1. Kawasaki Disease in the Time of COVID-19 and MIS-C: The International Kawasaki Disease Registry.
- Author
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Harahsheh, Ashraf, Shah, Samay, Dallaire, Frederic, Manlhiot, Cedric, Khoury, Michael, Lee, Simon, Fabi, Marianna, Mauriello, Daniel, Tierney, Elif, Sabati, Arash, Dionne, Audrey, Dahdah, Nagib, Choueiter, Nadine, Thacker, Deepika, Giglia, Therese, Truong, Dongngan, Jain, Supriya, Portman, Michael, Orr, William, Harris, Tyler, Szmuszkovicz, Jacqueline, Farid, Pedrom, and McCrindle, Brian
- Abstract
BACKGROUND: Patients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) have overlapping clinical features. We compared demographics, clinical presentation, management, and outcomes of patients according to evidence of previous SARS-CoV-2 infection. METHODS: The International Kawasaki Disease Registry (IKDR) enrolled KD and MIS-C patients from sites in North, Central, and South America, Europe, Asia, and the Middle East. Evidence of previous infection was defined as: Positive (household contact or positive polymerase chain reaction [PCR]/serology), Possible (suggestive clinical features of MIS-C and/or KD with negative PCR or serology but not both), Negative (negative PCR and serology and no known exposure), and Unknown (incomplete testing and no known exposure). RESULTS: Of 2345 enrolled patients SARS-CoV-2 status was Positive for 1541 (66%) patients, Possible for 89 (4%), Negative for 404 (17%) and Unknown for 311 (13%). Clinical outcomes varied significantly among the groups, with more patients in the Positive/Possible groups presenting with shock, having admission to intensive care, receiving inotropic support, and having longer hospital stays. Regarding cardiac abnormalities, patients in the Positive/Possible groups had a higher prevalence of left ventricular dysfunction, and patients in the Negative and Unknown groups had more severe coronary artery abnormalities. CONCLUSIONS: There appears to be a spectrum of clinical features from MIS-C to KD with a great deal of heterogeneity, and one primary differentiating factor is evidence for previous acute SARS-CoV-2 infection/exposure. SARS-CoV-2 Positive/Possible patients had more severe presentations and required more intensive management, with a greater likelihood of ventricular dysfunction but less severe coronary artery adverse outcomes, in keeping with MIS-C.
- Published
- 2023