May 17, 2020, 6:07 am | Read time: 4 minutes
Doctors report severely ill children with certain inflammations from several countries. Is there a connection to COVID-19? A study provides more clarity.
Children and COVID-19–there are reports worldwide of severe inflammations in younger patients related to a coronavirus infection. Now, a study from Bergamo, the center of the pandemic in Italy, sheds light on the characteristics of the rare inflammatory disease that resembles the so-called Kawasaki syndrome. As reported by doctors in the journal “The Lancet,” this could indeed be linked to COVID-19–though the doctors emphasize that only a small number of younger patients are affected.
Immune System Overreaction
Typically, a coronavirus infection in children is rather mild. However, in a few cases, the disease can apparently lead to symptoms reminiscent of Kawasaki syndrome, a rare childhood illness. This syndrome causes an overreaction of the immune system, presumably triggered by bacteria or viruses.
COVID-19 Symptoms Resemble Kawasaki Disease
It is already known that the coronavirus can cause such an overreaction in adults. However, a direct link between Kawasaki and COVID-19 has not yet been proven. Nonetheless, there are now reports from several countries of children experiencing inflamed blood vessels, rashes, and fever–symptoms that at least resemble Kawasaki disease.
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Valid Conclusions Difficult
Doctors from the “Papa Giovanni XXIII” hospital in Bergamo have now compared cases of children showing such disease characteristics between February 18 and April 20 with Kawasaki cases in the region from the five years before the pandemic began. In total, there were 19 cases of Kawasaki between January 2015 and mid-February this year. In the two months since, 10 children with Kawasaki-like symptoms have been treated, which, according to the study authors, represents a 30-fold increase–though the doctors themselves point out that it is difficult to draw valid conclusions based on such small numbers.
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Differences from Kawasaki Disease
Eight of the ten children admitted to the hospital after February 18 tested positive for SARS-CoV-2 in an antibody test. All children in the study survived, but those who fell ill during the pandemic showed more severe symptoms than those from the previous five years. Six of the children experienced heart complications, five showed signs of toxic shock syndrome. Additionally, more of them had to be treated with steroids than in the group before the pandemic outbreak. Another difference: The children who fell ill during the coronavirus wave were, on average, older than those previously diagnosed with Kawasaki. Due to these differences, the authors advocate classifying the inflammatory disease as a “Kawasaki-like syndrome.”
The Italian study, as well as a similar summary from the UK, indeed shows different courses that only partially correspond to a typical Kawasaki syndrome, often representing a so-called atypical Kawasaki syndrome, emphasizes Johannes Hübner, deputy head of the children’s clinic at the University of Munich, in an independent assessment. “An atypical Kawasaki syndrome shows some very nonspecific symptoms that we observe in many viral infections, such as fever and a rash.” Additionally, the connection with COVID-19 in some of the reported cases is unclear or not confirmed.
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Reporting System for Suspected Cases in Germany
“We have not heard of any such clusters of cases from Germany so far,” summarizes Hübner, who is also chairman of the German Society for Pediatric Infectious Diseases (DGPI). The DGPI is currently establishing a reporting system for suspected cases and will closely monitor the situation. “At the moment, the situation in Germany is certainly not alarming,” says the doctor.
Children Minimally Affected by SARS-CoV-2 Infection
Russell Viner, president of the British Royal College of Pediatrics and Child Health, also reassures: “Although the article suggests a possible newly emerging inflammatory syndrome related to COVID-19, it is important–both for parents and healthcare workers–to reiterate that children are overall minimally affected by the SARS-CoV-2 infection.”
Understanding the phenomenon in children could provide important information about immune responses to SARS-CoV-2 that could be relevant for both adults and children, says Viner. “Especially if it is an antibody-mediated phenomenon, this could have implications for vaccine studies and also explain why some children become severely ill with COVID-19 while the majority are not affected or asymptomatic.”