COVID-19: Italian Province Reports Spike in Kawasaki-Like Disease

By Amy Orciari Herman

Edited by Richard Saitz, MD, MPH, FACP, DFASAM

The province of Bergamo, Italy, experienced a 30-fold increase in Kawasaki-like disease during the region's novel coronavirus (COVID-19) outbreak, according to a Lancet study. The finding adds to mounting evidence linking COVID-19 to what some are calling "pediatric multisystem inflammatory syndrome."

Ten children who developed Kawasaki-like disease during the COVID-19 epidemic were compared with 19 patients diagnosed with the illness during the prior 5 years. Eight of the ten patients during the epidemic tested positive for SARS-CoV-2 antibodies.

The incidence of Kawasaki-like disease was 10 per month during COVID-19, versus just 0.3 per month previously. Additionally, the epidemic cohort was older (mean age, 7.5 vs. 3.0 years) and had a more severe disease course: they were more likely to have abnormal echocardiography (60% vs. 10%), Kawasaki disease shock syndrome (50% vs. 0%), and macrophage activation syndrome (50% vs. 0%). The epidemic cohort was also more likely to require steroids in addition to intravenous immunoglobulin (80% vs. 16%).

The researchers write, "The association between SARS-CoV-2 and Kawasaki-like disease should be taken into account when it comes to considering social reintegration policies for the paediatric population. However, the Kawasaki-like disease described here remains a rare condition, probably affecting no more than one in 1000 children exposed to SARS-CoV-2."

Separately, the authors of a Hospital Pediatrics editorial discuss whether the association between COVID-19 and Kawasaki disease is causal and conclude that while "promoting awareness is crucial ... we must tread carefully and objectively."