Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort

Annals of the Rheumatic Diseases - Tập 79 Số 8 - Trang 999-1006 - 2020
Marie Pouletty1,2, Charlotte Borocco3,4, Naïm Ouldali5,1, Marion Caseris1,6, Romain Basmaci7,8, Noémie Lachaume7,8, Philippe Bensaïd9, Samia Pichard9, Hanane Kouider10, Guillaume Morelle11, Irina Craiu11, Corinne Pondarré12, Anna Dehò1, A. Maroni1, Mehdi Oualha13, Zahir Amoura14,15, Julien Haroche14,15, Juliette Chommeloux14,16,17, Fanny Bajolle13, Constance Beyler1, Stéphane Bonacorsi1,8, Guislaine Carcelain1, Isabelle Koné‐Paut11,4, Brigitte Bader‐Meunier13,18, Albert Faye5,19,20, Ulrich Meinzer21,22,1, Caroline Galeotti11, Isabelle Melki13,20,18
1Hôpital Robert Debré, Paris
2Université Paris Cité
3Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses [Le Kremlin-Bicêtre]
4Université de Versailles Saint-Quentin-en-Yvelines
5Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables
6Service de Microbiologie [Hôpital Robert Debré - APHP]
7Hôpital Louis Mourier - AP-HP [Colombes]
8Infection, Anti-microbiens, Modélisation, Evolution
9Hôpital Victor Dupouy
10Centre Hospitalier René Dubos, Pontoise
11AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
12Centre Hospitalier Intercommunal de Créteil
13CHU Necker - Enfants Malades [AP-HP]
14CHU Pitié-Salpêtrière [AP-HP]
15Centre d'Immunologie et des Maladies Infectieuses
16Institut de cardiologie [CHU Pitié-Salpêtrière]
17Sorbonne Université - Faculté de Médecine
18Imagine - Institut des maladies génétiques (IHU)
19Faculté de Médecine [Université Paris Diderot - Paris 7]
20Hôpital Robert Debré
21Biologie et Génétique de la Paroi bactérienne - Biology and Genetics of Bacterial Cell Wall
22Centre de recherche sur l'Inflammation

Tóm tắt

BackgroundCurrent data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities.MethodsMulticentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (‘Kawa-COVID-19’). A historical cohort of ‘classical’ KD served as a comparator.ResultsSixteen patients were included (sex ratio=1, median age 10 years IQR (4·7 to 12.5)). SARS-CoV-2 was detected in 12 cases (69%), while a further three cases had documented recent contact with a quantitative PCR-positive individual (19%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 µg/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of ‘classical’ KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004).ConclusionKawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19.Trial registration numberNCT02377245

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Annals of the Rheumatic Diseases

Tập 79 Số 8

999-1006

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