An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study
Data
2020Autor
Verdoni, Lucio
Mazza, Angelo
Gervasoni, Annalisa
Martelli, Laura
Ruggeri, Maurizio
Ciuffreda, Matteo
Bonanomi, Ezio
D’Antiga, Lorenzo
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Resumo
Background The Bergamo province, which is extensively affected by the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In
the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and features of patients
with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic.
Methods All patients diagnosed with a Kawasaki-like disease at our centre in the past 5 years were divided according
to symptomatic presentation before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. Kawasakilike presentations were managed as Kawasaki disease according to the American Heart Association indications.
Kawasaki disease shock syndrome (KDSS) was defined by presence of circulatory dysfunction, and macrophage
activation syndrome (MAS) by the Paediatric Rheumatology International Trials Organisation criteria. Current or
previous infection was sought by reverse-transcriptase quantitative PCR in nasopharyngeal and oropharyngeal swabs,
and by serological qualitative test detecting SARS-CoV-2 IgM and IgG, respectively.
Findings Group 1 comprised 19 patients (seven boys, 12 girls; aged 3·0 years [SD 2·5]) diagnosed between Jan 1, 2015,
and Feb 17, 2020. Group 2 included ten patients (seven boys, three girls; aged 7·5 years [SD 3·5]) diagnosed between
Feb 18 and April 20, 2020; eight of ten were positive for IgG or IgM, or both. The two groups differed in disease
incidence (group 1 vs group 2, 0·3 vs ten per month), mean age (3·0 vs 7·5 years), cardiac involvement (two of 19 vs
six of ten), KDSS (zero of 19 vs five of ten), MAS (zero of 19 vs five of ten), and need for adjunctive steroid treatment
(three of 19 vs eight of ten; all p<0·01).
Interpretation In the past month we found a 30-fold increased incidence of Kawasaki-like disease. Children diagnosed
after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher
rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a
severe form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected in countries involved in the
SARS-CoV-2 epidemic.
Palabras clave
SARS-CoV-2; EpidemicLink para o recurso
https://doi.org/10.1016/Collections
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