So, several countries have already reported an unexpected increase in the number of complications of a new coronavirus infection in children with a syndrome similar to Kawasaki. Kawasaki syndrome is one of the forms of vasculitis that belongs to the group of autoimmune diseases and causes severe immunopathological inflammation of blood vessels (arteries, arterioles, capillaries, venules and veins). It is manifested by fever, changes in the mucous membranes, skin, damage to the coronary and other arteries with the possible formation of aneurysms, thrombosis and rupture of the vascular wall. Usually found in young children with COVID-19, there are cases at different ages. The treatment has not been developed.
Cases of such complications have been reported in 16 US states and several European countries. In the United States, 102 cases of such reactions in children were launched, three of which died. The Lancet magazine reported a 30-fold (!) Increase in the number of such cases in children in the Italian province of Bergamo. In France, 17 such children were identified in two weeks from the end of April to the beginning of May, although in the previous couple of years more than 1 child has not been identified in a two-week period. The age of patients is from 3 to 16 years.
Such children appeared in Russia, although the exact statistics of their number have not yet been made public. However, doctors deal with such patients. Natalia Lenskaya, Head of Therapy Department, Clinical Hospital No. 79, urges her colleagues to pay close attention to the problem of children with COVID infection. “Everyone was glad that the children did not get sick or get sick very easily,” says Natalia Georgievna. “They did not receive any treatment other than NSAIDs (non-steroidal anti-inflammatory drugs – Auth.). Hospitalization of the children was extremely low. It is unclear why the disease goes away for children it’s three days, and it’s so difficult for adults, but it’s just that the children have a different immune response, and suddenly, somewhere in one or two months after the disease, a severe form of vasculitis appears like Kawasaki’s syndrome. “Spain, Italy, Moscow, the USA – and no one understands anything. In fact, from the moment of illness, children started an autoimmune process that was not detected and gradually, under the influence of ultraviolet radiation, severe vasculitis developed.”
The doctor says that the appearance of the initial symptoms of vasculitis can be noticed immediately after ultraviolet radiation exposure: “I believe that at this stage the process can still be stopped with the help of glucocorticoids and the exclusion of ultraviolet radiation (UV). It must be understood that somewhere from the second month after If you don’t do anything, then you will inevitably develop (sooner or later) severe vasculitis against the background of the UFO. No other mechanism for the development of this syndrome can be imagined. Many children after COVID infections already have signs of lupus erythematosus syndrome due to ultraviolet radiation (the so-called decollete syndrome – grouped small rashes, delimited by the edge of the sweatshirt). Many take this rash for prickly heat or mosquito bites. Of the other manifestations, changes in the behavior of the child can be noted: nervousness , rapid mood swings, drowsiness, intermittent increased activity. Body temperature after ultraviolet radiation increases slightly (to about 36.8). All these phenomena disappear in a day if there was no repeated insolation. “
The therapist is sure that if nothing is done at the stage of the rash, which parents often do not attach importance to and which may occur a month after the illness, it can be very late. What the doctors do not really know yet, but they have assumptions in this regard. “I think that starting to treat children from the onset of COVID infection, it is possible that the development of severe autoimmune complications can be stopped and not brought to resuscitation. The sooner we realize this problem and take action, the more children we will be able to save!” – considers Dr. Lenskaya.
Is it worth it to be afraid of the sun? Should all children with the first symptoms of the new coronavirus be placed on hormones or should serious rheumatological complications develop?
– We do not reliably know about the existence of such a relationship, but we know that ultraviolet light affects immune cells and it is with this effect that annual exacerbations of autoimmune diseases such as lupus erythematosus and acute leukemia are associated. These observations are not very scientific, that is, they have no confirmation, although they are known to all doctors, ”says Pavel Vorobyov, chairman of the Moscow City Scientific Society of Therapists. – Today, with coronavirus, we see a huge number of autoimmune vasculitis, as well as reactions similar to Kawasaki syndrome. The latter are not so many, but rashes on the skin, indicating vasculitis, we fix flat and next. Accordingly, all vasculitis (lupus – also vasculitis) can worsen under the influence of sunlight, this may be the reason that in the summer they became more.
“Yes, and no one spoke about Kawasaki syndrome in the winter, and now it has been recorded more and more often …”
“There have been reports all the time, and syndromes like Kawasaki have been described among other vasculitis, not only in children but also in adults.” Perhaps these syndromes have a different course, not ordinary. So, with a standard course, there is a high temperature, but here everything can happen without an increase in body temperature. Such an autoimmune reaction to a viral infection.
– The professional community is discussing the appointment of glucocorticoids, that is, steroid hormones, to children with symptoms of coronavirus infection already at the beginning of the disease. How do you feel about this idea?
– Of course, this cannot be done without a doctor, because glucocorticoids are not first-line therapy. However, doctors should pay attention to this problem, which has not yet been widely discussed. There is a group of patients with a typical course of infection, and there are those who develop vasculitis-like conditions. In addition, patients began to appear with lesions (also vasculitic) of the nervous system, central and peripheral. Polyneuritis that lasts after COVID for a long time, and so far no one knows what to do with them. At a minimum, this is an indication for plasmapheresis – all vasculitis is treated with plasmapheresis. However, we do not have access to this method. Regarding the appointment of hormones, I have no confidence that they should be given to everyone in a row. At first I would start plasmapheresis with everything, and then I would think about glucocorticoids. In addition, not all vasculitis go on hormones.
– What is the reason for the low availability of plasmapheresis, is it expensive?
– Yes, a penny Soviet method! The old technique, it is used in few places. Because everyone wants to buy expensive drugs. And plasmapheresis often gives the best effect in individual nosologies. Yes, and consider it free.
– Should a surge in rheumatological diseases be expected after a pandemic?
– This is not excluded, unfortunately. We have never directly linked all autoimmune diseases to viruses and other pathogens. But, for example, there is borreliosis (Lyme disease), which is transmitted by ticks. According to some reports, all juvenile (juvenile) rheumatoid arthritis is a consequence of borreliosis. And who knows what adults have. For example, the cause of rheumatism is streptococcal infection, which triggers rheumatoid processes, damage to the heart valves. This is not news, but we forgot about it. All autoimmune diseases have an etiology.
– What do you think about the possibility of preventing complications from covid? Today, low molecular weight heparins are widely used, does this help?
“I can only make my assumptions.” Heparins greatly reduce all manifestations of the disease. I lead a lot of outpatient covid patients to whom we give direct oral anticoagulants. I have more than a hundred patients under observation. Taking such drugs literally breaks off the disease, even in the most difficult situations, and no complications develop.
“What should parents do if they notice symptoms of a syndrome like Kawasaki in a child?” For example, rashes like a collar?
– We must immediately go to the doctors, to dermatologists. But in general, we need to raise this problem, which no one talks about, but we must blow it. We all, alas, focused on mechanical ventilation. Our society of therapists today is trying to develop recommendations on how to deal with such syndromes. My opinion is that if plasmapheresis is not available, then anticoagulants are mandatory
… About the massive development of vasculitis after COVID, a doctor from Kiev, Elli Rozhdestvenskaya, writes in his social network. She conducted a survey among her colleagues and came to the conclusion that many patients who did not receive anticoagulants during the infection become disabled two or three months after the disease: “they cannot go to work, they feel weak, tired, complain of tachycardia, arrhythmia and neurological disorders. ” In addition, many cannot recover for 3-4 months: “someone has a fever, someone has a pre-stroke condition, everyone has neurological symptoms: numbness and loss of sensation, tingling in different parts of the body, sleep disturbances, arrhythmia, tachycardia weakness. ” Patients do not understand what is happening to them, and doctors too. “These are vascular systemic inflammations, vasculopathy,” says Ellie Rozhdestvenskaya.
Therefore, almost no one doubts that rheumatologists will soon have more patients.
–
