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What is Kawasaki disease and could it be related to COVID-19?

Read the latest update on COVID-19, Kawasaki Disease (KD) and PIMS-TS in children here

Recent reports from the United States of America, the United Kingdom and other European countries have identified clusters of children with an illness resembling Kawasaki shock syndrome. Some of these children have tested positive for COVID-19. Clinicians are reviewing a link between SARS-CoV-19 and Kawasaki disease.

Kawasaki disease is relatively uncommon, mostly affecting children under the age of 5 years. In Australia, one child is diagnosed with Kawasaki disease every day. Kawasaki disease is a collection of symptoms caused by vasculitis (inflammation of blood vessels) resulting from excessive immune activation. The cause is unknown and there is currently no diagnostic test, leaving doctors to diagnose the disease on the basis of clinical criteria (such as presence of rash, fever, swollen lymph nodes and red eyes). The most serious complication of Kawasaki disease is damage to the coronary arteries, which can require long-term management. Rarely, children can present critically unwell with shock (low blood pressure) due to impaired heart muscle function - known as Kawasaki shock syndrome. The observed syndrome has been provisionally labelled as Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 – PIMS-TS.

PAEDS collaborators Professor David Burgner, Dr Davinder Sing-Grewal and Dr Ryan Lucas discuss the recent reports here. "However tempting it might be to conclude COVID-19 may trigger Kawasaki disease, we should be cautious. There are as yet few details on the cases and not all children had positive tests for SARS-CoV-2 – nor all the features of Kawasaki shock syndrome. Many children are also older than is typical of Kawasaki disease. Further, both Kawasaki disease and COVID-19 cause illness via excessive inflammation – particularly of blood vessels. And both diseases can progress to a state of overwhelming whole-body inflammation sometimes called a cytokine storm. So it might be difficult to differentiate one disease from the other in their most severe forms."

Reassuringly, PAEDS conducts national surveillance of Kawasaki disease and COVID-19. The authors wrote that capturing the enhanced surveillance of both illnesses will allow "Australia to develop a clearer picture of whether and how COVID-19 might relate to Kawasaki disease. At present it remains an intriguing but unproven association."

Read more about PAEDS surveillance here.