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dcyphr | Kawasaki-like Disease: Emerging Complication During the COVID-19 Pandemic

Introduction

Italy was the first European country to be impacted by COVID-19. At the time this article was published, Italy had about 130,000 COVID-19 cases, and the city of Bergamo had the most infections and deaths. People with COVID-19 often suffer from severe respiratory ailments. Emerging evidence seems to suggest that the respiratory tract isn’t the only part of the body at risk of damage from COVID-19. Tissue damage in COVID-19 patients are often caused by the immune system rather than the virus itself. This may be the result of Kawasaki disease, which mainly affects children. While its causes are not well known, it’s believed that it’s a result of harmful immune system responses to pathogen exposure. Whether these responses happen in a person is dictated by his or her genetics. The authors of this article noticed an uptick in Kawasaki-like cases in Italy after the COVID-19 pandemic emerged. In the study discussed, the authors describe the occurrence and characteristics of such cases.


Methods

Patients


The authors of the paper examined records of patients diagnosed with Kawasaki disease within the past five years. They got these records from a hospital in Bergamo, Italy. A person was said to have a Kawasaki-like case if they had symptoms consistent with the criteria set by the American Heart Association. These include a fever, changes in the oral region, rashes, and so on. They divided these patients into those who were diagnosed before the COVID-19 pandemic, group 1, and those diagnosed after, group 2.


Clinical and Laboratory Evaluation


Medical records with additional details on each patient were also obtained from the hospital.


Confirmation of SARS-Cov-2-Infection

Several different tests were used to confirm whether Kawasaki patients diagnosed since the start of the pandemic have COVID-19. Antibody tests were also performed.


Treatment


Patients’ risk of resistance to immunoglobulin treatment was tested. After receiving a set amount of immunoglobulin through the bloodstream, their vital signs and blood tests were taken.


Statistical Analysis


The Student’s t test, Chi squared test, and Fisher’s exact test were used to analyze the data collected.


Role of the Funding Source


There was no funding source.


Results

After the COVID-19 pandemic began, there were, on average, 10 new Kawasaki-like cases reported in the hospital compared to 0.3 per month before the pandemic. After the start of the pandemic, it seems that these cases were more routinely occurring in older age groups (7.5 years vs 3). Also, a greater portion of the cases reported during the pandemic were Incomplete Kawasaki disease compared to cases reported before the pandemic (50% vs. 31%). In the incomplete form of Kawasaki disease, only 2 - 3 known symptoms are shown, and its associated fever doesn’t last as long. Additionally, there were differences in blood makeup between patients in these two groups. Those diagnosed with Kawasaki disease during the pandemic had less white blood cells, lymphocytes and platelets, more neutrophils, and so on. 


Discussion

The exact cause of Kawasaki disease has yet to be determined. It is widely believed to be triggered by abnormal immune responses to pathogens. During the past twenty years, people have proposed that coronaviruses are linked to the onset of Kawasaki disease. Serological tests done in Japan appear to support this proposal. In this study, the authors refer to all apparent incidences of Kawasaki disease as Kawasaki-like disease, as they seem to have different features from historical incidences of the disease.


The results of this study seem to suggest that Kawasaki disease symptoms appear some time after, as opposed to right during the start of viral infections. More importantly, the study has shown a strong association between COVID-19 and the frequency of Kawasaki-like disease cases. Although this study should be repeated with larger samples before this association can be definitively established, its results indicate that other places impacted by COVID-19 can expect to see more Kawasaki-like disease cases. The authors recommend the use of adjunctive steroids in treating these cases.