Children so far have fortunately not been very
affected by this illness. Internationally Children have comprised 1.7-2% of
national cases. Most children have had mild symptoms and many instances have
developed no symptoms at all despite testing positive.
There has been a lot of recent newspaper articles,
case reports and social media reports of a severe Kawasaki like illness in
children associated with this pandemic.
What is Kawasaki disease?
Kawasaki disease is a well-known autoimmune
self-limiting vasculitis (the cells of your immune system attack your own body
especially small and medium sized blood vessels including the vessels supplying
the heart). The trigger of this autoimmune phenomenon remains a conundrum since
it was first discovered In January 1967 in Tokyo and several theories including
an infective trigger to super antigen have been explored. It affects more boys
than girls and predominantly affects children under the age of 5 with an annual
incidence of 10-100/100,000 children. The incidence of Kawasaki Disease has
been increasing over the past decade which is partly attributed to a greater
awareness and diagnosis.
There is no specific test to confirm whether the child
has Kawasaki’s disease rather it is diagnosed based on a constellation of clinical symptoms, blood tests and scans like the echocardiogram of the heart.
The main features of Kawasaki disease are
Fever for at least a period of 5 days
Erythema (redness) of lips and the mouth cavity or cracks on
Rash on the body
Swelling and redness of hands and feet later with peeling of the skin esp. tips of toes and fingers
Redness of the whites of the eyes(conjunctivitis)
Swelling of lymph nodes
The aim of treatment of Kawasaki disease is the to
reduce the inflammation and eventually protect the heart. Your paediatrician
along with input from a paediatric rheumatologist will suggest medication such
as immunoglobulins, aspirin and/or steroids which will need to be done in the
syndrome in children’: Kawasaki like illness in the COVID-19 pandemic
Many countries especially Italy, France, Spain, USA and UK, that have seen a peak of COVID-19
infection have reported a small number of cluster of children presenting very
similar to Kawasaki disease in association with a toxic shock syndrome. This is
seen nearly 3 weeks after the peak of the infection. The term used to
describe it is ‘Multisystem inflammatory disorder of children and adolescents.
The key is the presentation of these children a couple
of weeks after the peak of the infection in the general population (generally
adults). Tests on these children show that the COVID-19 RT-PCR test may be
negative and they may be positive for the antibodies. This enhances our
understanding that it is not the acute infection with the virus but hyperinflammatory response of the body that leads to
involvement of multiple organs including the heart. Many studies are currently
underway to make us understand this new presentation of the COVID-19 that is
Although there are some similarities with the Kawasaki
disease that has been discussed above, it is an entirely new entity which
requires urgent recognition and treatment.
The small number of children who have been affected
are generally between 5-15 years of age and have presented with:
a fever for at least 3 days
features resembling Kawasaki disease: rash, redness to
the eyes, redness with swelling to the palms and soles or the mouth cavity. In
addition to this they may have
loose stools, vomiting, tummy pain that may be severe,
low blood pressure
ability to affect multiple organs including the heart
Breathing may or may not be affected
Although rare the multisystem inflammatory disorder
requires urgent immediate medical attention which will enable your
Paediatrician to examine and assess your child at the earliest, conduct the
tests needed and commence treatment without delay.
Management will generally be hospitalisation. The
child after an initial assessment will have a treatment protocol drawn up which
will involve medicines that will help dampen this inflammatory response. These
will generally comprise use of steroids, immunoglobulins, antibiotics and immune-modulators
to name a few. The encouraging news is that children who have presented with
the multisystem inflammatory disorder have done extremely well when identified
It is important to reiterate here that this is extremely rare. The nature of the Multisystem Inflammatory syndrome in the COVID-19 pandemic will become clearer as we have more data from countries that have experienced a peak before us. The key for now is to be aware and vigilant but not to panic.
By Dr. Suruchi GoyalAgarwal,
Consultant – Paediatrics and Paediatric Endocrinology, Columbia Asia Hospital Whitefield