An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study

The Bergamo province, which is extensively affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence...

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Bibliographic Details
Published in:	The Lancet 2020-06, Vol.395 (10239), p.1771-1778
Main Authors:	Verdoni, Lucio, Mazza, Angelo, Gervasoni, Annalisa, Martelli, Laura, Ruggeri, Maurizio, Ciuffreda, Matteo, Bonanomi, Ezio, D'Antiga, Lorenzo
Format:	Article
Language:	eng
Subjects:	Arthritis Betacoronavirus Blood Cell activation Child Child, Preschool Children Clinical trials Cohort analysis Coronary artery disease Coronavirus Infections - epidemiology Coronaviruses COVID-19 Disease Outbreaks Epidemics Erythema Female Fever Girls Heart diseases Heart rate Hospitals Humans Immune response Immunoglobulin G Immunoglobulin M Immunoglobulins Infections Italy Kawasaki disease Laboratories Macrophages Male Medical research Mucocutaneous lymph node syndrome Mucocutaneous Lymph Node Syndrome - epidemiology Observational studies Outbreaks Pandemics Pathogenesis Pediatrics Pneumonia, Viral - epidemiology Respiratory diseases Retrospective Studies Rheumatology SARS-CoV-2 Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Statistical analysis Steroids Ultrasonic imaging Viral diseases Viruses Vital signs
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Summary:	The Bergamo province, which is extensively affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic. All patients diagnosed with a Kawasaki-like disease at our centre in the past 5 years were divided according to symptomatic presentation before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. Kawasaki- like presentations were managed as Kawasaki disease according to the American Heart Association indications. Kawasaki disease shock syndrome (KDSS) was defined by presence of circulatory dysfunction, and macrophage activation syndrome (MAS) by the Paediatric Rheumatology International Trials Organisation criteria. Current or previous infection was sought by reverse-transcriptase quantitative PCR in nasopharyngeal and oropharyngeal swabs, and by serological qualitative test detecting SARS-CoV-2 IgM and IgG, respectively. Group 1 comprised 19 patients (seven boys, 12 girls; aged 3·0 years [SD 2·5]) diagnosed between Jan 1, 2015, and Feb 17, 2020. Group 2 included ten patients (seven boys, three girls; aged 7·5 years [SD 3·5]) diagnosed between Feb 18 and April 20, 2020; eight of ten were positive for IgG or IgM, or both. The two groups differed in disease incidence (group 1 vs group 2, 0·3 vs ten per month), mean age (3·0 vs 7·5 years), cardiac involvement (two of 19 vs six of ten), KDSS (zero of 19 vs five of ten), MAS (zero of 19 vs five of ten), and need for adjunctive steroid treatment (three of 19 vs eight of ten; all p
ISSN:	0140-6736 1474-547X