Infectious Disease

COVID-19 positivity, myocarditis differentiate MIS-C from Kawasaki disease

March 31, 2021

2 min read

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Cattalini does not report any relevant financial information. Co-author Angelo Ravelli, MD, of the University of Genoa, reports that AbbVie, Angelini, Bristol-Myers Squibb, Novartis, Pfizer, Reckitt-Benkiser, Roche, and Johnson & Johnson provide assistance and / or speaking or consulting fees.

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COVID-19 positivity, older age onset, and the presence of myocarditis are more common in multisystem inflammatory syndromes in children than in Kawasaki disease. This is evident from data published by Pediatric Rheumatology.

“There is now increasing evidence of the existence of a childhood multi-inflammatory syndrome associated with SARS-CoV-2 infection that has some similarities with Kawasaki disease (KD) and toxic shock syndrome (TSS). ” Marco Weather in Cattalini, MD, from the University of Brescia, in Italy, and colleagues wrote. “This condition has been termed Pediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 Infection (PIMS-TS) or Multisystem Inflammatory Syndrome Associated with Coronavirus Disease 2019 (MIS-C) is. “

COVID-19 positivity, older age onset, and the presence of myocarditis are more common with MIS-C than with Kawasaki disease, according to data. Data derived from Cattalini M, et al. Pediatr Rheumatol. 2021; doi: 10.1186 / s12969-021-00511-7.

“However, little is known about the true extent of the clinical spectrum of diseases and the precise role of SARS-CoV-2 infection,” they added. “In addition, it is still not clear whether SARS-CoV-2 can also be viewed as a trigger for KD development or whether KD had special and unusual clinical manifestations during the SARS-CoV-2 epidemic.”

To analyze the clinical features and treatment response to MIS-C, to examine the relationship with Kawasaki disease, and to determine whether the units were indeed different, Cattalini and colleagues conducted an observational, retrospective, multicenter study. The Italian Pediatric Society’s Rheumatology Study Group launched a national online survey on April 24, 2020 aimed at patients diagnosed with Kawasaki disease or a Kawasaki-like multisystem disease during the COVID-19 pandemic. The researchers admitted a total of 149 children who were hospitalized between February 1, 2020 and May 31, 2020.

Participants included 96 children with Kawasaki disease and 53 children with Kawasaki disease-like multisystem disease, or “Kawacovid”. The researchers collected demographic, clinical data, laboratory data, treatment information and results in an anonymized online database. The relationship between clinical presentation and COVID-19 infection has also been reported.

Cattalini and colleagues then compared the clinical characteristics of patients diagnosed with Kawasaki disease during the COVID-19 pandemic with 598 children with the disease observed in three Italian children’s hospitals from January 1, 2000 to December 31, 2019 used chi-square or Fisher’s exact and non-parametric Wilcoxon-Mann-Whitney tests to examine the differences between the two groups.

According to the researchers, children with Kawasaki-like multisystemic disease were significantly older to begin with and were more likely to show gastrointestinal and respiratory involvement. Heart involvement was also more common in patients with Kawasaki-like multisystem disease, with 60.4% exhibiting myocarditis. 37.8% of patients with Kawasaki-like multisystemic disease had hypotension or non-cardiogenic shock. The risk of admission to the intensive care unit was also higher in patients with Kawasaki-like multisystem disease.

Meanwhile, coronary artery abnormalities were more common in children with Kawasaki disease.

Other distinguishing features of Kawasaki-like multisystem disease were lymphopenia, higher C-reactive protein levels, and elevated ferritin and troponin T levels, the researchers wrote.

Children with Kawasaki disease were more likely to receive immunoglobulins (IVIG) – 81.3% versus 66% (P = 0.04) – and acetylsalicylic acid – 71.9% versus 43.4% (P = 0.001) – compared to patients with Kawasaki disease-like multisystem disease. The latter group, meanwhile, received more glucocorticoids – 56.6% versus 14.6% (P <0.0001).

COVID-19 positivity was predominant in 75.5% of children in the Kawasaki-like multisystem disease group, compared with 20% in children with Kawasaki disease (P <0.0001).

When comparing Kawasaki disease in the pandemic with historical Kawasaki disease, researchers found no statistical difference in terms of clinical manifestations and laboratory data.

“Our study suggests that SARS-CoV-2 infection is the causative agent of PIMS-TS in children,” wrote Cattalini and colleagues. “Older age at the beginning and clinical features such as the occurrence of myocarditis characterize this multi-inflammatory syndrome, which shares specific clinical manifestations with KD. Our patients responded well to treatment and had good results with few complications and no deaths. “

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