tetano
Editor, Senior Moderator
Ann Rheum Dis
. 2020 Jun 11;annrheumdis-2020-217960.
doi: 10.1136/annrheumdis-2020-217960. Online ahead of print.
Paediatric Multisystem Inflammatory Syndrome Temporally Associated With SARS-CoV-2 Mimicking Kawasaki Disease (Kawa-COVID-19): A Multicentre Cohort
Marie Pouletty[SUP] 1 2 [/SUP], Charlotte Borocco[SUP] 3 4 [/SUP], Naim Ouldali[SUP] 1 5 [/SUP], Marion Caseris[SUP] 1 6 [/SUP], Romain Basmaci[SUP] 7 8 [/SUP], No?mie Lachaume[SUP] 7 8 [/SUP], Philippe Bensaid[SUP] 9 [/SUP], Samia Pichard[SUP] 9 [/SUP], Hanane Kouider[SUP] 10 [/SUP], Guillaume Morelle[SUP] 11 [/SUP], Irina Craiu[SUP] 12 [/SUP], Corinne Pondarre[SUP] 13 [/SUP], Anna Deho[SUP] 14 [/SUP], Arielle Maroni[SUP] 14 [/SUP], Mehdi Oualha[SUP] 15 [/SUP], Zahir Amoura[SUP] 16 17 [/SUP], Julien Haroche[SUP] 16 17 [/SUP], Juliette Chommeloux[SUP] 18 [/SUP], Fanny Bajolle[SUP] 19 [/SUP], Constance Beyler[SUP] 20 [/SUP], St?phane Bonacorsi[SUP] 6 8 [/SUP], Guislaine Carcelain[SUP] 21 [/SUP], Isabelle Kon?-Paut[SUP] 3 4 [/SUP], Brigitte Bader-Meunier[SUP] 22 23 [/SUP], Albert Faye[SUP] 1 2 5 [/SUP], Ulrich Meinzer[SUP] 1 2 24 25 [/SUP], Caroline Galeotti[SUP] 3 [/SUP], Isabelle Melki[SUP] 26 22 27 [/SUP]
Affiliations
Abstract
Background: Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities.
Methods: Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('Kawa-COVID-19'). A historical cohort of 'classical' KD served as a comparator.
Results: Sixteen patients were included (sex ratio=1, median age 10 years IQR (4?7 to 12.5)). SARS-CoV-2 was detected in 11 cases (69%), while a further five cases had documented recent contact with a quantitative PCR-positive individual (31%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 ?g/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of 'classical' KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004).
Conclusion: Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19. Trial registration number NCT02377245.
Keywords: cytokines; inflammation; outcome and process assessment, health care.
. 2020 Jun 11;annrheumdis-2020-217960.
doi: 10.1136/annrheumdis-2020-217960. Online ahead of print.
Paediatric Multisystem Inflammatory Syndrome Temporally Associated With SARS-CoV-2 Mimicking Kawasaki Disease (Kawa-COVID-19): A Multicentre Cohort
Marie Pouletty[SUP] 1 2 [/SUP], Charlotte Borocco[SUP] 3 4 [/SUP], Naim Ouldali[SUP] 1 5 [/SUP], Marion Caseris[SUP] 1 6 [/SUP], Romain Basmaci[SUP] 7 8 [/SUP], No?mie Lachaume[SUP] 7 8 [/SUP], Philippe Bensaid[SUP] 9 [/SUP], Samia Pichard[SUP] 9 [/SUP], Hanane Kouider[SUP] 10 [/SUP], Guillaume Morelle[SUP] 11 [/SUP], Irina Craiu[SUP] 12 [/SUP], Corinne Pondarre[SUP] 13 [/SUP], Anna Deho[SUP] 14 [/SUP], Arielle Maroni[SUP] 14 [/SUP], Mehdi Oualha[SUP] 15 [/SUP], Zahir Amoura[SUP] 16 17 [/SUP], Julien Haroche[SUP] 16 17 [/SUP], Juliette Chommeloux[SUP] 18 [/SUP], Fanny Bajolle[SUP] 19 [/SUP], Constance Beyler[SUP] 20 [/SUP], St?phane Bonacorsi[SUP] 6 8 [/SUP], Guislaine Carcelain[SUP] 21 [/SUP], Isabelle Kon?-Paut[SUP] 3 4 [/SUP], Brigitte Bader-Meunier[SUP] 22 23 [/SUP], Albert Faye[SUP] 1 2 5 [/SUP], Ulrich Meinzer[SUP] 1 2 24 25 [/SUP], Caroline Galeotti[SUP] 3 [/SUP], Isabelle Melki[SUP] 26 22 27 [/SUP]
Affiliations
- PMID: 32527868
- DOI: 10.1136/annrheumdis-2020-217960
Abstract
Background: Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities.
Methods: Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('Kawa-COVID-19'). A historical cohort of 'classical' KD served as a comparator.
Results: Sixteen patients were included (sex ratio=1, median age 10 years IQR (4?7 to 12.5)). SARS-CoV-2 was detected in 11 cases (69%), while a further five cases had documented recent contact with a quantitative PCR-positive individual (31%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 ?g/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of 'classical' KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004).
Conclusion: Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19. Trial registration number NCT02377245.
Keywords: cytokines; inflammation; outcome and process assessment, health care.