(Daily News Scan - DNS English) Kawasaki Disease and Its Symptoms
Most of the nations around the globe are fighting against Coronavirus. India is also not left behind in this fight. While the numbers of coronavirus patients are increasing day by day, new symptoms associating it are also being discovered from time to time. Children infected with coronavirus are showing some symptoms like rashes and inflammation that are associated with a rare illness called Kawasaki disease. Similar symptoms could be found in children who were tested negative for Covid-19. Such cases were reported since the month of April from US and Europe. Children in India too are experiencing similar symptoms. Doctors in India have started seeing such cases over the last few weeks.
In this DNS we will know about Kawasaki disease and its link to Covid-19.
The Kawasaki disease mainly affects children. The disease derives its name from a Japanese paediatrician, Tomisaku Kawasaki, who reported the first case in 1961 of a four-year-old boy. Later on similar cases were found in other children.
The root cause of this disease is not known. However, the disease symptoms include red eyes, rashes, and a swollen tongue with reddened lips, often termed as strawberry tongue and an inflamed blood vessel system all over the body. There is constant high fever for at least five days. Coronary functions in the heart are also affected by this disease.
Children who are infected with Covid-19, are mostly asymptomatic or sometimes develop mild symptoms. But in rare cases children with Covid-19 have shown symptoms similar to those of Kawasaki disease, 2-3 weeks after getting infected with coronavirus. In India, too, the cases that have been coming up have shown some of the symptoms associated with Kawasaki disease, but with slight differences.
In one of the cases that appeared in month of June a 14 year old girl came with high fever and rashes. She was tested Covid-19 positive. One June 26, she was admitted to the ICU and was critical, but has since recovered and was discharged recently. She had rashes and high fever like Kawasaki, but other symptoms like red eyes, red tongue were not present. Her heart was swollen but coronary functions were not affected like in Kawasaki.
In one of the hospitals, paediatric cardiologist have come across four cases in the last three months with Kawasaki-like symptoms, of whom two required ventilator support. But all four were tested negative for Covid-19.
The four children had rashes, inflammation in entire blood vessel system, but they did not entirely fit in Kawasaki disease definition.
Kawasaki mostly affects children under the age of five. In Covid-19 cases, even adolescents are showing these symptoms. While Kawasaki involves coronary changes, this has not been the case with all Covid-19-positive children with Kawasaki-like symptoms. The strawberry tongue may or may not be present in those with Covid-19.
The Royal College of Paediatricians and Child Health (RCPCH) has observed that this syndrome shares symptoms with other inflammatory syndromes in children like Kawasaki disease, staphylococcal and streptococcal toxic shock syndromes, bacterial sepsis and macrophage activation syndrome. It can also present with unusual abdominal symptoms.
The RCPCH says that in multisystem inflammatory syndrome, children may or may not test positive for Covid-19 and show inflammation, persistent fever, single or multi-organ dysfunction.
The Centers for Disease Control and Prevention (CDC) in the US states that- currently it is unknown if multisystem inflammatory syndrome (MIS) is specific to children or if it also occurs in adults. The CDC has taken note of cases in the UK and New York, where children with recent or current Covid-19 infection developed inflammation. There is limited information available about risk factors, pathogenesis, clinical course, and treatment for MIS.
But a few things are very clear, it is seen in patients aged less than 19; inflammation, abdominal pain, diarrhoea are common; heart attack and septic shock may happen. According to WHO, there also will be a history of contact with a positive case of Covid-19.
If we talk about the treatment, the 14 year old patient was on steroids to reduce inflammation, at a dosage 10 times higher than usual. She was also treated with the drug Tocilizumab for Covid-19 management. As per the doctor “Antivirals may not work in such cases.”
The four other children who were affected by the same disease, among them 2 were on ventilator for 10 days. They were in septic shock, unable to breathe, their heart functions were poor, and they could not pass urine due to kidney problems.
As per the doctors, in symptoms like these where very less information is available, only symptomatic therapy is provided. A supportive therapy for each organ was provided to them. Steroids remain a key treatment to reduce inflammation.
In India any registry on Kawasaki-like disease or multisystem inflammatory syndrome to know how many children have it along with Covid-19 is still not maintained. Last month, World Health Organization (WHO) termed this new illness “multisystem inflammatory disorder.
