A link between the COVID-19 pandemic and Kawasaki-like multi-system inflammatory syndrome in children

Manal Fouad, Elshamaa

Introduction: COVID-19 (coronavirus disease 2019) – the epidemic outbreak caused by coronavirus-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – is a global public health problem. Children are less affected and have a mild form of the illness. The association between SARS-CoV-2 disease, COVID-19 and late symptoms of vasculitis is often suspected, in particular in young asymptomatic patients, especially due to the post-viral immune response. Objective: The aim of the review is to describe the characteristics of children and adolescents affected by the development of Kawasaki-like mult-system inflammatory syndrome (KD) (MISC), and assesses its possible temporal association with SARS-CoV-2 infection Brief description of the state of knowledge: A group of children who presented with KD-type MISC during the COVID-19 pandemic have been identified in the United Kingdom, the United States, and Italy. Some children were diagnosed with SARS-CoV-2 infection by real-time polymerase chain reaction and IgG antibodies. SARS-CoV-2 infection and hyperinflammation in COVID-19 can serve as an ‘initial trigger’ for KD. IVIG should be administered within seven days of onset of illness until KD symptoms disappear and COVID-19 test is negative. Large numbers of children in African countries with the SARS-CoV-2 epidemic are likely to be affected by KD, and in such cases, a shortage of IVIG supplies is expected. Conclusions: This article suggests a correlation between COVID-19 and Kawasaki-like MISC, which is important for the care of sick children. However, the definitive relationship between childhood KD and COVID-19 needs to be confirmed by a large cohort study on a large numbers of infant and children patients worldwide.