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Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study.
BMJ. 2020 06 03; 369:m2094.BMJ

Abstract

OBJECTIVES

To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

DESIGN

Prospective observational study.

SETTING

General paediatric department of a university hospital in Paris, France.

PARTICIPANTS

21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020.

MAIN OUTCOME MEASURES

The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus.

RESULTS

21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home.

CONCLUSIONS

The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

Authors+Show Affiliations

Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 149 rue de Sèvres, 75015 Paris, France. Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 149 rue de Sèvres, 75015 Paris, France.Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris. Paris, France.M3C-Necker-Enfants Malades University Hospital, Université de Paris, Paris, France.Virology Laboratory, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, Paris, France.Pediatric Emergency Department, Necker-Enfants Malades University Hospital, AP-HP; INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Université de Paris, Paris, France.Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 149 rue de Sèvres, 75015 Paris, France.Pediatric and Emergency Unit, Louis Mourier Hospital, Université de Paris, Paris, France.Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris. Paris, France.Pediatric Emergency Unit, Hôpital Intercommunal, Créteil, France.Department of Clinical Microbiology, Necker-Enfants Malades University Hospital, AP-HP; EHU 7328 PACT, Imagine Institute, Université de Paris, Paris, France.Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 149 rue de Sèvres, 75015 Paris, France martin.chalumeau@aphp.fr. Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, INSERM, Université de Paris, Paris, France.Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Imagine Institute, Pediatric Hematology and Immunology Unit, Necker-Enfants Malades Hospital, AP-HP, Université de Paris, Paris, France. St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller Unversity, Howard Hughes Medical Institute, New York, NY, USA.Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 149 rue de Sèvres, 75015 Paris, France. Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, INSERM, Université de Paris, Paris, France.Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 149 rue de Sèvres, 75015 Paris, France.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32493739

Citation

Toubiana, Julie, et al. "Kawasaki-like Multisystem Inflammatory Syndrome in Children During the Covid-19 Pandemic in Paris, France: Prospective Observational Study." BMJ (Clinical Research Ed.), vol. 369, 2020, pp. m2094.
Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:m2094.
Toubiana, J., Poirault, C., Corsia, A., Bajolle, F., Fourgeaud, J., Angoulvant, F., Debray, A., Basmaci, R., Salvador, E., Biscardi, S., Frange, P., Chalumeau, M., Casanova, J. L., Cohen, J. F., & Allali, S. (2020). Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ (Clinical Research Ed.), 369, m2094. https://doi.org/10.1136/bmj.m2094
Toubiana J, et al. Kawasaki-like Multisystem Inflammatory Syndrome in Children During the Covid-19 Pandemic in Paris, France: Prospective Observational Study. BMJ. 2020 06 3;369:m2094. PubMed PMID: 32493739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. AU - Toubiana,Julie, AU - Poirault,Clément, AU - Corsia,Alice, AU - Bajolle,Fanny, AU - Fourgeaud,Jacques, AU - Angoulvant,François, AU - Debray,Agathe, AU - Basmaci,Romain, AU - Salvador,Elodie, AU - Biscardi,Sandra, AU - Frange,Pierre, AU - Chalumeau,Martin, AU - Casanova,Jean-Laurent, AU - Cohen,Jérémie F, AU - Allali,Slimane, Y1 - 2020/06/03/ PY - 2020/6/5/entrez PY - 2020/6/5/pubmed PY - 2020/6/17/medline SP - m2094 EP - m2094 JF - BMJ (Clinical research ed.) JO - BMJ VL - 369 N2 - OBJECTIVES: To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN: Prospective observational study. SETTING: General paediatric department of a university hospital in Paris, France. PARTICIPANTS: 21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020. MAIN OUTCOME MEASURES: The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus. RESULTS: 21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home. CONCLUSIONS: The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/32493739/Kawasaki_like_multisystem_inflammatory_syndrome_in_children_during_the_covid_19_pandemic_in_Paris_France:_prospective_observational_study_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=32493739 DB - PRIME DP - Unbound Medicine ER -