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Lee YH. Research trends on causes of Kawasaki disease in the COVID-19 era: focus on viral infections. Clin Exp Pediatr 2023; 66:1-11. [PMID: 35760413 PMCID: PMC9815937 DOI: 10.3345/cep.2022.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/14/2022] [Indexed: 01/13/2023] Open
Abstract
Despite studies on the etiology of Kawasaki disease (KD) ongoing for half a century since its discovery, its cause has not yet been clearly identified. Although the clinical, epidemiological, and pathophysiological characteristics of KD are presumed to be closely related to infectious diseases, studies of various pathogens to identify its etiology have been actively conducted. To date, bacteria, fungi, and viruses have been investigated to determine the relationship between KD and infection, among which viruses have attracted the most attention. In particular, during the coronavirus disease 2019 pandemic, there were many reports in Europe of a sharp increase in cases of Kawasaki-like disease (KLD), while conflicting reports that the prevalence of KD decreased due to thorough "social distancing" or "wearing mask" in Asian countries drew more attention regarding the association between KD and viral infection. Therefore, the differential diagnosis of KD from KLD with these similar spectra has become a very important issue; simultaneously, research to solve questions about the association between KD and viral infections, including sudden acute respiratory syndrome coronavirus 2, is drawing attention again. Moreover, a new concept has emerged that immune responses occurring in patients with KD can be caused by the pathogen itself as well as host cells damaged by infection. This paper summarizes the research trends into KD etiology and related pathophysiology, especially its association with viral infections, and present future research tasks to increase our understanding of KD.
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Affiliation(s)
- Young Hwan Lee
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
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Khoury L, Livnat G, Hamad Saied M, Yaacoby‐Bianu K. Pneumonia in the presentation of Kawasaki disease: The syndrome or a sequence of two diseases? Clin Case Rep 2022; 10:e6676. [PMID: 36483871 PMCID: PMC9723393 DOI: 10.1002/ccr3.6676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/29/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Two cases of Kawasaki disease (KD) presented as persistent lung consolidation associated with Group A Streptococcus and Influenza A co-infection, which resolved following intravenous immunoglobulin. Thus, pediatricians should consider the diagnosis of KD in the presence of pneumonia that is nonresponsive to antibiotic therapy with prolonged fever and inflammatory reactions.
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Affiliation(s)
- Lana Khoury
- Department of Pediatrics, Carmel Medical CenterHaifaIsrael
| | - Galit Livnat
- Pediatric Pulmonology Unit and CF Center, Carmel Medical CenterHaifaIsrael
- B. Rappaport Faculty of Medicine, Technion–Israel Institute of TechnologyHaifaIsrael
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An Intriguing Case of Multisystem Inflammatory Syndrome in an Adult Patient with Remote Infection with COVID-19 and Acute Chlamydia. Case Rep Infect Dis 2021; 2021:6620240. [PMID: 34631180 PMCID: PMC8494571 DOI: 10.1155/2021/6620240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/11/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction COVID-19 is associated with a broad range of immune inflammatory phenomena, with different manifestations in adults and children. We describe a case of COVID-19-related multisystem inflammatory syndrome in an adult (MIS-A), similar to that described in children (MIS-C), which may have been set off by an unrelated secondary infection. Case A 27-year-old male patient presented with acute epididymitis secondary to acute Chlamydia infection that progressed to multisystem inflammatory failure with respiratory failure requiring endotracheal intubation and mechanical ventilation, cardiogenic shock with heart failure, and gastrointestinal and renal dysfunction. He tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction on a nasopharyngeal swab thrice within 4 days of presentation, but positive for SARS-CoV-2 immunoglobulin G antibody signifying remote infection. The patient was treated with tocilizumab and steroids, along with doxycycline for concurrent Chlamydia infection, resulting in dramatic improvement in all organ function. We suspect that C. trachomatis infection in this instance may have triggered an aberrant immune response that was shaped by prior exposure to SARS-CoV-2. Conclusion We present a case of an adult patient with acute Chlamydia trachomatis infection occurring in the wake of asymptomatic (or at least unrecognized) COVID-19 resulting in MIS-A. Clinicians should be alert to the possibility of other such unusual reactions occurring in the aftermath of COVID-19. This case also highlights the importance for clinicians who care for adult patients of being familiar with the multisystem inflammatory syndrome of children, as an identical syndrome may occur in adult patients.
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Fernández-Cooke E, Grasa CD, Domínguez-Rodríguez S, Barrios Tascón A, Sánchez-Manubens J, Anton J, Mercader B, Villalobos E, Camacho M, Navarro Gómez ML, Oltra Benavent M, Giralt G, Bustillo M, Bello Naranjo AM, Rocandio B, Rodríguez-González M, Núñez Cuadros E, Aracil Santos J, Moreno D, Calvo C. Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain. Front Pediatr 2021; 8:617039. [PMID: 33537269 PMCID: PMC7849209 DOI: 10.3389/fped.2020.617039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.
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Affiliation(s)
- Elisa Fernández-Cooke
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Carlos D. Grasa
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Ana Barrios Tascón
- Department of Pediatrics, Hospital Universitario Infanta Sofia, Madrid, Spain
| | - Judith Sánchez-Manubens
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Anton
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Enrique Villalobos
- Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marisol Camacho
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Department of Pediatrics, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Manuel Oltra Benavent
- Department of Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Giralt
- Pediatric Cardiology Unit, Department of Pediatrics, Hospital Universitario Vall d'Hebron Barcelona, Barcelona, Spain
| | - Matilde Bustillo
- Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ana María Bello Naranjo
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Canarias, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario de Donostia, Guipuzcoa, Spain
| | | | | | - Javier Aracil Santos
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - David Moreno
- Department of Pediatrics, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
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