179 children with symptoms similar to Kawasaki syndrome or disease are listed in France. 52% are girls. The link is made with the Covid-19. What are the symptoms ? When to go to the hospital? What do we know about these cases in France? Can it be treated?
[Mise à jour le vendredi 5 juin 2020 à 12h55] In Italy, United Kingdom, Belgium but also in France. In April, doctors alerted authorities to cases of inflammatory syndromes observed in young children with some symptoms close to the Kawasaki disease and mostly with recent Covid-19 infection. In France, 179 cases have been reported, reports Public Health France in its epidemiological point of June 4, 2020. Should we be worried about the gradual return to school announced? What was the state of health of these children? What is this disease?
The alert in France was given in April by the Necker hospital which reported the cases of 25 children hospitalized in intensive care in the Paris region with an inflammatory syndrome. “This inflammatory syndrome involves the heart, the lungs or the digestive system, explained doctor Damien Bonnet, coordinator of the M3C Necker network in Paris to the daily Midi Libre. The clinical condition of some patients recalls the Kawasaki disease.” Some children had a recent Covid-19 infection. In order to better identify these atypical clinical pictures, hospital paediatricians have been invited, since April 30, to report each new case possibly related to COVID19 to Santé Publique France, as well as retrospectively since March 1, 2020. “As of June 2, 179 reports of pediatric multi-system inflammatory syndromes (PIMS) confirmed or suspected of being related to COVID-19 and occurring since March 1, 2020, have been reported “, indicates Public Health France. Among these cases:
→ More than half of the cases have been reported in the Ile-de-France region. Between 10 and 20 cases have been reported in the Auvergne-Rhône-Alpes, Grand Est and Provence-Alpes-Côte d’Azur regions.
→ 93 cases (52%) concerned girls.
→ The median age (50%) of cases was 7 years (25% of cases were ≤ 3 years old and 75% ≤ 11 years old).
→ 9-year-old boy with neurodevelopmental comorbidity died. Her COVID19 serology was positive.
→ clinical manifestations consisted of systemic inflammation syndromes with myocarditis in 83 patients.
→ a resuscitation stay was necessary for 83 children and a critical care unit for 27. The other children were hospitalized in the pediatric ward.
Distribution of cases of pediatric systemic inflammatory diseases by age group, France, as of May 26, 2020.
| Age group | <1 year | 1-4 years | 5-9 years | 10-14 years | ≥ 15 years |
|---|---|---|---|---|---|
| Number of cases | 11 | 53 | 52 | 46 | 10 |
| % | 6 | 31 | 30 | 27 | 6 |
It’s possible. “It is suspected that it is an inflammatory reaction of the body to an infectious agent, still unknown. These syndromes manifest themselves in the context ofchildren who were infected with covid-19 about a month before“ said Professor Arnaud Fontanet on April 30 at a hearing in the Senate.
“These results strongly support a link between SARS-CoV-2 infection and this pathology”
According to the data transmitted by Santé Publique France out of 179 cases reported in France, PCR and / or serology for SARS-CoV-2 were positive in half of the cases (n = 89, 50%) and the link to the virus was probable in 21 (12%) other patients. For 19 patients (10%), the link with COVID-19 was considered possible with results still pending. For the other 50 (28%) this link could not be established. These results are in favor of a link between SARS-CoV-2 infection and this pathology. In the 129 cases for which the link with COVID-19 was possible, probable or proven, multi-systemic inflammation syndromes were associated with myocarditis in 89 patients (69%). The average time of onset of these systemic inflammatory diseases is to 4 weeks after infection with SARS-CoV-2. Professor Jean-François Delfraissy, President of the Covid-19 scientific committee, recalled in April that “this Kawasaki pediatric aspect illustrates the complexity of this virus (Sars-CoV-2), you have to be really modest on a scientific level. We have to wait, there is still a need for knowledge. ” The alert first came from United Kingdom where the National Health Service (NHS, Country Health Agency) reported cases of a dozen children hospitalized in serious condition with fever, inflammation of the arteries (such as Kawasaki disease) and mostly Covid-19 positive. “It’s a new disease which we believe can be caused by coronavirus, said British Health Minister Matt Hancock on LBC radio. We are not 100% sure because some of the people who contracted it have not tested positive (with coronavirus). So we are currently doing a lot of research. But this is something that concerns us. ” Matt Hancock confirmed “an apparent increase in the number of children of all ages with multisystem inflammatory conditions requiring intensive care in London and other parts of the United Kingdom”.
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Kawasaki disease or “Lympho-cutaneous-mucosal syndrome“has been described by Tomisaku Kawasaki in 1967. It is a vasculitis that is to say a disease characterized by inflammation of blood vessels who, if left untreated, can be complicated with life-threatening coronary aneurysms. Even though this disease has been reported worldwide, it is much more common in Asian populations, especially at Japan. In the vast majority of cases, it affects infants and young children before puberty. This disease is rare in adolescents and adults. Children with Kawasaki disease have a poor general condition. Symptoms suggestive of Kawasaki disease:
- a prolonged unexplained fever, above 38 ° C, which persists for at least 5 days and does not respond to antipyretics or antibiotics,
- skin rash;
- conjunctivitis that appears with fever;
- oropharyngeal involvement (erythema of the lips, dryness, cracks and sometimes bleeding). The tongue is raspberry;
- cervical lymphadenopathy (swollen glands);
- damage to the feet and hands: erythema of the palms or soles as well as edema, peeling of the skin, that is to say a loss of the surface layer of the epidermis, mainly affecting the area towards the organs genitals, soles, or palms.
The severity of this disease is defined by heart risks that it can generate, in the absence of treatments. “Cardiac complications occur in 25 to 30% of untreated patients, reports La Revue du Praticien. The most important complication is represented by coronary aneurysms, which usually occur between 10 and 30 days after the onset of illness. “
The diagnosis of Kawasaki disease is difficult to ask in the beginning, because many childhood illnesses have similar symptoms. It is in front of the association of the aforementioned signs, conventionally five of the six signs mentioned above, that the diagnosis is confirmed. A blood test is sometimes performed showing inflammation at his level, but in case of confirmation of Kawasaki disease, a Echocardiography should be practiced in search of a coronary aneurysm that is to say a malformation of an artery of the heart which makes all the gravity of this childhood disease. Thromboses, blood clots obstructing a blood vessel, can also complicate this disease.
Kawasaki disease requires hospitalization. The pathology is treated using a drug combination. Aspirin is used to prevent the formation of thromboses, associated with a course of immunoglobulins passed by the venous route. In addition, the cardiac ultrasound should be repeated to monitor the occurrence of a possible aneurysm. “Kawasaki disease has become exceptionally serious since it was treated early and effectively with immunoglobulins” explains Dr Fanny Bajolle of the Reference Center “Congenital Cardiac Malformations Complexes-M3C” of Necker Hospital for Sick Patients. Of relapses are possible but rare.
Sources:
COVID-19 Weekly epidemiological update of May 29, 2020. Public Health France.
Kawasaki disease in four tables. Dr Fanny Bajolle. Reference Center “Complex Congenital Cardiac Malformations-M3C” of the Necker Children’s Hospital. 2011.
Kawasaki disease; R. Cimaz *, J.-C. Lega; Hospice Civils de Lyon, Claude-Bernard University, Lyon-1; 2007.
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