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Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort.
Ann Rheum Dis. 2020 08; 79(8):999-1006.AR

Abstract

BACKGROUND

Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities.

METHODS

Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('Kawa-COVID-19'). A historical cohort of 'classical' KD served as a comparator.

RESULTS

Sixteen patients were included (sex ratio=1, median age 10 years IQR (4·7 to 12.5)). SARS-CoV-2 was detected in 12 cases (69%), while a further three cases had documented recent contact with a quantitative PCR-positive individual (19%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 µg/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of 'classical' KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004).

CONCLUSION

Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19. Trial registration number NCT02377245.

Authors+Show Affiliations

General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France. Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France.Department of Pediatric Rheumatology Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France. Université Paris Sud-Saclay, UVSQ, 94276 Le Kremlin-Bicêtre, France.General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France. INSERM UMR 1123, ECEVE, Paris, France.General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France. Department of Microbiology, Robert Debré University Hospital,AP-HP, Paris, France.Departments of General Paediatrics and Paediatric Emergency, Louis-Mourier Hospital, AP-HP, Colombes, France. Infection-Antimicrobials-Modelling-Evolution IAME, INSERM, UMR-1137, Université de Paris, 75018, Paris, France.Departments of General Paediatrics and Paediatric Emergency, Louis-Mourier Hospital, AP-HP, Colombes, France. Infection-Antimicrobials-Modelling-Evolution IAME, INSERM, UMR-1137, Université de Paris, 75018, Paris, France.Department of General Paediatrics, Victor Dupouy Hospital, Argenteuil, France.Department of General Paediatrics, Victor Dupouy Hospital, Argenteuil, France.Department of General Paediatrics, René Dubos, Pontoise Hospital, Pontoise, France.Department of General Paediatrics, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.Paediatric emergency Department, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.Sickle cell disease referal center, INSERM U955, Centre hospitalier Intercommunal de Créteil, Paris XII University, Créteil, France.Paediatric Intensive Care Unit, Robert Debré University Hospital, AP-HP, Paris, France.Paediatric Intensive Care Unit, Robert Debré University Hospital, AP-HP, Paris, France.Paediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France.Inserm UMR-S 1135, Sorbonne Université, Paris, France. Department of Immunology and Infectious disease (CIMI-Paris), Pitié-Salpêtrière Hospital, AP-HP, Paris, France.Inserm UMR-S 1135, Sorbonne Université, Paris, France. Department of Immunology and Infectious disease (CIMI-Paris), Pitié-Salpêtrière Hospital, AP-HP, Paris, France.Medical Intensive Care Unit, Institut de Cardiologie, AP-HP, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France.Cardiopaediatric Unit, M3-C, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France.Cardiopaediatric Unit, Robert Debré University Hospital, AP-HP, Paris, France.Department of Microbiology, Robert Debré University Hospital,AP-HP, Paris, France. Infection-Antimicrobials-Modelling-Evolution IAME, INSERM, UMR-1137, Université de Paris, 75018, Paris, France.Department of Immunology, Robert Debré University Hospital, AP-HP, Paris, France.Department of Pediatric Rheumatology Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France. Université Paris Sud-Saclay, UVSQ, 94276 Le Kremlin-Bicêtre, France.Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France. Laboratory of Immunogenetics of paediatric autoimmune diseases, INSERM UMR 1163, Paris, France.General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France. Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France. INSERM UMR 1123, ECEVE, Paris, France.General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France. Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France. Center for Research on Inflammation, INSERM, UMR1149, Paris, France. Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France.Department of Pediatric Rheumatology Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France isabelle.melki@aphp.fr. Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France. Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32527868

Citation

Pouletty, Marie, et al. "Paediatric Multisystem Inflammatory Syndrome Temporally Associated With SARS-CoV-2 Mimicking Kawasaki Disease (Kawa-COVID-19): a Multicentre Cohort." Annals of the Rheumatic Diseases, vol. 79, no. 8, 2020, pp. 999-1006.
Pouletty M, Borocco C, Ouldali N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 2020;79(8):999-1006.
Pouletty, M., Borocco, C., Ouldali, N., Caseris, M., Basmaci, R., Lachaume, N., Bensaid, P., Pichard, S., Kouider, H., Morelle, G., Craiu, I., Pondarre, C., Deho, A., Maroni, A., Oualha, M., Amoura, Z., Haroche, J., Chommeloux, J., Bajolle, F., ... Melki, I. (2020). Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Annals of the Rheumatic Diseases, 79(8), 999-1006. https://doi.org/10.1136/annrheumdis-2020-217960
Pouletty M, et al. Paediatric Multisystem Inflammatory Syndrome Temporally Associated With SARS-CoV-2 Mimicking Kawasaki Disease (Kawa-COVID-19): a Multicentre Cohort. Ann Rheum Dis. 2020;79(8):999-1006. PubMed PMID: 32527868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. AU - Pouletty,Marie, AU - Borocco,Charlotte, AU - Ouldali,Naim, AU - Caseris,Marion, AU - Basmaci,Romain, AU - Lachaume,Noémie, AU - Bensaid,Philippe, AU - Pichard,Samia, AU - Kouider,Hanane, AU - Morelle,Guillaume, AU - Craiu,Irina, AU - Pondarre,Corinne, AU - Deho,Anna, AU - Maroni,Arielle, AU - Oualha,Mehdi, AU - Amoura,Zahir, AU - Haroche,Julien, AU - Chommeloux,Juliette, AU - Bajolle,Fanny, AU - Beyler,Constance, AU - Bonacorsi,Stéphane, AU - Carcelain,Guislaine, AU - Koné-Paut,Isabelle, AU - Bader-Meunier,Brigitte, AU - Faye,Albert, AU - Meinzer,Ulrich, AU - Galeotti,Caroline, AU - Melki,Isabelle, Y1 - 2020/06/11/ PY - 2020/05/12/received PY - 2020/05/27/revised PY - 2020/06/02/accepted PY - 2020/6/13/pubmed PY - 2020/7/23/medline PY - 2020/6/13/entrez KW - cytokines KW - inflammation KW - outcome and process assessment, health care SP - 999 EP - 1006 JF - Annals of the rheumatic diseases JO - Ann. Rheum. Dis. VL - 79 IS - 8 N2 - BACKGROUND: Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities. METHODS: Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('Kawa-COVID-19'). A historical cohort of 'classical' KD served as a comparator. RESULTS: Sixteen patients were included (sex ratio=1, median age 10 years IQR (4·7 to 12.5)). SARS-CoV-2 was detected in 12 cases (69%), while a further three cases had documented recent contact with a quantitative PCR-positive individual (19%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 µg/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of 'classical' KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004). CONCLUSION: Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19. Trial registration number NCT02377245. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/32527868/Paediatric_multisystem_inflammatory_syndrome_temporally_associated_with_SARS_CoV_2_mimicking_Kawasaki_disease__Kawa_COVID_19_:_a_multicentre_cohort_ L2 - https://ard.bmj.com/cgi/pmidlookup?view=long&amp;pmid=32527868 DB - PRIME DP - Unbound Medicine ER -