Children have been hospitalized in serious condition in intensive care in Paris in recent weeks with an inflammatory syndrome close to Kawasaki disease, alert doctors. In other countries too. Most were infected with the coronavirus about a month ago. Should we worry? What are the symptoms ? What risks and treatments?
[Mise à jour le lundi 4 mai à 16h08] In Italy, United Kingdom, Belgium but also in France. Doctors alert on cases of inflammatory syndromes observed in young children (between 10 and 15 years old) in recent weeks with symptoms close to the Kawasaki disease. The link is envisaged with the Covid-19. Should we worry about the approach of deconfinement and the gradual return to school announced from May 11? What do scientists say? What is this disease?
The alert in France was given by the Necker hospital which reported the cases of 25 children hospitalized in intensive care in the Paris region, over the past three weeks, with an inflammatory syndrome. “This inflammatory syndrome involves the heart, the lungs or the digestive system, explains doctor Damien Bonnet, coordinator of the M3C Necker network in Paris on a daily basis Noon Free. The clinical condition of some patients is reminiscent of the Kawasaki disease.” This doctor reports “an increasing number of children of all ages hospitalized in a context of multi-systemic inflammation frequently associating circulatory failure with elements in favor of a myocarditis“. Fortunately, “children respond well to treatment. To date, no patient has had serious consequences, but this requires monitoring and an alert “ says Professor Pierre-Louis Léger, head of the pediatric neonatal resuscitation service at Trousseau Hospital in Paris, interviewed by RMC. Sure France Info, the Minister of Health Olivier Véran explained taking “very seriously ” these cases : “I mobilize the healthcare community, the scientific community in France and abroad to have as much data as possible, to see if there is a need to make a link between the coronavirus and this form which, until now, had not been observed anywhere. So a lot of vigilance and a certain concern “.
It’s possible. “It is suspected that it is an inflammatory reaction of the body to an infectious agent, still unknown. These syndromes manifest themselves in the context ofchildren who were infected with covid-19 about a month before“ underlines Professor Arnaud Fontanet on April 30 during a Senate hearing, who believes that “It will remain something rare even if it is worrying”. And his colleague, Professor Jean-François Delfraissy, President of the Covid-19 scientific committee, added: “This Kawasaki pediatric aspect illustrates the complexity of this virus (Sars-CoV-2), you have to be really modest on a scientific level. We have to wait, there is still a need for knowledge.” The alert first came from United Kingdom where the National Health Service (NHS) has reported cases of dozen children hospitalized in serious condition with fever, inflammation of the arteries (such as Kawasaki disease) and mostly Covid-19 positive. “It’s a new disease which we believe can be caused by coronavirus, said British Health Minister Matt Hancock on the radio AML. We are not 100% sure because some of the people who contracted it have not tested positive (with coronavirus). So we are currently doing a lot of research. But this is something that concerns us. ” Matt Hancock confirmed “an apparent increase in the number of children of all ages with multisystem inflammatory conditions requiring intensive care in London and other parts of the United Kingdom”.
Kawasaki disease or “Lymphocutaneous mucosal syndrome“has been described by Tomisaku Kawasaki in 1967. It is a vasculitis that is to say a disease characterized by a inflammation of blood vessels who, if left untreated, can be complicated with life-threatening coronary aneurysms. Even though this disease has been reported worldwide, it is much more common in Asian populations, especially at Japan. In the vast majority of cases, it affects infants and young children before puberty. This disease is rare in adolescents and adults. Children with Kawasaki disease have a poor general condition. Symptoms suggestive of Kawasaki disease:
- an unexplained prolonged fever, above 38 ° C, which persists for at least 5 days and does not respond to antipyretics or antibiotics,
- skin rash;
- conjunctivitis that appears with fever;
- oropharyngeal involvement (erythema of the lips, dryness, cracks and sometimes bleeding). The tongue is raspberry;
- cervical lymphadenopathy (swollen glands);
- damage to the feet and hands: erythema of the palms or soles as well as edema, peeling of the skin, that is to say a loss of the surface layer of the epidermis, mainly affecting the area towards the organs genitals, soles, or palms.
The severity of this disease is defined by heart risks that it can generate, in the absence of treatments. “Cardiac complications occur in 25 to 30% of untreated patients, reports The Practitioner’s Review. The most important complication is represented by coronary aneurysms, which usually occur between 10 and 30 days after the onset of illness. “
“Kawasaki disease has become exceptionally serious since it was treated early and effectively with immunoglobulins”
The diagnosis of Kawasaki disease is difficult to ask in the beginning, because many childhood illnesses have similar symptoms. It is before the association of the aforementioned signs, conventionally five of the six signs mentioned above, that the diagnosis is confirmed. A blood test is sometimes performed showing inflammation at his level, but in case of confirmation of Kawasaki disease, a Echocardiography should be practiced in search of a coronary aneurysm that is to say a malformation of an artery of the heart which makes all the gravity of this childhood disease. Thromboses, blood clots obstructing a blood vessel, can also complicate this disease.
Kawasaki disease requires hospitalization. The pathology is treated using a drug combination. Aspirin is used to prevent the formation of thromboses, associated with a course of immunoglobulins passed by the venous route. In addition, the cardiac ultrasound should be repeated to monitor the occurrence of a possible aneurysm. “Kawasaki disease has become exceptionally serious since it was treated early and effectively with immunoglobulins” explains Dr Fanny Bajolle from the Reference Center “Complex Congenital Cardiac Malformations-M3C” of the Necker Children’s Hospital. Of relapses are possible but rare.
Sources:
Kawasaki disease in four tables. Dr Fanny Bajolle. Reference Center “Complex Congenital Cardiac Malformations-M3C” of the Necker Hospital for Sick Children. 2011.
Kawasaki disease; R. Cimaz *, J.-C. Lega; Hospice Civils de Lyon, Claude-Bernard University, Lyon-1; 2007.
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