Tag Archives: kawasaki disease

COVID-19 might cause inflammatory disease in children

A growing number of hospital reports are linking COVID-19 hotspots with inflammatory disorders — similar to a rare condition called Kawasaki disease.

Kawasaki disease is a condition that mainly affects children under the age of 5. It’s also known as mucocutaneous lymph node syndrome. It typically manifests itself through a rash, swollen glands in the neck, and red eyes, fingers, and toes. Most children get rid of the Kawasaki-like symptoms in a matter of weeks, with correct treatment, but the disease is almost always treated in a hospital. Around 25% of children with Kawasaki disease experience complications with their heart, and it can be fatal in 2-3% of cases.

It’s a serious condition, and understandably, doctors in Italy were concerned when they saw an unexpected spike in children coming in with Kawasaki-like symptoms.

Doctors at a hospital in Bergamo, the epicenter of the Italian outbreak have described a series of ten cases of young children with symptoms similar to the rare inflammatory disease.

Before the outbreak, only 19 children had been diagnosed with the condition at the hospital in the five years prior. Now, from late February to late April 2020, the hospital has reported 10 cases — which is a 30-fold increase for the interval of time.

It’s still a very low incidence overall, says Dr. Lucio Verdoni, author of the report from the Hospital Papa Giovanni XXIII in Bergamo, Italy.

“We noticed an increase in the number of children being referred to our hospital with an inflammatory condition similar to Kawasaki Disease around the time the SARS-CoV-2 outbreak was taking hold in our region. Although this complication remains very rare, our study provides further evidence on how the virus may be affecting children. Parents should follow local medical advice and seek medical attention immediately if their child is unwell. Most children will make a complete recovery if they receive appropriate hospital care.”

Children who presented with these symptoms after 18 February 2020 were older (mean age 7.5 years) than the group diagnosed in the previous five years (mean age 3 years). Doctors also noticed that children were turning up with these symptoms were more likely to develop serious complications.

For instance, (60%, 6/10 cases) had heart complications, compared to only 10% before the COVID-19 outbreak. Also, half of the children (5/10) had signs of toxic shock syndrome, whereas none of the children treated before February 2020 had this complication.

Although it’s still a small sample size, similar reports have been published throughout Europe, including in France, the UK, and Spain, the New York Times reports. New York has also reported 102 cases and three deaths as of Wednesday, a large increase from previously reported numbers.

Taken together, all this seems to suggest an association between the outbreak of SARS-CoV-2 and an inflammatory condition similar to Kawasaki Disease — and potentially, even worse.

However, before we draw any definite conclusions, more data needs to be carefully gathered and analyzed from all around the world. Dr. Lorenzo D’Antiga, lead author of the study notes:

“We are starting to see case reports of children presenting at hospital with signs of Kawasaki Disease in other areas hit hard by the COVID-19 pandemic, including New York and South East England. Our study provides the first clear evidence of a link between SARS-CoV-2 infection and this inflammatory condition, and we hope it will help doctors around the world as we try to get to grips with this unknown virus.”

This shouldn’t be a reason for parents to panic, researchers say. The overall incidence is still very low, and parents should be alert, but not panicked, says Dr. Annalisa Gervasoni, another author of the study and a Paediatric Specialist at the Hospital Papa Giovanni XXIII in Bergamo, Italy:

“In our experience, only a very small proportion of children infected with SARS-CoV-2 develop symptoms of Kawasaki Disease. However, it is important to understand the consequences of the virus in children, particularly as countries around the world grapple with plans to start relaxing social distancing policies,” concludes Annalisa.

The study has been published in The Lancet.

Kawasaki disease origin finally traced (probably)

The Kawasaki disease, a strange and highly dangerous disease first identified in Japan has been traced to the croplands in China.

If the study’s conclusions are correct, than the Kawasaki disease may be the first condition known to spread by a wind-borne toxin. Credits: Christian Kober/Robert Harding World Imagery/Corbis

Also called lymph node syndrome, the Kawasaki disease is an autoimmune disease largely seen in children under five years of age in which the medium-sized blood vessels throughout the body become inflamed. To oversimplify it, the body starts to attack its own blood vessels, which can have dramatic and potentially fatal consequences (even after a few years without any symptoms). Kawasaki disease can only be diagnosed clinically (i.e. by medical signs and symptoms). There exists no specific laboratory test for this condition – therefore, the condition is often times extremely difficult to diagnose.

The pathogens responsible for the disease enter through mucous membranes and work their way into the arteries – and while it has been previously suggested that the disease may be carried by wind from far away, its origins still remained unknown. Now, researchers believe they have finally pinpointed the location to the vast farmlands of northeastern China where maize (corn), rice and wheat are grown.

In order to reach this conclusion, the team analysed infection records for Japan during the epidemics of 1979, 1982, and 1986 as well as more recent seasonal outbreaks. They analyzed the wind patterns and speed for those periods, and ultimately calculated the likely incubation time for the disease — 6 hours to 2.5 days, but probably less than 24 hours.

They reached these figures after comparing the arrival time of winds from the source region in China with the timing of the first diagnosed cases during various epidemics. Initially, this was actually pretty misleading, so they also went for a different approach.

Previous data had already shown a significant correlation between Kawasaki disease and tropospheric wind patterns; winds blowing from central Asia correlate with Kawasaki disease cases in Japan, Hawaii and San Diego, but since even the cause(s) of the disease remained unknown, researchers were hesitant to draw any clear conclusions about its origin.

 

“The incubation time suggests we should be looking in a very different direction,” says study co-author Jane Burns, a paediatrics researcher at the University of California, San Diego

They suspected that the disease is carried by a bacteria or fungus, and they analyzed what kind of particles the winds from China were carrying. Indeed, they found a remarkably high concentration of the fungus Candida.

“I think there is evidence that [Kawasaki disease] looks like other bacterial toxin diseases,” says Samuel Dominguez, a pediatric infectious-disease specialist at the University of Colorado School of Medicine in Aurora.

So, as we demonstrated in a previous article, correlation does not imply causality – the Candida fungus may be irrelevant for the Kawasaki disease, it may have a tangential effect, it may be the partial or full cause of the disease – but so far, this is the best clue to the disease we have so far, so we’ll definitely be seeing some more research in this direction.

Scientific Reference: Rodó, X. et al. Proc. Natl Acad. Sci. USA http://dx.doi.org/10.1073/pnas.1400380111 (2014).