Recent reports of children experiencing Kawasaki disease, possibly tied to the COVID- 19 pandemic, are raising concerns among patients and paediatricians.
Most children with COVID-19 are asymptomatic or exhibit only mild symptoms. However, in the past few months, first in Europe, and more recently in the U.S., a small number of children developed a more serious inflammatory syndrome with COVID-19, often leading to hospitalization and occasionally requiring intensive care.
COVID-19 infection leading to critical illness in children remains very infrequent. According to the leaders of the American Heart Association’s Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts), a few patients display symptoms found in otherpaediatric inflammatory conditions, most notably Kawasaki disease.
Children with this new, possibly COVID- 19-related syndrome may have some or all the features of Kawasaki disease. These children have a persistent fever, inflammation and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) and may or may not test positive for COVID-19.
“We want to reassure parents – this appears to be uncommon. While Kawasaki disease can damage the heart or blood vessels, the heart problems usually go away in five or six weeks, and most children fully recover,” said Jane Newburger, M.D., M.P.H., FAHA, American Heart Association Young Hearts Council member, associate cardiologist-in-chief, academic affairs; medical director of the neurodevelopmen-tal program; and director of the Kawasaki Program at Boston Children’s Hospital; and Commonwealth Professor of Pediatrics at Harvard Medical School. “Rarely, but sometimes, the coronary artery damage persists. Because of this, Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. Prompt treatment is critical to prevent significant heart problems.”
Since some children are becoming very ill extremely quickly, children with these symptoms should be swiftly evaluated and cared for in hospitals with paediatric cardiac intensive care units, as needed. Because there is a small but increasing number of children with fever and evidence of inflammation who are not severely ill, all children with unexplained fever and elevated C- Reactive Protein (CRP) or white blood cell count should be carefully monitored.
In order to learn more, the American Heart Association’s Young Hearts Council feels it is important for children to be enrolled, wherever possible, in COVID-19 research projects that include obtaining serum or plasma samples, DNA and RNA studies for biobanking. Clinical trials and data integration across existing and planned registries of children ill from COVID-19 are needed. The Council is adopting the case definition put forth by the Royal College of Paediatrics and Child Health https://bit.ly/2O6Sgfi
Further research is needed on the full spectrum of inflammatory disorders that appear to be related to COVID-19. Recently, the American Heart Association funded 12 research grants looking at the heart and brain health implications of coronavirus including a study examining impacts on the cardiovascular system due to a robust inflammatory response.
The American Heart Association’s Young Hearts Council is a volunteer scientific group of leading paediatric cardiologists. 
What is Kawasaki Disease?
Kawasaki disease (KD), also known as Kawasaki syndrome or mucocutaneous lymph node syndrome, is the most common cause of acquired heart disease in children in developed countries.
It is a rare condition that presents with a fever above 38.8°C to 40°C for at least five days. The fever is accompanied by at least four of the following five symptoms:
- A rash over the torso, especially in the groin area.
- Redness and swelling of the palms and soles of the feet when the illness starts. Light peeling of the skin on the fingertips and toes occurs in the second and third weeks. Larger pieces of skin can peel off the hands and feet as well.
- Bloodshot eyes that can be sensitive to light.
- Swollen lymph glands in the neck (one large lymph node that measures more than 1.5 cm). Sometimes the neck feels stiff.
- Irritation and inflammation of the mouth, lips and throat. “Strawberry” tongue – the tongue is bumpy and red with enlarged taste buds. KD affects children and a smaller percentage of teens, creating inflammation in the blood vessels, particularly the coronary arteries. The average age of those affected is 2. 75% are younger than 5 and boys are 1.5 times more likely than girls to get KD.
Although the illness occurs worldwide and across all racial or ethnic groups, it’s more frequent in Japan and in children of Asian descent. Named after Dr. Tomisaku Kawasaki, a Japanese paediatrician, the condition wasn’t recognised as a separate syndrome until 1967. It may have been around for a long time before that.
Prompt treatment is critical to prevent significant heart problems. Most children recover fully.
