COVID-19 and Kawasaki disease: What should parents know?

So far in the COVID-19 pandemic, data from China, Italy and other European countries showed that coronavirus infections were much less common in children than adults. When children did get sick with the virus, they didn’t become as sick. However, in late April, reports of children with hyperinflammatory symptoms emerged in England. Now, New York City health authorities have warned of these hyperinflammatory symptoms — called pediatric multisystem inflammatory syndrome potentially associated with COVID-19 — that look a lot like a disease known as Kawasaki disease.

What is Kawasaki disease?

The disease was named for pediatrician Tomisaku Kawasaki, M.D., the first physician to document the condition. Dr. Kawasaki saw his first patient with the condition’s symptoms in Japan in 1961; the condition wasn’t recognized as a separate syndrome until 1967.

The symptoms of Kawasaki disease usually appear in phases. The first phase, which can last for up to two weeks, usually involves a fever that lasts for at least five days. Other symptoms include:

  • Severe redness in the eyes
  • A rash on the stomach, chest and genitals
  • Red, dry, cracked lips
  • Swollen tongue with a white coating and big, red bumps (called “strawberry tongue”)
  • Swelling and a purple-red color in the palms of the hands and soles of the feet
  • Swollen lymph nodes

During the second phase, which usually begins within two weeks of the fever’s start, skin on the hands and feet may begin to peel in large pieces. Treatment may not prevent this symptom. A child also may have joint pain, diarrheavomiting or abdominal pain.

Kawasaki disease is one of the most common causes of acquired heart disease in children, according to the American Heart Association.

“It can cause inflammation in the heart and seems to potentially even cause inflammation specifically in the walls of the muscles of the coronary arteries, the small blood vessels that feed the heart muscle,” said Brian J. Holland, M.D., chief of pediatric cardiology with Norton Children’s Heart Institute, affiliated with the UofL School of Medicine. “That can cause them to become weakened; they get dilated, and they can get aneurysms.”

Inflammation also can affect the lining, valves and the outer membrane around the heart. Other complications include arrhythmias or abnormal functioning of some heart valves. Children who experience heart complications from Kawasaki disease may need surgery and/or lifelong heart care.

COVID-19 and Kawasaki disease connection?

Some interesting reports began to emerge from England in late April: In one week, eight children were admitted to a hospital in London with a hyperinflammatory state.

“Of course, it was happening at a time when there were lots of COVID-19 cases,” said Kristina A. Bryant, M.D., pediatric infectious disease specialist with Norton Children’s Infectious Diseases, affiliated with the UofL School of Medicine, “but the first time these children were tested, they were all negative, which was really curious.”

Those children then were given an antibody test; antibodies are the proteins that the body makes after an infection.

“Turns out they actually did have COVID-19 infections,” Dr. Bryant said.

Since the initial report from London, multiple children’s hospitals in the U.S., primarily on the East Coast, have reported treating children who have been admitted with this multisystem hyperinflammatory state. New York public health authorities released a report May 4 about 15 of the pediatric cases seen in New York City.

“Some of these children have features of Kawasaki disease,” Dr. Bryant said. “Sometimes they look a lot like they have a serious bacterial infection called toxic shock. Most of the time toxic shock is caused by staph or strep germs, but in fact some of these children have been infected with COVID-19.”

“The patients that they’re seeing in New York City now who have this Kawasaki disease-like illness that they think might be related to COVID-19, these are patients who had normal hearts prior to that,” Dr. Holland said. “Patients who had previous heart surgery or previous heart issues do not appear to be at higher risk for this pediatric multisystem inflammatory syndrome potentially associated with COVID-19.”

What should parents do?

“When a child gets a fever in our community, it is still much more likely to be another virus than COVID-19. It is also important to remember that children with fever and a rash could have a tickborne illness.” Dr. Bryant said. “When your child has fever, contact your pediatrician. Your pediatrician probably has given you advice about when you can wait and watch and when you need to give Tylenol. If a fever persists more than a couple days, call your pediatrician.”

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Dr. Holland said that the news around pediatric multisystem inflammatory syndrome potentially associated with COVID-19 can help pediatric emergency medicine physicians and pediatric cardiologists be aware and ready to take precautions when seeing patients presenting with fever, including those at Norton Children’s Hospital.

“I think it’s actually going to be really important that if there’s a patient who comes in with a high fever who doesn’t have other symptoms of COVID-19, we may want to check their heart and make sure that they’re not having any signs of pediatric multisystem inflammatory syndrome potentially associated with COVID-19,” Dr. Holland said. “Additionally, we need to keep our eyes on those patients who we know have been infected to make sure that they don’t develop something that slowly develops over time related to their heart.”


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