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Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey.
Pediatr Rheumatol Online J. 2021 Mar 16; 19(1):29.PR

Abstract

BACKGROUND

There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities.

METHODS

The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups.

RESULTS

One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data.

CONCLUSION

Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.

Authors+Show Affiliations

Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.University of Trieste, Piazzale Europa, 2, Trieste, Italy.Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.Division of Rheumatology, Bambino Gesù Children's Hospital, IRCCS, Pizza di Sant'Onofrio, 4, 00165, Rome, Italy.Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.Paediatric Department, Hospital Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy.Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.Department of Paediatrics, Pediatria 2, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80129, Naples, Italy.UOSD Centro Malattie Autoinfiammatorie ed Immunodeficienze, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.Department of Pediatrics, University of Milan, Children's Hospital V Buzzi, Via Lodovico Castelvetro 32, 20154, Milan, Italy.Department of Pediatrics, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Via Giuseppe Masserenti 9, 40138, Bologna, Italy.Department of Pediatrics and Public Health, University of Turin, Via Giuseppe Verdi 8, 10124, Turin, Italy.Department of Woman's and Child's Health, University of Padova, Via 8 Febbraio 1848, 35122, Padua, Italy.Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini and DINOGMI, Università di Genova, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy.Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127, Palermo, Italy.Pediatric Rheumatology Center, Pediatric Unit, "Giovanni XXIII", Pediatric Hospital, Via Giovanni Amendola 207, 70126, Bari, Italy.Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.Pediatric Rheumatology Unit, AOU Meyer, University of Florence, Via Gaetano Pieraccini 24, 50139, Florence, Italy.Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122, Milan, Italy.Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini and DINOGMI, Università di Genova, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.University of Trieste, Piazzale Europa, 2, Trieste, Italy. andrea.taddio@burlo.trieste.it. Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy. andrea.taddio@burlo.trieste.it.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

33726806

Citation

Cattalini, Marco, et al. "Defining Kawasaki Disease and Pediatric Inflammatory Multisystem Syndrome-temporally Associated to SARS-CoV-2 Infection During SARS-CoV-2 Epidemic in Italy: Results From a National, Multicenter Survey." Pediatric Rheumatology Online Journal, vol. 19, no. 1, 2021, p. 29.
Cattalini M, Della Paolera S, Zunica F, et al. Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey. Pediatr Rheumatol Online J. 2021;19(1):29.
Cattalini, M., Della Paolera, S., Zunica, F., Bracaglia, C., Giangreco, M., Verdoni, L., Meini, A., Sottile, R., Caorsi, R., Zuccotti, G., Fabi, M., Montin, D., Meneghel, A., Consolaro, A., Dellepiane, R. M., Maggio, M. C., La Torre, F., Marchesi, A., Simonini, G., ... Taddio, A. (2021). Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey. Pediatric Rheumatology Online Journal, 19(1), 29. https://doi.org/10.1186/s12969-021-00511-7
Cattalini M, et al. Defining Kawasaki Disease and Pediatric Inflammatory Multisystem Syndrome-temporally Associated to SARS-CoV-2 Infection During SARS-CoV-2 Epidemic in Italy: Results From a National, Multicenter Survey. Pediatr Rheumatol Online J. 2021 Mar 16;19(1):29. PubMed PMID: 33726806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey. AU - Cattalini,Marco, AU - Della Paolera,Sara, AU - Zunica,Fiammetta, AU - Bracaglia,Claudia, AU - Giangreco,Manuela, AU - Verdoni,Lucio, AU - Meini,Antonella, AU - Sottile,Rita, AU - Caorsi,Roberta, AU - Zuccotti,Gianvincenzo, AU - Fabi,Marianna, AU - Montin,Davide, AU - Meneghel,Alessandra, AU - Consolaro,Alessandro, AU - Dellepiane,Rosa Maria, AU - Maggio,Maria Cristina, AU - La Torre,Francesco, AU - Marchesi,Alessandra, AU - Simonini,Gabriele, AU - Villani,Alberto, AU - Cimaz,Rolando, AU - Ravelli,Angelo, AU - Taddio,Andrea, AU - ,, Y1 - 2021/03/16/ PY - 2020/11/10/received PY - 2021/02/28/accepted PY - 2021/3/17/entrez PY - 2021/3/18/pubmed PY - 2021/3/30/medline KW - Coronary artery abnormalities KW - Hypotension KW - Kawasaki disease KW - Multisystem inflammatory syndrome associated with coronavirus disease KW - Myocarditis KW - Pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection KW - SARS-CoV-2 SP - 29 EP - 29 JF - Pediatric rheumatology online journal JO - Pediatr Rheumatol Online J VL - 19 IS - 1 N2 - BACKGROUND: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths. SN - 1546-0096 UR - https://www.unboundmedicine.com/medline/citation/33726806/Defining_Kawasaki_disease_and_pediatric_inflammatory_multisystem_syndrome_temporally_associated_to_SARS_CoV_2_infection_during_SARS_CoV_2_epidemic_in_Italy:_results_from_a_national_multicenter_survey_ L2 - https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-021-00511-7 DB - PRIME DP - Unbound Medicine ER -