J Korean Med Sci.  2023 Dec;38(49):e410. 10.3346/jkms.2023.38.e410.

Clinical and Laboratory Characteristics of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children

• Phi DL
• Dao TL
• Manh To M
• Nguyen TB
• Nguyen DC
• Gautret P
• Hoang VT

• KMID: 2549175
• DOI: http://doi.org/10.3346/jkms.2023.38.e410

Abstract

Geographical and racial factors constitute important distinctions between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C), but no study has been conducted in Vietnam. Forty-one children with KD from January 2018 to July 2020 and 42 with KD/MIS-C from August 2020 to December 2022 were included in this study. Of the patients, 52.3% were aged between 12 and 35 months. Only two were aged over 5 years, and both were belong to the KD/MIS-C group. A 59.5% of the patients were male. Apart from fever, all symptoms tended to be more frequent in patients with KD/MIS-C. The prevalence of diffuse skin rash, hand and foot edema or erythema and gastrointestinal signs was significantly higher in patients hospitalized with KD/MIS-C. There was no significant difference in laboratory findings between the two groups. Coronary artery dilation was more frequently observed in patients with KD/MIS-C compared to those with KD (40.5% vs. 14.6%, P = 0.009).

Keyword

Kawasaki Disease; Multisystem Inflammatory Syndrome in Children; Multisystem Inflammatory Syndrome in Children

Reference

1. Noval Rivas M, Arditi M. Kawasaki disease and multisystem inflammatory syndrome in children. Rheum Dis Clin North Am. 2023; 49(3):647–659. PMID: 37331738.

2. Gkoutzourelas A, Bogdanos DP, Sakkas LI. Kawasaki disease and COVID-19. Mediterr J Rheumatol. 2020; 31(Suppl 2):268–274. PMID: 33196004.

3. Patel JM. Multisystem inflammatory syndrome in children (MIS-C). Curr Allergy Asthma Rep. 2022; 22(5):53–60. PMID: 35314921.

4. Chen MR, Kuo HC, Lee YJ, Chi H, Li SC, Lee HC, et al. Phenotype, susceptibility, autoimmunity, and immunotherapy between Kawasaki disease and coronavirus disease-19 associated multisystem inflammatory syndrome in children. Front Immunol. 2021; 12:632890. PMID: 33732254.

5. Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int. 2021; 41(1):19–32. PMID: 33219837.

6. Lee MS, Liu YC, Tsai CC, Hsu JH, Wu JR. Similarities and differences between COVID-19-related multisystem inflammatory syndrome in children and Kawasaki disease. Front Pediatr. 2021; 9:640118. PMID: 34222140.

7. Sharma C, Ganigara M, Galeotti C, Burns J, Berganza FM, Hayes DA, et al. Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat Rev Rheumatol. 2021; 17(12):731–748. PMID: 34716418.

8. Wessels PA, Bingler MA. A comparison of Kawasaki disease and multisystem inflammatory syndrome in children. Prog Pediatr Cardiol. 2022; 65:101516. PMID: 35313700.

9. Yeo WS, Ng QX. Distinguishing between typical Kawasaki disease and multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2. Med Hypotheses. 2020; 144:110263. PMID: 33254568.

10. Zhang QY, Xu BW, Du JB. Similarities and differences between multiple inflammatory syndrome in children associated with COVID-19 and Kawasaki disease: clinical presentations, diagnosis, and treatment. World J Pediatr. 2021; 17(4):335–340. PMID: 34013488.

11. Bar-Meir M, Guri A, Godfrey ME, Shack AR, Hashkes PJ, Goldzweig O, et al. Characterizing the differences between multisystem inflammatory syndrome in children and Kawasaki disease. Sci Rep. 2021; 11(1):13840. PMID: 34226639.

12. Cattalini M, Della Paolera S, Zunica F, Bracaglia C, Giangreco M, Verdoni L, 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. PMID: 33726806.

13. Esteve-Sole A, Anton J, Pino-Ramirez RM, Sanchez-Manubens J, Fumadó V, Fortuny C, et al. Similarities and differences between the immunopathogenesis of COVID-19-related pediatric multisystem inflammatory syndrome and Kawasaki disease. J Clin Invest. 2021; 131(6):131.

14. Pick JM, Wang S, Wagner-Lees S, Badran S, Szmuszkovicz JR, Wong P, et al. Abstract 17092: coronary artery aneurysms are more common in post-COVID-19 multisystem inflammatory syndrome in children (MIS-C) than pre-pandemic Kawasaki disease. Circulation. 2020; 142(Suppl_3):A17092–A17092.

15. Rashid U, Nawaz R, Mahmood T, et al. Multisystem inflammatory syndrome (MIS-C) in children on Kawasaki syndrome spectrum: what’s new, local regional experience from Pakistan. Prof Med J. 2022; 29(9):1392–1399.

16. Zhou C, Zhao Y, Wang X, Huang Y, Tang X, Tang L. Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease. Pediatr Pulmonol. 2021; 56(12):3688–3698. PMID: 34583417.

17. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017; 135(17):e927–e999. PMID: 28356445.

18. Centers for Disease Control and Prevention. Multisystem inflammatory syndrome (MIS). Updated 2020. Accessed June 19, 2023. https://www.cdc.gov/mis/mis-c/hcp_cstecdc/index.html .

19. Godfred-Cato S, Abrams JY, Balachandran N, Jaggi P, Jones K, Rostad CA, et al. Distinguishing multisystem inflammatory syndrome in children from COVID-19, Kawasaki disease and toxic shock syndrome. Pediatr Infect Dis J. 2022; 41(4):315–323. PMID: 35093995.

20. Cherqaoui B, Koné-Paut I, Yager H, Bourgeois FL, Piram M. Delineating phenotypes of Kawasaki disease and SARS-CoV-2-related inflammatory multisystem syndrome: a French study and literature review. Rheumatology (Oxford). 2021; 60(10):4530–4537. PMID: 33493353.

21. Fabi M, Filice E, Biagi C, Andreozzi L, Palleri D, Mattesini BE, et al. Multisystem inflammatory syndrome following SARS-CoV-2 infection in children: one year after the onset of the pandemic in a high-incidence area. Viruses. 2021; 13(10):2022. PMID: 34696451.

22. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020; 324(3):259–269. PMID: 32511692.

23. Middelburg JG, Crijnen TEM, D’Antiga L, Verdoni L, Chikermane A, Garg P, et al. Association of ethnicity with multisystem inflammatory syndrome in children related to SARS-CoV-2 infection: an international case-referent study. Front Pediatr. 2021; 9:707650. PMID: 34722416.

24. Li W, Tang Y, Shi Y, Chen Y, Liu E. Why multisystem inflammatory syndrome in children has been less commonly described in Asia? Transl Pediatr. 2020; 9(6):873–875. PMID: 33457311.

25. Rowley AH. Multisystem inflammatory syndrome in children and Kawasaki disease: two different illnesses with overlapping clinical features. J Pediatr. 2020; 224:129–132. PMID: 32585239.

26. Belay ED, Abrams J, Oster ME, Giovanni J, Pierce T, Meng L, et al. Trends in geographic and temporal distribution of US children with multisystem inflammatory syndrome during the COVID-19 pandemic. JAMA Pediatr. 2021; 175(8):837–845. PMID: 33821923.

27. Consiglio CR, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19. Cell. 2020; 183(4):968–981.e7. PMID: 32966765.

28. Olin A, Henckel E, Chen Y, Lakshmikanth T, Pou C, Mikes J, et al. Stereotypic immune system development in newborn children. Cell. 2018; 174(5):1277–1292.e14. PMID: 30142345.

29. Matsubara D, Kauffman HL, Wang Y, Calderon-Anyosa R, Nadaraj S, Elias MD, et al. Echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States. J Am Coll Cardiol. 2020; 76(17):1947–1961. PMID: 32890666.

30. Farooqi KM, Chan A, Weller RJ, Mi J, Jiang P, Abrahams E, et al. Longitudinal outcomes for multisystem inflammatory syndrome in children. Pediatrics. 2021; 148(2):e2021051155. PMID: 34266903.

31. Advani N, Sastroasmoro S, Ontoseno T, Uiterwaal CS. Long-term outcome of coronary artery dilatation in Kawasaki disease. Ann Pediatr Cardiol. 2018; 11(2):125–129. PMID: 29922008.