May 16th, 2020
SARS2 coronavirus seems to be triggering a very rare inflammat ory disease in children. It is similar to, yet different from, the traditional definition of Kawasaki's disease as reported to date. There have been a rash of cases with three recorded deaths in the New York City Area.
Historically, Kawasaki's disease has been around for decades and is a troublesome vasculitis, inflammation of blood vessels, that follows a viral illness in young children. It is most often seen in very young children aged less than 5 years old, but older children and adults can develop this disorder.
At our clinic, we will see a case of Kawasaki's once or twice a decade.
Kawasaki's disease begins with high fever that lasts for at least 5 days and is associated with:
1) red eyes, lips, and mouth
2) swollen, red hands and feet
3) enlarged lymph nodes
5) In rare cases - after 10 days of fever and symptoms, inflammation of the coronary arteries that supply the heart with blood and oxygen can occur. If these changes occur during the inflammatory stage of the illness, then the affected children present later as adults with arrhythmias, heart attacks and sudden death. (Burns et. al.1996) During the acute phase of the disease, we find the critical time to intervene with treatments aimed at reducing the inflammation and stopping the sequela from occurring.
The COVID19 version is different in that many children in New York and Italy have presented with fever, vomiting and progressing to shock, loss of blood pressure, rapidly. They appear to be much sicker than traditional kawasaki's disease and in a shorter time frame. As with Kawasaki's disease, the COVID version is also not related to comorbid disease and affects healthy individuals.
"Within the cluster were five children who had features similar to Kawasaki disease (ie, non-purulent conjunctivitis, polymorphic rash, mucosal changes, and swollen extremities); however, another five children presented with fewer than three of the diagnostic clinical signs and were older than patients with classic Kawasaki disease. There was also a high proportion of shock, with five of ten children presenting with hypotension requiring fluid resuscitation, and two of ten children needing inotropic support." (Viner et. al. 2020)
The great news is that like other childhood effects of SARS2/COVID, death is exceedingly rare. If you see these symptoms in a young child, please seek care that can significantly reduce the long term risk of heart disease.