Kawasaki-like syndrome in children


2 May 2020

A new twist in this new pandemic. On April 27, five pediatric resuscitation services in the Greater Paris Region (Île-de-France, population 12 million) informed health authorities of an unexpected number of children with overlapping symptoms of severe COVID-19, toxic shock syndrome and Kawasaki disease. The British Paediatric Critical Care Society and the National Health Service (NHS) launched a similar alert on the same day. Nearly 100 cases have been found in children in France, Great Britain, Italy, Spain, Switzerland and the United States.

In Paris, the Necker hospital reported more than 20 children and adolescents from 3 to 17 years old hospitalized in intensive care. The first cases were seen around 15 April. Symptoms included abdominal pain, diarrhea and vomiting, sometimes fever, myocarditis, and a strong inflammatory syndrome. Although not all children tested SARS-CoV-2 positive, all seem to have been in contact with the virus. No deaths have been reported so far.

Kawasaki syndrome (see the chapter in the MSD Manual) is a rare childhood inflammatory disease which most often occurs before the age of 6. There might be a correlation with COVID-19, but the direct relationship and the mechanism are unclear.

In summary:

  • A new syndrome of a Kawasaki-like myocarditis may be emerging in children of all ages.
  • The syndrome is rare.
  • This syndrome may be related to SARS-CoV-2 but could as well be related to a different infectious pathogen with similar characteristics.
  • So far, little is known about the new syndrome.
  • To be remembered: serious COVID-19 complications are very rare among children. Throughout Europe, SARS-CoV-2 has caused very few victims among children. In Britain, only 9 children aged 0 to 19 have died after testing positive for coronavirus (0.05% of the 21,678 deaths recorded on March 27).

Further reading

Soni PR, Noval Rivas M, Arditi M. A Comprehensive Update on Kawasaki Disease Vasculitis and Myocarditis. Curr Rheumatol Rep. 2020 Feb 5;22(2):6. PubMed: https://pubmed.gov/32020498. Full-text: https://doi.org/10.1007/s11926-020-0882-1

Modesti BM, Plewa MC. Kawasaki disease. NCBI bookshelf. Last update 24 July 2019. Accessed 5 May 2020. Full-text: https://www.ncbi.nlm.nih.gov/books/NBK537163/

Hedrich CM, Schnabel A, Hospach T. Kawasaki Disease. Front Pediatr. 2018 Jul 10;6:198. PubMed: https://pubmed.gov/30042935. Full-text: https://doi.org/10.3389/fped.2018.00198

Ramphul K, Mejias SG. Kawasaki disease: a comprehensive review. Arch Med Sci Atheroscler Dis. 2018 Mar 21;3:e41-e45. PubMed: https://pubmed.gov/30775588. Full-text: https://doi.org/10.5114/amsad.2018.74522

Agarwal S, Agrawal DK. Kawasaki disease: etiopathogenesis and novel treatment strategies. Expert Rev Clin Immunol. 2017 Mar;13(3):247-258. PubMed: https://pubmed.gov/27590181. Full-text: https://doi.org/10.1080/1744666X.2017.1232165

Dietz SM, van Stijn D, Burgner D, et al. Dissecting Kawasaki disease: a state-of-the-art review. Eur J Pediatr. 2017 Aug;176(8):995-1009. PubMed: https://pubmed.gov/28656474. Full-text: https://doi.org/10.1007/s00431-017-2937-5

Jamieson N, Singh-Grewal D. Kawasaki Disease: A Clinician´s Update. Int J Pediatr. 2013;2013:645391. PubMed: https://pubmed.gov/24282419. Full-text: https://doi.org/10.1155/2013/645391