Distinctive Features of Kawasaki Disease Following SARS-CoV-2 Infection: a Controlled Study in Paris, France,Journal of Clinical Immunology

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Distinctive Features of Kawasaki Disease Following SARS-CoV-2 Infection: a Controlled Study in Paris, France
Journal of Clinical Immunology ( IF 9.1 ) Pub Date : 2021-01-04 , DOI: 10.1007/s10875-020-00941-0
Julie Toubiana _{1,

2} , Jérémie F Cohen _{1,

3} , Joséphine Brice ₁ , Clément Poirault ₁ , Fanny Bajolle ₄ , William Curtis ₅ , Florence Moulin ₆ , Soraya Matczak _{1,

2} , Marianne Leruez ₇ , Jean-Laurent Casanova _{8,

9} , Martin Chalumeau _{1,

3} , Melissa Taylor ₁ , Slimane Allali ₁

Affiliation

Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Necker Hospital for Sick Children, Université de Paris, 75015, Paris, France.
Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.
Centre of Research in Epidemiology and Statistics - CRESS, INSERM, Université de Paris, F-75004, Paris, France.
M3C-Necker Enfants Malades, AP-HP, Paris, France.
Pediatric Emergency Department, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, Paris, France.
Pediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, Paris, France.
Virology Laboratory, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, Paris, France.
Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Imagine Institute, Pediatric Hematology and Immunology Unit, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, Paris, France.
St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.

Background

An outbreak of multisystem inflammatory syndrome in children, including Kawasaki disease (KD), emerged during COVID-19 pandemic. We explored whether Kawasaki-like disease (KD), when associated with confirmed SARS-CoV-2 infection, has specific characteristics.

Methods

We included children and adolescents with KD criteria admitted in the department of general pediatrics of a university hospital in Paris, France, between January 1, 2018, and May 26, 2020. The incidence of KD was compared between the outbreak and a pre-outbreak control period (January 1, 2018, to April 25). Characteristics of patients with positive SARS-CoV-2 testing (KD-SARS-CoV-2) were compared to those of the pre-outbreak period (classic KD).

Results

A total of 30 and 59 children with KD were admitted during the outbreak and pre-outbreak periods, respectively (incidence ratio 13.2 [8.3–21.0]). During the outbreak, 23/30 (77%) children were diagnosed as KD-SARS-CoV-2. When compared with patients with classic KD, those with KD-SARS-CoV-2 were more frequently of sub-Saharan African ancestry (OR 4.4 [1.6–12.6]) and older (median 8.2 vs. 4.0 years, p < 0.001), had more often initial gastrointestinal (OR 84 [4.9–1456]) and neurological (OR 7.3 [1.9–27.7] manifestations, and shock syndrome (OR 13.7 [4.2–45.1]). They had significantly higher CRP and ferritin levels. Noticeably, they had more frequently myocarditis (OR 387 [38–3933]).

Conclusions

Children and adolescents with KD-SARS-CoV-2 have specific features when compared with those with classic KD. These findings should raise awareness and facilitate the study of their pathogenesis.

中文翻译：

感染 SARS-CoV-2 后川崎病的显着特征：法国巴黎的一项对照研究

背景

在 COVID-19 大流行期间出现了包括川崎病 (KD) 在内的儿童多系统炎症综合征暴发。我们探讨了与确诊的 SARS-CoV-2 感染相关的川崎样病 (KD) 是否具有特定特征。

方法

我们纳入了 2018 年 1 月 1 日至 2020 年 5 月 26 日期间在法国巴黎一所大学医院普通儿科收治的符合 KD 标准的儿童和青少年。比较了疫情与疫情前的 KD 发病率控制期（2018 年 1 月 1 日至 4 月 25 日）。将 SARS-CoV-2 检测呈阳性的患者（KD-SARS-CoV-2）的特征与暴发前时期（经典 KD）的特征进行比较。

结果

在暴发期间和暴发前期间，分别有 30 名和 59 名 KD 儿童入院（发病率 13.2 [8.3-21.0]）。在疫情爆发期间，23/30 (77%) 的儿童被诊断为 KD-SARS-CoV-2。与经典 KD 患者相比，患有 KD-SARS-CoV-2 的患者更常具有撒哈拉以南非洲血统（OR 4.4 [1.6-12.6]）和年龄更大（中位数 8.2 对 4.0 岁，p < 0.001），初始胃肠道（OR 84 [4.9-1456]）和神经系统（OR 7.3 [1.9-27.7] 表现和休克综合征（OR 13.7 [4.2-45.1]）更常见。他们的 CRP 和铁蛋白水平显着升高。值得注意的是，他们患心肌炎的频率更高（OR 387 [38–3933]）。