Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study

  1. Julie Toubiana
  2. Clément Poirault
  3. Alice Corsia
  4. Fanny Bajolle
  5. Jacques Fourgeaud
  6. François Angoulvant
  7. Agathe Debray
  8. Romain Basmaci
  9. Elodie Salvador
  10. Sandra Biscardi
  11. Pierre Frange
  12. Martin Chalumeau
  13. Jean-Laurent Casanova
  14. Jérémie F Cohen
  15. Slimane Allali

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Abstract

Objectives

To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Design

Prospective observational study.

Setting

General paediatric department of a university hospital in Paris, France.

Participants

21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020.

Main outcome measures

The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus.

Results

21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home.

Conclusions

The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.10.20097394: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Ethics Committee (Comité de Protection des Personnes Ouest IV, n° DC-2017-2987).
    Consent: All parents provided written informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    For the purposes of this study, the diagnosis of KD was based on the criteria of the American Heart Association for complete and incomplete KD,7 and the criteria proposed by Kanegaye et al. were used for the diagnosis of KDSS.
    American Heart Association
    suggested: (American Heart Association, RRID:SCR_007210)
    Statistical analysis involved use of SPSS v21 (SPSS Inc., Chicago, IL).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations; First, there is a potential recruitment bias that may have contributed to the significant rise in the number of KD patients hospitalised in our paediatric department. Our hospital is the referral centre for severe pediatric COVID-19 in the Paris area. Second, the low number of patients precluded in-depth comparisons of phenotypes with adequate statistical power. Conclusions: Our study documents an outbreak of KD in the Paris area and its association with recent SARS-CoV-2 infection. KD cases reported here have characteristics that differ from classic KD: this present form seems to be much more frequent among children of African ancestry, with predominant acute gastrointestinal manifestations, haemodynamic instability and myocarditis. These clinical findings should prompt a high degree of vigilance among primary care and emergency physicians, and preparedness in countries with a high proportion of children of African ancestry, while facing SARS-CoV-2 epidemic.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1136/bmj.m2094
  3. Version published to 10.1101/2020.05.10.20097394 on medRxiv