May 13, 2020

expert reaction to analysis of 10 cases of Kawasaki-like disease in young children reported in Bergamo, Italy

An observational study, published in The Lancet, has looked at 10 cases of a Kawasaki-like disease in young children that may be related to COVID-19. All the children were observed in Bergamo, Italy, near the heart of the Italian COVID-19 outbreak.

Dr Julia Kenny, consultant in paediatric infectious diseases & immunology at Evelina London Children’s Hospital, said:

“The report from doctors at the Hospital Papa Giovanni XXIII in Lombardy describes a possibly COVID related hyper-inflammatory syndrome which appears consistent with recent presentations seen in a number of children in South East England (reported in a letter published in The Lancet on 6 May).

“Evelina London Children’s Hospital has more than 50 children with a similar syndrome and whilst very few tested positive for the virus on swabs the majority of the children tested positive for COVID-19 antibodies when subsequently tested, suggesting their disease is associated with exposure to the virus.

“These children have also shown significant cardiac symptoms and have proved difficult to evaluate clinically, often appearing less unwell than their very abnormal blood tests and cardiac investigations would suggest.

“As this new syndrome has only been identified in the past four weeks, it will be vital to learn more about its presentation and treatment, and to establish how the disease mechanism is linked to COVID-19 which has pre-dominantly affected adult patients to date.”

Prof Alastair Sutcliffe, Professor of General Paediatrics, University College London (UCL), said:

“Emergent reports from across the world have suggested an association between a Kawaski- like syndrome and COVID infection in children. This Italian report brings this together by way of an observational cohort study which is still unable to demonstrate causality, but is nonetheless evidence.

“In Kawasaki’s disease, the child becomes very irritable swollen glands in the neck, conjunctivitis and a measles like rash. Its cause is unknown although some studies have implicated as yet recognised viruses. Fortunately, if treated early the thing that both children’s doctors and their patients families fear, will not happen. Rather oddly Kawasaki’s is a form of vasculitis and even more oddly the vasuclitis only affects generally the coronary arteries. These balloon out (so called aneurysm) and if they burst will be lethal.

“In this Italian study in the epicentre of European COVID, a number of children, well above the background rate presented with a Kawasaki-like illness and also had COVID-19.

“The report reflects other anecdotes from worldwide. The flip side of this, is that very pleasingly very few children get serious COVID-19 disease as they don’t express on their lung cells the ACE2 receptor which this cunning virus gets into our lung cells. So therefore yes, there is apparently a small risk but no grounds for panic. Merely consider the diagnosis more readily in a child testing positive for COVID antibodies. COVID is a worldwide living experiment and an opportunity to study many effects of this terrible plague on illnesses other than COVID. For example what does social isolation do to pneumonia rates. And this insight into this Kawasaki like disease is just one more brick in the wall.”

“An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study” by Lucio Verdoni et al. was published in The Lancet at 23:30 UK time on Wednesday 13 May.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.