Background

In April 2020 some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU).

Methods

Medical data of KD patients from 1st January 2018 until 30th May 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (1st March-30th May 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV).

Results

One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004 respectively).

We found that 56% of KD patients presenting during the pandemic had confirmed SARS-COV-2 infection. Twenty-three (88.5%) of the CoV+ patients fulfilled both PIMS-TC and MIS-C criteria; from CoV- cohort, 45% of patients fulfilled the criteria for MIS-C, and 40% for PIMS-TS.

CoV+ patients were significantly older (7.5 vs 2.5yr), mainly non-Caucasian (64 vs 29%), had incomplete KD presentation (73 vs 32%), lower leucocyte (9.5 vs 15.5x109) and platelet count (174 vs 423x109/L), higher inflammatory markers (C-Reactive Protein 18.5 vs 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4766 vs 505 pg/ml), less aneurysm development (3.8 vs 11.1%) and more myocardial dysfunction (30.8 vs 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period (Table 1).

Conclusions

The KD CoV+ patients mostly meet PIMS-TC and MIS-C criteria. Around half of the KD patients presenting during the pandemic had confirmed SARS-COV-2 infection. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.

Clinical Trial Registration

Clinical trial registration: N/A