“The syndrome in children with Covid was not Kawasaki but a multisystemic inflammation”: the Bambino Gesù hospital study

It looked like the syndrome in every way. Kawasaki: on the other hand, the serious inflammatory disease found in recent months in several children who have contracted Covid is a Multisystemic inflammation syndrome (Mis-C). It is the conclusion of a study ofBambino Gesù Pediatric Hospital and the Karolinska Institutet in Stockholm, published in the scientific journal Cell, which shows how the two pathologies have similar manifestations, but different immunological characteristics. The research paves the way for early diagnosis with specific tests and targeted treatments.

Researchers investigated the mechanism that triggers the severe inflammatory response in children with Covid-19: it’s virus, they explain, infects adults and children alike, but in the smallest they make it one very smooth shape and often asymptomatic. However, a possible complication is Covid-associated Multisystemic Inflammation Syndrome, which occurs one to two months after infection and manifests with vasculitis (inflammation of the blood vessels) heart and intestinal problems and a systemic increase in inflammation. Initially mistaken for Kawasaki disease, this inflammatory disease is systemic and caused in children by SARS-Cov2 infection. A very rare condition, but it was reported in hundreds of reports around the world. There Pathogenesis – that is, the mechanism by which the disease develops – is not yet clear, but Mis-C has characteristics that overlap with Kawasaki disease that suggest the same autoimmune origin.

I study – they got involved 101 children: 13 were Covid patients who developed multi-system inflammatory form, 41 with Covid (but without Mis-C) 28 with diagnosed Kawasaki pathology in the pre-Covid era 19 sani. The study ‘Immunological studies in children affected by Covid and acute diseases’ was developed by doctors and researchers of the Child Jesus during the health emergency to try to understand the Sars-CoV-2 disease in the child, together with researchers from the Karolinska Institute. Research collaborated in Palidoro Covid Center, the General Pediatrics group that in recent years has been dedicated to the study of Kawasaki disease and to the Clinical Immunology and Vaccination of the Department of Pediatrics of the University Hospital. The levels of immune system cells, cytokines and antibodies in the blood of children with Mis-C were analyzed and compared with children who had developed a mild Covid infection, with healthy children and with those with Kawasaki syndrome. already diagnosed.

Similarities and differences – In both diseases, Kawasaki and Mis-C, an alteration in the levels of cytokines (mediators of inflammation) involved in the immune response, but with differences: for example l’interleuchina 17a (IL-17a) increased significantly in children with Kawasaki disease, but not in those with mild coronavirus or those with Mis-C. Compared to children with Kawasaki syndrome, a high presence of mis-C has been identified in Covid patients who develop autoantibodies, that is, antibodies directed against particular portions of heart tissue or substances in the body itself, which act against two specific proteins (endoglin and RPBJ). These autoantibodies can determine vascular and heart damage typical of Mis-C. Also from a cellular point of view are Substantial differences emerged between the two pathologies.. In fact, children with Covid have a particular type of T lymphocytes (subtype of white blood cells delegates of the body’s defense) with impaired immune function compared to children with Kawasaki disease. Monitoring of T lymphocytes and the spectrum of antibodies in children with COVID-19 will allow early diagnosis of those patients who are at risk of developing a form of Mis-C.

“These results represent an important discovery also to choose protocols for the treatment of systemic inflammation related to SARS-CoV2 infection and Kawasaki disease with greater precision and based on scientific evidence “, explains Dr. Paolo Palma, responsible for Clinical Immunology and Vaccination of the Child Jesus and the study. Research results show the indication to treat with immunoglobulins at high doses to limit the effect of autoantibodies, with anakinra (an immunosuppressive active substance that blocks interleukin-1 receptors) and with cortisone in children with MIS-C at an early stage to block inflammation secondary to vessel damage. In contrast, the use of tocilzumab (anti-IL6) and TNF-α blocking drugs is not recommended in pediatric patients. For Kawasaki patients, data suggests for the first time the potential efficacy of an IL-17 blocker (secukinumab) in controlling the inflammation underlying this disease.

Here the complete study on Cell

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