Kawasaki disease is not new, but it has begun to be talked about these days as a result of several cases of a strange syndrome that has been seen in children and that could be related to the new coronavirus.
The alarm went off last Sunday, April 26, when the Pediatric Intensive Care Society of the United Kingdom (PICS) published on Twitter an “urgent alert” in which it was reported a small increase in the cases of sick children who presented “overlapping characteristics of toxic shock syndrome and atypical Kawasaki disease with blood parameters ” .
Days later, it was known that the Spanish Association of Pediatrics (AEP) had sent a statement to pediatricians and other doctors alerting them to cases of pediatric shock in the United Kingdom, Italy, France and Belgium . The statement reported the appearance “in the last two weeks of a number of pediatric patients, characterized by an unusual picture of abdominal pain, accompanied by gastrointestinal symptoms (diarrhea and / or vomiting), with an acceptable general condition, but which may evolve in a few hours towards shock, with tachycardia and hypotension, even in the absence of fever ”. “In addition, they are usually accompanied by fever, erythroderma and conjunctival injection overlapping with two possible entities such as Kawasaki disease and toxic shock syndrome .”
And now is when the public enemy number 1 of the moment enters the scene: the coronavirus. It turns out that some of the children who had presented this strange syndrome had tested positive for coronavirus but others had not, so the association between both pathologies cannot yet be established . In this sense, last Tuesday the director of the Center for the Coordination of Health Alerts and Emergencies, Fernando Simón, said at a press conference the following: “Right now in a syndrome that is being seen in some children, some of them seem to have been infected with the coronavirus and others not. Therefore, right now it is difficult to make an assessment of its association with a previous infection with coronavirus ”.
The AEP, in another statement, called for calm because “the clinical picture reported in this professional communication is very infrequent , and very few cases have been described in Spain. Thanks to the Spanish pediatric model, by which primary care pediatricians are the children’s first contact with health -very well trained and already alerted to these possible conditions-, this would allow us to act at the first symptoms. As has been shown in clinical practice, we continue to insist that the vast majority of cases COVID-19 occurs mildly in children “.
Kawasaki disease
And what is Kawasaki disease? This rare disease that affects children causes the walls of the blood vessels to become inflamed: arteries, veins and capillaries . Although the majority of children who contract it recover completely (there is treatment, mainly pharmacological. In very few cases surgery is needed), its most feared complication is the coronary aneurysm , in which the heart arteries dilate.
The cause of Kawasaki disease is unknown, but according to the Heart Foundation, it is suspected that there may be a genetic component that causes the immune system to overreact after an infection probably caused by a virus.
Symptoms of Kawasaki disease are: high fever lasting more than five days, rash, especially on the torso, swollen lymph nodes, red eyes, and / or swollen lips, throat, and tongue. Abdominal pain can also occur. And sometimes flaking of the hands and fingers .
Toxic shock
Toxic shock is caused by a toxin produced by some types of staph bacteria. It is serious (it can be fatal in up to 50% of cases) and presents with fever, shock, and problems in various organs of the body (kidney, heart, and liver failure).
Symptoms of toxic shock include: confusion, diarrhea, malaise, headaches, high fever, sometimes accompanied by chills, low blood pressure, muscle aches, nausea and vomiting, organ failure (usually the kidneys and liver) , redness of the eyes, mouth and throat, seizures and a generalized red rash that resembles a sunburn: peeling of the skin occurs 1 to 2 weeks after the rash, especially on the palms of the hands or soles of the feet.
And what are the causes? Risk factors include the use of tampons if they are not changed frequently (the first cases of toxic shock described were due to this cause), having recently had surgery, infection of a wound after surgery, a staph infection, infections skin, burns, foreign bodies inside the body and having recently given birth .
Pediatric shock that has been observed
What is the strange syndrome that can end in shock observed in children these days? It is a pathology that presents characteristics of Kawasaki disease and toxic shock.
“Cases of shock in children that are temporarily coinciding with the COVID-19 epidemic are very rare; the clinical picture is characterized by fever, vomiting, initially or it may appear only with abdominal pain, skin rash, red eyes, and poor general condition. We do not yet know the cause, but it can be triggered by bacterial infections and has a well-established treatment regardless of the type of infectious agent that causes it ”, can be read in the AEP statement issued on April 28. “From the AEP we are proceeding to compile all the existing information and well-documented scientific evidence regarding this pediatric clinical picture that is being described in different countries.”
As we have commented previously, this pediatric shock has affected some children who had tested positive for coronavirus by doing PCR (detects RNA of the virus), others by doing serological tests (detects antibodies that the body has developed to fight the disease, which indicates that the person has passed COVID-19) and others were negative . Therefore, it is not yet possible to establish a link between the new coronavirus and the pediatric shock reported these days by several European countries.
