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Kawasaki disease: what is it?
Kawasaki disease is an inflammation and necrosis of the vascular walls of arteries and veins associated with immune dysfunction (febrile systemic vascularity).
Sometimes it involves coronary arteries. Moreover, without treatment, it can be complicated by coronary aneurysms, in 25 to 30% of cases. It is also the most common cause of acquired heart disease in children in industrialized countries, and may pose a risk for ischemic heart disease in adults.
Who is it reaching? Infants and children between the ages of 1 and 8 most commonly suffer from Kawasaki disease.
Could SARS-CoV-2 infection result in serious clinical manifestations in children, similar to the symptoms observed in Kawasaki disease? At the end of April 2020, pediatric services in the UK, France and the US reported a small number of cases of hospitalized children with systemic inflammatory disease, whose symptoms are reminiscent of this rare inflammatory disease. The emergence of these clinical signs and their link with Covid-19 raise questions. About sixty children were suffering from it in France, at the time of confinement linked to the coronavirus.
But then is there really a link between the SARS-CoV-2 coronavirus and Kawasaki disease? “There is a strong coincidence between the onset of these cases and the Covid-19 pandemic, but not all patients have tested positive. Several questions therefore remain unanswered and are the subject of further investigation in the pediatric departments, ”concludes Inserm. This link therefore needs to be further explored, even if currently, the government believes that Kawasaki disease does not seem likely to be another presentation of Covid-19. The latter notes, however, that “its onset could be favored by a nonspecific viral infection”. Indeed, “Covid-19 being a viral disease (like others), it is therefore plausible that children, following contact with Covid-19, develop Kawasaki disease in the long term, as is the case for other viral infections, ”he confirms, nevertheless recalling the importance of contacting his doctor in case of doubt. Still, the Necker Hospital is pleased with the fact that all the children received the usual treatment for the disease, and all responded favorably, with a rapid improvement in clinical signs and in particular a recovery of good cardiac function. . At the same time, a national census will be set up by the Public Health France agency.
What are the causes of Kawasaki disease?
The exact causes of this non-contagious disease are not known, but it is possible that it is caused by a viral or bacterial infection in children. Inserm informs that “its onset has been associated with several types of viral infections, and in particular with respiratory or enteric viruses. “It could be a reaction mechanism after a viral epidemic, advance for his part Olivier Véran, the Minister of Health.
The disease observed in affected children is thought to be a consequence of the overactivation of the immune system following infection with one of these viruses. “
What are the symptoms of Kawasaki disease?
Kawasaki disease is distinguished by prolonged fever, rash, conjunctivitis, inflammation of the mucous membranes, and lymphadenopathy. Also, the early manifestations are acute myocarditis with heart failure, arrhythmias, endocarditis and pericarditis. Coronary artery aneurysms can then form. Extravascular tissue can also become inflamed, including the upper respiratory tract, pancreas, bile ducts, kidneys, mucous membranes and lymph nodes.
“This clinical presentation evokes Kawasaki disease. The search for an infection by Covid-19 was found to be positive, either via PCR or by serology (antibody assay), the initial phase of the infection having gone unnoticed in most cases, without a link can be established at this stage with the Covid ”, indicates the establishment. Rare, this acute disease is characterized by inflammation of the lining of the blood vessels, especially those of the heart (coronary arteries). It mainly affects young children before the age of 5. Although cases have been reported worldwide, the disease is more common in Asian populations, says Inserm in an information point.
According to its figures, in Europe, 9 out of 100 children report the disease each year, with an annual peak in winter and spring. According to the specialist site Orphanet, the disease begins with a persistent fever, which is subsequently accompanied by other typical manifestations: swelling of the hands and feet, rashes, conjunctivitis, red cracked lips and red swollen tongue (“raspberry tongue ”), Swelling of the lymph nodes in the neck, or irritability. “Despite a lot of research, there is no diagnostic test available, and its diagnosis is based on clinical criteria after excluding other diseases with high and persistent fever,” he says.
Kawasaki disease: when to worry
Other children with more atypical forms of the disease, with more damage to the heart (inflammation of the heart muscle) than in its classic form. The latter also suffer from a cytokine storm, as for severe forms of Covid-19. Finally, children immediately presented with heart failure due to inflammatory disease of the myocardium (muscle tissue of the heart), with little or no signs of the disease.
What are the treatments for Kawasaki disease?
Thanks to early treatment with immunoglobulins (also called antibodies), the vast majority of patients recover quickly and do not retain any sequelae.
A rapid diagnosis remains essential because there is a risk of damage to the coronary arteries. “This damage occurs in one in five untreated children. In most children, they are minor and do not last long. In contrast, they persist longer in others. In this case, the walls of the coronary arteries weaken and form aneurysms (localized swelling of the wall of a blood vessel having the shape of a balloon “, notes the association” AboutKidsHealth “.