The one thing that we all really know about COVID19 is that this novel virus keeps evolving and is showing the world new things every week.
Recently, 64 children in NYS and other children in Europe and the US have now been affected with a new inflammatory syndrome.Up to now, we haven’t heard kids being largely affected with clinical illness associated with COVID 19.
Now reports of a mysterious syndrome in children which may be related to COVID-19 has been reported by several physicians in recent weeks including:- Fever- Rash- Eye irritation- Swollen Lymph nodes- Swelling of the Hands and feet in Europe and the US, in severe cases, some children have very low blood pressure or SHOCK and treated in the ICUs.
Some physicians describe this illness as being similar to Kawasaki Disease, a rare blood vessel disorder. I saw this disease as a rheumatology fellow.
What is Kawasaki disease?
This disease was first characterized in the 1960s and was originally called “mucocutaneous lymph node disease” and usually occurs in children older than 3 months but is usually most common in children under 5 years old. Older children can be affected and boys are affected more. The disease is usually seen in winter and spring months like other viral illnesses. Adults tend not to get this disease. The etiology is unknown however there is a suggestion of a possible infectious cause. The MEDIUM-SIZED ARTERIES are affected so it is considered a vasculitis. The coronary arteries may be affected which supplies the heart muscle.
Features of Kawasaki Disease are:
- Fever lasting 5 or more days (Temp 100.4 or higher)
- Diffuse rash (starting at the chest area)- Redness of the eyes (conjunctival injection) WITHOUT eye discharge
- Redness or swelling of palms of hands or soles of feet which may peel
- “Strawberry tongue”– Redness or cracking of the lips and tongue- Swollen lymph nodes in the neck (usually unilateral)-Irritability can be seen in young children
Some children may also experience joint pain and welling as well as abdominal pain, diarrhea and vomiting. These symptoms may slowly go away in most cases but there are complications to worry about.
There does appear to be some similarities with the new syndrome in children being recognized during the pandemic.
COMPLICATIONS in kids include: Risk of developing aneurysms within the heart putting them at risk for HEART ATTACKS or blood clots.
The heart blood vessels AND heart muscle may be affected. Heart valve problems may also occur.- KD can cause death in a small percentage of children if the coronary artery is affected.
DIAGNOSIS
It is made largely based on clinical symptoms and physical exam.
A physician may check for:
- Inflammation markers, white blood cell count, hemoglobin
- Other autoimmune tests to rule out other disorders (RF, ANCA antibodies).
- It is important to rule out INFECTION (measles, tick-borne illnesses, and Scarlett fever caused by Streptococcal organisms.- Juvenile Rheumatoid Arthritis must also be excluded by a rheumatologist.
- Testing for B-type natriuretic peptide (BNP), a substance that is leaked by the heart when stressed
- EKG (electrocardiogram)- Echocardiogram
- All children who are suspected to have KD NEED to be evaluated by a cardiologist to continue cardiac monitoring.
COMPLICATIONS in kids include: Risk of developing aneurysms within the heart putting them at risk for HEART ATTACKS
TREATMENT for Kawasaki Disease
is Intravenous Immunoglobulin or an immune protein to decrease inflammation and decrease the chance of developing the coronary aneurysms. High dose Aspirin therapy is given a few times a daily initially but reduced. Some kids have to take it indefinitely. Aspirin use in children must be monitored for Reye Syndrome, a life-threatening complication that occurs if the child had influenza or chickenpox. The brain and liver are affected by this syndrome. For most children, there are no long term complications from KD however a few have coronary artery involvement and need chronic heart monitoring by a cardiologist.
It is still unclear if SARS-CoV-2 virus causes a typical Kawasaki disease or a similar syndrome. Let’s wait and see but physicians NEED to know about this pediatric presentation.
Disclaimer: This blog contains my personal opinion based on personal and clinical experience, tips from trainers, health coaches and lastly research. This blog does not endorse specific treatments, procedures, products. You should always consult with a doctor, nutritionist, or other healthcare professional to discuss your own health and lifestyle goals and regimen based on your medical history. Thank you for reading!