Little Hearts Need to be Cautious of COVID-19 and Kawasaki Disease

Translated by AI
In the midst of the COVID-19 pandemic, a link between diseases with symptoms similar to Kawasaki disease and COVID-19 has been discovered, resulting in deaths of children from complications due to inflammation of the heart or coronary arteries, which nourish the heart muscle becoming swollen or blocked, leading to muscle ischemia. Therefore, parents and guardians should not be complacent, monitor and closely observe symptoms, and if in doubt, immediately take the child to see a doctor.
Children and COVID-19
COVID-19 infection, officially known as SAR–CoV-2, is a virus that was first detected in Wuhan, China in December 2019. Since then, it has spread globally, with the World Health Organization (WHO) declaring it a global pandemic in March 2020. Millions of confirmed infections and several hundred thousand deaths from the disease have been reported worldwide. The first patient in Thailand was reported in January 2020, being the first case found outside of China. COVID-19 is caused by a virus in the Corona Virus family. Initial reports found that most severely ill patients were adults. In China and the United States, patients under the age of 18 accounted for only 2.2% and 2% of infections, respectively.
Children infected with COVID-19 often show no symptoms or only mild symptoms. Around mid-April 2020 (about one month after the outbreak in Europe), pediatricians in England reported unexplained sick children with high fever, headache, sore throat, abdominal pain, and vomiting. Some showed rashes and shock, similar to Toxic Shock Syndrome. Some showed rashes, red eyes, red mouth, meeting the diagnostic criteria for Kawasaki disease (Kawasaki Disease). Additionally, some patients were found to have coronary artery swelling similar to children with Kawasaki Disease, with almost all showing immune responses indicating a past COVID-19 infection, whether or not the virus was found in the respiratory tract of the patients.
The Royal College of Paediatrics and Child Health in the UK issued a letter warning about the disease on 27 April 2020, naming it Pediatric Multisystem Inflammatory Syndrome – Temporally Associated with COVID-19 (PIMS-TS). Subsequently, the condition has been confirmed in children from several countries in Europe and the USA, with some cases being severe enough to cause death. The Center for Disease Control (CDC) in the USA issued a warning about the disease on 14 May 2020, naming it Multisystem Inflammatory Syndrome in Children Associated with COVID-19 (MIS-C).
Heart Disease and KAWASAKI DISEASE
Kawasaki Disease was first discovered by Dr.Tomisaku Kawasaki in 1961, with reports published in Japanese and English medical journals in 1967 and 1974 respectively. The exact cause of the disease is still unknown but it commonly occurs in children under the age of 5 with a fever lasting more than 4 – 5 days. Other symptoms include
- Rash
- Red eyes
- Red mouth and/or tongue (Strawberry Tongue)
- Swelling and redness of the hands and feet
- Swollen lymph nodes in the neck
If at least 4 of the symptoms are present, it is called Complete Kawasaki Disease. In some cases, there may be fewer than 4 symptoms, called Incomplete Kawasaki Disease. A significant complication of the disease is inflammation of the coronary arteries (Coronary Artery), which can lead to swelling of the heart arteries (Aortic Aneurysm), possibly leading to acute myocardial infarction and sudden heart death.
Heart Disease and MIS-C
Multisystem Inflammatory Syndrome in Children or MIS-C causes inflammation in multiple organs, with symptoms and clinical presentations similar to Kawasaki Disease, such as
- High fever
- Rash
- Red eyes
- Red mouth
- Swollen lymph nodes
Coronary Artery Aneurysm has been reported in some patients, but there are several differences, e.g., the age of MIS-C patients tends to be older compared to Kawasaki Disease, which usually affects younger children. Gastrointestinal symptoms and shock are more common in MIS-C than in Kawasaki Disease, and laboratory results often show more severe inflammation. Additionally, no increased incidence of MIS-C has been found in children of East Asian descent, such as Japan, Korea, China, as observed in Kawasaki Disease.
Care for Patients with MIS-C and KAWASAKI DISEASE
Currently, there is no clear guideline for treating MIS-C like Kawasaki Disease, as MIS-C is a newly identified condition that can pose a risk to various organs, especially the heart and blood circulation system. Patients with symptoms that could indicate this disease should see a doctor, who will consider appropriate treatment. Patients diagnosed with MIS-C should be hospitalized for monitoring. Patients meeting the diagnostic criteria for Kawasaki Disease usually receive similar treatment, whereas others may receive supportive care. Some patients require treatment in the Intensive Care Unit (ICU) and/or drugs to suppress an overactive immune system.
Both MIS-C and Kawasaki Disease are caused by an abnormal autoimmune response, showing similar symptoms. Whether COVID-19 infection can cause Kawasaki Disease is still unclear. Therefore, if a child has symptoms similar to MIS-C or Kawasaki Disease, even without a history of contact with a COVID-19 infected person, parents should immediately take them to see a doctor. Prompt treatment can increase the chances of recovery and survival. Moreover, everyone should follow the Ministry of Health’s recommendations to prevent the spread of COVID-19.
Ref.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.
