Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

COVID-19 and Kawasaki Like Disease: The Known-Known, the Unknown-Known and the Unknown-Unknown

Version 1 : Received: 7 May 2020 / Approved: 9 May 2020 / Online: 9 May 2020 (09:01:24 CEST)

How to cite: Morand, A.; Urbina, D.; Fabre, A. COVID-19 and Kawasaki Like Disease: The Known-Known, the Unknown-Known and the Unknown-Unknown. Preprints 2020, 2020050160 (doi: 10.20944/preprints202005.0160.v1). Morand, A.; Urbina, D.; Fabre, A. COVID-19 and Kawasaki Like Disease: The Known-Known, the Unknown-Known and the Unknown-Unknown. Preprints 2020, 2020050160 (doi: 10.20944/preprints202005.0160.v1).

Abstract

In the end of April nearly 100 cases of children aged between 6 month and 9 years with Kawasaki like disease were reported (mostly in Europe) probably linked to COVID-19. With the increasing awareness of this condition the number of cases reported is increasing worldwide. We aim to sum up the known data about this new entity based on published data (in a case report, a series of 8 cases and in newspapers and society statement) and using our knowledge of classical Kawasaki disease. It seems to be a post infectious disease with an onset between 2-4 weeks after the infection, probably in genetically predisposed children aged between 6 month to 17 years. A very rough estimation of incidence based on current data from Bergamo, Italy, and New York State and a lot assumption is between 0.016% (95% CI:0.013-0.02%) - 0.31% (95% CI: 0.2-0.47%) of infected children. Clinical signs overlaps with Kawasaki disease in some children, but another feature is prominent gastrointestinal manifestations. For the 9 detailed patients most had incomplete presentation for Kawasaki disease (with a mean 1.7 (+/-1.2) criteria per patient for the 5 non fever criterion) and only one had a classical form. In some cases, presentation is closer to toxic shock syndrome or isolated myocarditis. Persistent fever seems to be constant and biological exploration are consistent with inflammation (elevated CRP, ferritin and D-Dimers). Management is described as supportive and children seem to improve rapidly, but can require cardiac or respiratory support. In date of 11 may 2020 there is 4 deaths confirmed linked to these new entities (1 in UK and 3 in New York). Paediatricians and general practitioners need to be aware of these possible evolution following COVID-19 infection. However it seems to be rare and children are probably still spared from most morbidities and mortality linked to COVID-19 infection .There are need of published detailed cohorts to better delineate these entities.

Subject Areas

Sars-Cov2; Covid-19; Children; Kawasaki disease; toxic shock syndrome

Comments (1)

Comment 1
Received: 19 May 2020
Commenter: Alexandre FABRE
The commenter has declared there is no conflict of interests.
Comment: Since we submitted this preprint several publications have further delineated this syndrome and his common point with Kawasaki disease notably kawasaki toxic shock and also specifics features. Series and cases Reports https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30163-2/fulltext (1 case report : 05 18 2020) USA https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.120.048360?af=R& (35 case : 05 17 2020) France https://www.medrxiv.org/content/10.1101/2020.05.10.20097394v1.article-metrics (17 cas : 05 14 2020) France https://www.sciencedirect.com/science/article/pii/S014067362031103X (10 cases : 05 13 2020) Italia https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31094-1/fulltext (8 cases : 05 07 2020) UK https://hosppeds.aappublications.org/content/early/2020/04/06/hpeds.2020-0123.long (1 case : 04 07 2020) USA Editorial   https://www.cambridge.org/core/journals/cardiology-in-the-young/article/covid19-and-kawasaki-syndrome-should-we-really-be-surprised/2AD153D73A34F46B580097685BD403D2  (‪05 15 2020‬)   https://www.bmj.com/content/369/bmj.m1990 (05 15 2020‬)   https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31129-6/fulltext  (‪05 13 2020‬)   https://hosppeds.aappublications.org/content/early/2020/05/11/hpeds.2020-000356?cct=2287  (‪04 11 2020‬)   https://www.jpeds.com/article/S0022-3476(20)30556-4/abstract (‪05 03 2020‬)   https://www.bmj.com/content/369/bmj.m1710/rapid-responses (‪04 28 2020‬) Epidemiologic Epidémiologie : https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/documents/bulletin-national/covid-19-point-epidemiologique-du-14-mai-2020 (05 14 2020) France https://www.ecdc.europa.eu/en/publications-data/paediatric-inflammatory-multisystem-syndrome-and-sars-cov-2-rapid-risk-assessment (05 15 2020) Statements Statement https://www.who.int/publications-detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 (WHO 05 15 2020) https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-coronavirus-covid-19-statements-on-14-may-2020#statement-on-paediatric-inflammatory-multisystem-syndrome (05 15 2020) Australia https://emergency.cdc.gov/han/2020/han00432.asp (05 14 2020) USA https://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19 (05 01 2020) UK https://picsociety.uk/wp-content/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdf (PICS 04 27 2020) UK Review https://dontforgetthebubbles.com/pims-ts/
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