• Margareta A. Christianti

Kawasaki Disease and COVID-19: Are They Related?



The world has been facing a pandemic since the beginning of 2020. This situation had been declared as a Public Health Emergency of International Concern by WHO, which later named the disease caused by SARS-Cov-2 COVID-19.[1] As for every other phenomenon that happens for the first time, scientists are still trying to understand more about the virus that is bringing the world to its knees and many issues are currently under debate.


Recently, there have been many reports from pediatrics and dermatologists on a possible correlation between COVID-19 and a rare disease affecting children named Kawasaki Disease (KD). This hypothesis has arisen as, shortly after the spread of the epidemic, an outbreak of Kawasaki-like disease was observed, reaching an increase of 30 times the incidence in those regions with a high number of positive cases.[2] So, the question that has now been debating is the following: is coronavirus the reason behind the increasing cases of KD?


Before answering this question, let’s take a look at KD. It is an inflammation of blood vessels (vasculitis) that occurs in children under five years old.[3] Other common symptoms include large lymph nodes in the neck, rash in the genital area, and red eyes, lips, palms, or soles of the feet. Within three weeks from the onset, the skin of the hands and feet may peel, after which recovery typically occurs.[4] Only in a few cases severe complications with cardiovascular impairment are experienced.

Despite half a century has passed since KD was first reported in Japan, this disease is a poorly understood condition and experts are still investigating the cause behind it. Nonetheless, it is assumed that genetic predisposition may play an important role, meaning that children may inherit from their parents the genes responsible for susceptibility to KD.[5-6] Some evidence also suggests an infectious trigger and, interestingly, various reports described in the past an association between viral respiratory infections and KD.[7]


Coming back to our question, is there any real association between COVID-19 and Kawasaki Disease?


​The fact that in countries with large outbreaks of coronavirus have been reported more cases of pediatric KD-like symptoms and that most of these patients show positive serology for COVID-19 is unlikely just a coincidence. Nonetheless, experts advocate caution and say that it will take many months before the epidemiologists can let us know whether there is a direct link or not.


“There is an urgent need for collection of standardized data describing clinical presentations, severity, outcomes, and epidemiology," the WHO said on May 15th.[1] Until then, a definite answer to our question can’t be given. In any case, parents should not panic about this as it is a rare complication in the pediatric population and in only very few cases serious complications occur.


Reference

1. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen (accessed on May 2, 2020).

2. Verdoni, L. et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. The Lancet (2020). doi:10.1016/s0140-6736(20)31103-x

3. https://www.abc.net.au/news/2020-04-29/kawasaki-disease-symptoms-is-it-linked-coronavirus-in-australia/12197008 (accessed on May 2, 2020).

4. https://www.rch.org.au/kidsinfo/fact_sheets/Kawasaki_disease/ (accessed on May 4, 2020).

5. https://edition.cnn.com/2020/04/28/health/kawasaki-disease-explainer-covid-19-intl-scli/index.html (accessed on May 4, 2020).

6. Ramphul, K. & Mejias, S. Kawasaki disease: a comprehensive review. Archives of Medical Science - Atherosclerotic Diseases 3, 41-45 (2018).

7. Turnier, J. et al. Concurrent Respiratory Viruses and Kawasaki Disease. PEDIATRICS 136, e609-e614 (2015).

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