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2020 ; 395
(10239
): 1771-1778
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gab.com Text
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English Wikipedia
An outbreak of severe Kawasaki-like disease at the Italian epicentre of the
SARS-CoV-2 epidemic: an observational cohort study
#MMPMID32410760
Verdoni L
; Mazza A
; Gervasoni A
; Martelli L
; Ruggeri M
; Ciuffreda M
; Bonanomi E
; D'Antiga L
Lancet
2020[Jun]; 395
(10239
): 1771-1778
PMID32410760
show ga
BACKGROUND: 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. METHODS: 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. FINDINGS: 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<0·01). INTERPRETATION: In the past
month we found a 30-fold increased incidence of Kawasaki-like disease. Children
diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response
to the virus, were older, had a higher rate of cardiac involvement, and features
of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe
form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected
in countries involved in the SARS-CoV-2 epidemic. FUNDING: None.