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/ Aleksandra Suzi, stock.adobe.com
London – Most children show mild symptoms after infection with the new SARS-CoV-2 coronavirus at best. In rare cases, however, there appears to be a severe inflammatory reaction similar to Kawasaki syndrome. British pediatricians have published a guide to facilitate diagnosis.
Kawasaki syndrome is an inflammatory disease of the blood vessels (vasculitis) in childhood that can cause irreversible damage to the coronary vessels. The disease begins with a sudden onset of fever that lasts for at least 5 days.
In addition, first there is a rash (erythema and dementia of the hands and feet that heals with scaling), secondly, a polymorphic rash, thirdly, bilateral and painless conjunctival injections without exudate (dry conjunctivitis), fourthly, changes in the lips and oral cavity (erythema and tears) lips, strawberry tongue, diffuse injection of oral and pharyngeal mucosa) and fifth, cervical lymphadenopathy (approximately 1.5 cm in diameter, generally unilateral). The diagnosis is made when 4 of the 5 signs are present (in addition to fever).
The cause of Kawasaki syndrome is unclear. An incorrect reaction of the immune system to banal respiratory infections is suspected. Possible triggers include rhinovirus and respiratory syncytial virus (RSV), as well as the 4 harmless coronaviruses 229E, HKU1, NL63, and OC43.
In the past few weeks there have been isolated reports of young children suffering from Kawasaki syndrome after being infected with SARS-CoV-2. Veena Jones of the Palo Alto Center in Stanford, California and hired employees Hospital pediatrics (2020; DOI: 10.1542 / hpeds.2020-0123) presented the case of a 6-month-old girl who developed a high fever of 38.3C after a viral infection and with classic conjunctivitis, tongue changes, skin rash, and hand swelling and feet of Kawasaki syndrome.
A test for SARS-CoV-2 was positive. Jones, therefore, suspects that the new coronavirus was the cause of Kawasaki syndrome in the baby. He was treated with intravenous immunoglobulins and high doses of acetylsalicylic acid according to the US guidelines. USA A first cardiological examination (as yet) did not provide any evidence of dilations or aneurysms in the coronary arteries, which are among the dreaded consequences of the disease.
Similar cases from several European countries have also been described in recent days. For example, 3 children with severe inflammation have been treated at the University of Geneva Hospital since the crown epidemic began. A spokeswoman for the clinic there said last week that a child had recovered and had been discharged, one in a normal state and the other in intensive care. According to press reports, last week two children with symptoms of Kawasaki syndrome were treated at the Dresden University Hospital. However, it was still unclear whether they were related to a coronavirus infection.
Cases from Italy and Spain have also been reported. In the United Kingdom, the National Health Service (NHS) sent emails to members of the Pediatric Intensive Care Society a week ago. The Royal College of Pediatrics and Child Health (RCPCH) released a case definition on Friday. In addition to persistent fever and the classic symptoms of Kawasaki syndrome, it also includes signs of inflammation in laboratory findings (neutrophilia, increased CRP, and lymphopenia), as well as signs of functional disorders in single or multiple organs.
Other microbial causes, such as bacterial sepsis, staphylococcal or streptococcal shock syndrome, myocarditis-related infections, such as enterovirus, should be excluded. A positive test for SARS-CoV-2 is not required.
The appearance of acute vasculitis in children is consistent with observations in adults, according to which SARS-CoV-2 causes inflammation of the endothelium, which is also responsible for lung failure (ARDS), among other things. © © rme / aerzteblatt.de
