More Kawasaki Disease In Italian Children With ‘Strong’ Link To COVID-19, Reports Lancet Study
Kawasaki disease is a severe inflammatory disease in children

Children are 30 times more likely to experience Kawasaki-like disease in Bergamo, Italy’s epicentre of infections and deaths, reported a Lancet study of 29 children on Wednesday. The SARS-CoV-2 virus could trigger symptoms similar to those of a severe cardiovascular illness called Kawasaki disease.

While there were 19 cases of Kawasaki disease in the past five years between January 2015 and February 2020, there were 10 cases of Kawasaki-like disease between February-April 2020.

Initial calculations suggested that the rate of Kawasaki disease shot up by a factor of ‘at least’ 30 between February-April 2020, in comparison to the pre-pandemic period between January 2015 and February 2020. However, the initial calculation is an underestimate, said researchers, as emergency referrals in Bergamo’s hospital were 6 times higher in the pre-pandemic period compared to the months leading up to COVID-19.

After correcting for the 6-fold difference in emergency referral before and after the pandemic,  the total incidence of Kawasaki disease shot up to 3.5% in February-April 2020 compared to 0.019% between January 2015 and February 2020, or a 184-fold increase.

Kawasaki disease incidence has surged since COVID-19

The Italian retrospective cohort study of 29 children, which compared the number of patients with Kawasaki-like disease before and after the pandemic began, provides the most convincing evidence yet that the SARS-CoV-2 virus can trigger Kawasaki-like disease.

In the group of 10 children that developed Kawasaki-like disease between February-April 2020, 8 of them developed IgG antibodies for COVID-19:

“These results and considerations support the hypothesis that the immune response to SARS-CoV-2 is responsible for a Kawasaki-like disease in susceptible patients.

“Kawasaki-like disease….has a clear starting point after the first case of COVID-19 was diagnosed [in Bergamo],” said researchers from Hospital Papa Giovanni XXIII in Bergamo, Italy.

While all the children diagnosed with Kawasaki-like disease during the COVID-19 pandemic survived, they had more severe symptoms than those in the last 5 years, with 6 of 10 patients having heart complications, compared with only 2 of 19 (11%) of those diagnosed before.

5 of the 10 children diagnosed during the pandemic had signs of toxic shock syndrome, compared with none of the children diagnosed previously. Toxic shock syndrome is a rare, life-threatening illness with symptoms including a high fever, low blood pressure, and rash.

While the Lancet study acknowledged some limitations, such as the need for a larger sample size to confirm the strong link between COVID-19 and Kawasaki-like disease, they warned that “a similar outbreak of Kawasaki-like disease is expected in countries affected by the SARS-CoV-2 pandemic.” 

Kawasaki disease has been spotted all over the map since COVID-19 arose, with 125 cases in France, 100 cases in New York, 10 cases in London and 3 in Switzerland.

These findings have important implications for policy-makers as they begin lifting their lockdowns, said researchers:

“The association between SARS-CoV-2 and Kawasaki-like disease should be taken into account when it comes to considering social reintegration policies for the paediatric population.”

Although the cause of Kawasaki disease remains unknown, the Lancet study builds on an existing body of evidence that coronaviruses like SARS-CoV-2 can trigger the disease.  

In developed countries, Kawasaki disease is the most frequently acquired heart disease, affecting “no more than one in 1000 children exposed to SARS-CoV-2”, said the researchers. 

A Third Of Patients With COVID-19 Have Acute Kidney Failure, Reports New York Study

In a parallel development, it is becoming more apparent that severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, is more than a respiratory disease – Of some 5 500 hospitalized COVID-19 patients in New York, a third had acute kidney injuries and nearly 15% required dialysis, reported a study on Thursday published in Kidney International.

“Acute kidney failure occurs frequently among patients with COVID-19 disease..It occurs early [in the disease] and is associated with poor prognosis,” said researchers.

Mechanical ventilators can help patients with severe COVID-19 breathe.

In the study, almost 40% of patients with COVID-19 entered the hospital with kidney failure, suggesting that kidney failure occurs early in the disease.

Once patients were placed on a ventilator, kidney failure was even more likely, as 90% of patients on ventilators developed kidney failure. 

Individuals most at risk of acute kidney failure included those with diabetes type II, heart disease, hypertension, older people and people of black ethnicity.

Image Credits: BruceBlaus, The Lancet, Agência Brasília .