tetano
Editor, Senior Moderator
Rheumatology (Oxford)
. 2021 Jan 25;keab026.
doi: 10.1093/rheumatology/keab026. Online ahead of print.
Delineating phenotypes of Kawasaki disease and SARS-CoV-2-related inflammatory multisystem syndrome: A French study and literature review
Bilade Cherqaoui[SUP] 1 2 3 [/SUP], Isabelle Kon?-Paut[SUP] 1 2 4 [/SUP], H?l?ne Yager[SUP] 1 [/SUP], Fleur Le Bourgeois[SUP] 5 [/SUP], Maryam Piram[SUP] 2 4 6 [/SUP]
Affiliations
Abstract
Objective: To better define the clinical distinctions between the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related paediatric inflammatory multi-system syndrome (PIMS) and Kawasaki disease (kDa).
Methods: We compared three groups of patients: group 1, cases from our national historic kDa database (kDa-HIS); group 2, patients with kDa admitted to an intensive care unit (kDa-ICU) from both our original cohort and the literature; and group 3, patients with PIMS from the literature.
Results: kDa-HIS included 425 patients (male to female ratio 1.3, mean age 2.8 ? 2.4 years), kDa-ICU 176 (male to female ratio 1.3, mean age 3.5 ? 3.1 years), and PIMS 404 (male to female ratio 1.4, mean age 8.8 ? 3.7 years). As compared with kDa-HIS patients, kDa-ICU and PIMS patients had a higher proportion of cardiac failure and digestive and neurological signs. They also had lower frequency of typical mucocutaneous signs, lower platelet count, higher C-reactive protein level, and lower sodium level. As compared with kDa-HIS and kDa-ICU patients, PIMS patients were older and more frequently had myocarditis. They had fewer coronary abnormalities and lower sodium level. Unresponsiveness to intravenous immunoglobulins was more frequent in kDa-ICU than kDa-HIS and PIMS patients.
Conclusion: On clinical grounds, regular kDa, kDa-ICU and PIMS might belong to a common spectrum of non-specific pathogen-triggered hyperinflammatory states. The causes of increasing inflammation severity within the three entities and the different effects on the heart remain to be determined.
Keywords: COVID-19; Intensive Care Unit; Intravenous Immunoglobulins; Kawasaki disease; PIMS/MIS-C; SARS-CoV-2–related inflammatory multisystem syndrome; Shock syndrome; Systemic vasculitis.
. 2021 Jan 25;keab026.
doi: 10.1093/rheumatology/keab026. Online ahead of print.
Delineating phenotypes of Kawasaki disease and SARS-CoV-2-related inflammatory multisystem syndrome: A French study and literature review
Bilade Cherqaoui[SUP] 1 2 3 [/SUP], Isabelle Kon?-Paut[SUP] 1 2 4 [/SUP], H?l?ne Yager[SUP] 1 [/SUP], Fleur Le Bourgeois[SUP] 5 [/SUP], Maryam Piram[SUP] 2 4 6 [/SUP]
Affiliations
- PMID: 33493353
- DOI: 10.1093/rheumatology/keab026
Abstract
Objective: To better define the clinical distinctions between the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related paediatric inflammatory multi-system syndrome (PIMS) and Kawasaki disease (kDa).
Methods: We compared three groups of patients: group 1, cases from our national historic kDa database (kDa-HIS); group 2, patients with kDa admitted to an intensive care unit (kDa-ICU) from both our original cohort and the literature; and group 3, patients with PIMS from the literature.
Results: kDa-HIS included 425 patients (male to female ratio 1.3, mean age 2.8 ? 2.4 years), kDa-ICU 176 (male to female ratio 1.3, mean age 3.5 ? 3.1 years), and PIMS 404 (male to female ratio 1.4, mean age 8.8 ? 3.7 years). As compared with kDa-HIS patients, kDa-ICU and PIMS patients had a higher proportion of cardiac failure and digestive and neurological signs. They also had lower frequency of typical mucocutaneous signs, lower platelet count, higher C-reactive protein level, and lower sodium level. As compared with kDa-HIS and kDa-ICU patients, PIMS patients were older and more frequently had myocarditis. They had fewer coronary abnormalities and lower sodium level. Unresponsiveness to intravenous immunoglobulins was more frequent in kDa-ICU than kDa-HIS and PIMS patients.
Conclusion: On clinical grounds, regular kDa, kDa-ICU and PIMS might belong to a common spectrum of non-specific pathogen-triggered hyperinflammatory states. The causes of increasing inflammation severity within the three entities and the different effects on the heart remain to be determined.
Keywords: COVID-19; Intensive Care Unit; Intravenous Immunoglobulins; Kawasaki disease; PIMS/MIS-C; SARS-CoV-2–related inflammatory multisystem syndrome; Shock syndrome; Systemic vasculitis.