317.

Hirata S, Nakamura Y, Yanagawa H. Incidence rate of recurrent Kawasaki disease and related risk factors: from the results of nationwide surveys of Kawasaki disease in Japan. Acta Paediatr. 2001; 90(1): 40–4. https://doi.org/10.1111/j.1651-2227.2001.tb00253.x.

Nakada T. Usefulness of an initial single intravenous immunoglobulin infusion with delayed use of aspirin against Kawasaki disease relapse: a single-center retrospective study. Journal of Advanced Research in Medicine 2019; 6 (1): 18–24.

https://doi.org/10.24321/2349.7181.201905.

Egami K, Muta H, Ishii M, Suda K, Sugahara Y, Iemura M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease, J Pediatr 2006; 149: 237–40.

Nakada T. Acute Phase Treatment and Medium-Term Outcomes in Kawasaki Disease. European Journal of Medical and Health Sciences 2020; 2 (4), August: 1–7.

http://dx.doi.org/10.24018/ejmed.2020.2.4.419.

Kobayashi T, Inoue Y, Takeuchi K, OkadaY, Tamura K, Tomomasa T, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006; 113: 2606–12. http://www.circulationaha.org.DOI:10.1161/CIRCULATIONAHA.105.592865.

World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Published May 15, 2020. Accessed May 22, 2020. https://www.who. int/publications-detail/multisystem-inflammatorysyndrome-in-children-and-adolescents-withcovid-19.

Gavish R, Levinsky Y, Dizitzer Y, Bilavsky E, Livni G, Pirogovsky A, et al. The COVID-19 pandemic dramatically reduced admissions of children with and without chronic conditions to general paediatric wards. Acta Paediatrica 2021; 00: 1–6. DOI: 10.1111/apa.15792.

Homepage of Japanese Society of Kawasaki disease. 8 January 2021. http://www.jskd.jp/pdf/KD-COVID-Questionnaire0108.pdf.

Tomita Y, Shimaya M, Yamaura Y, Tsujiguchi R, Takahashi K, Fukaya T. Kawasaki disease: Epidemiological differences between past and recent periods, and implications of distribution dynamism. Pediatr Int. 2018; 60(4): 349-56. doi: 10.1111/ped.13522.

Makino N, Nakamura Y, Yashiro M, Kosami K, Matsubara Y, Ae R, et al. Nationwide epidemiologic survey of Kawasaki disease in Japan, 2015–2016. Pediatr Int 2019; 61: 397–403.

https://doi.org/10.1111/ped.13809.

Yasuda Y, Ishiguchi H, Ishikura M, Yoshida M, Imoto K, Sonoyama K, et al. Incidence and Demographic Trends for Acute Coronary Syndrome in a Non-Epidemic Area During the Coronavirus Disease Pandemic in Japan ― A 2-Institutional Observational Study ―. Circ Rep 2021; 3: 95–9. doi:10.1253/circrep.CR-20-0141.

Homepage of Japanese Society of Kawasaki disease. 25 February 2021. http://www.jskd.jp/pdf/210225MIS-C.pdf.

Cattalini M, Soliani M, Costanza Caparello MC, Cimaz R. Sex Differences in Pediatric Rheumatology. Review Clin Rev Allergy Immunol. 2019; 56(3): 293-307. doi: 10.1007/s12016-017-8642-3.

Sudo D, Nakamura Y. Nationwide surveys show that the incidence of recurrent Kawasaki disease in Japan has hardly changed over the last 30 years. Acta Paediatrica 2017; 106 (5): 796–800. https://doi.org/10.1111/apa.13773.

Chbeir D, Gaschignard J, Bonnefoy R, Beyler C, Melki I, Faye A, et al. Kawasaki disease: abnormal initial echocardiogram is associated with resistance to IVIg and development of coronary artery lesions. Pediatr Rheumatol Online J. 2018; 16(1): 48. https://doi.org/10.1186/s12969-018-0264-7.

Friedman KG, Gauvreau K, Hamaoka-Okamoto A, Tang A, Berry MS, Tremoulet A, et al. Coronary artery aneurysms in Kawasaki disease: risk factors for progressive disease and adverse cardiac events in the US population. J Am Heart Assoc. 2016; 5: e003289. https://doi:10.1161/JAHA.116.003289.

Nakada T. Outcomes in patients with Kawasaki disease associated with coronary artery lesions before initial therapy. Med J Aomori 2020; 65 (1): 1–7.

##plugins.themes.bootstrap3.article.details##

How to Cite
Nakada, T. (2021). Clinical Features of Kawasaki Disease during SARS-CoV-2 Epidemic: A Single-Center Retrospective Study. European Journal of Clinical Medicine, 2(3), 5–8. https://doi.org/10.24018/clinicmed.2021.2.3.33