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Abstract
Background Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities.
Methods Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (‘Kawa-COVID-19’). A historical cohort of ‘classical’ KD served as a comparator.
Results Sixteen patients were included (sex ratio=1, median age 10 years IQR (4·7 to 12.5)). SARS-CoV-2 was detected in 12 cases (69%), while a further three cases had documented recent contact with a quantitative PCR-positive individual (19%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 µg/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of ‘classical’ KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004).
Conclusion Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19.
Trial registration number
NCT02377245
- inflammation
- outcome and process assessment, health care
- cytokines
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Footnotes
Handling editor Josef S Smolen
Correction notice This article has been corrected since it published Online First. Data within the 'Investigations consistent with prior SARS-CoV-2 infection' section and table 2 has been updated.
Contributors MP, NO, MC, UM and IM designed the study. MP, CB, GC, SB, CB, CG and IM collected clinical data. MP, NO and IM analysed data. MP, CB, CG and IM wrote the paper. CG, MC, UM, AF, IK-P, BB-M and IM supervised the study. All authors have read final approval of the version published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Parental/guardian consent obtained.
Ethics approval The study protocol followed ethics guidelines (CPP no.CO-10–002) and was approved by the Advisory Committee on Information Processing in Research in the Field of Health (no.10.155bis) and the National Commission of Informatics and Freedom (CNIL N°2014908).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. De-identified participant data may be available upon reasonable request by sending an email to marie.pouletty@aphp.fr or isabelle.melki@aphp.fr.