Coronavirus and Kawasaki disease: genetic factor and first child death

Published by Manon C. · Published on 18 May 2020 at 13h38
For several weeks, a connection has been made by dosctors between the coronavirus infection and the Kawasaki disease in children leading to heart failures. This Tuesday May 12th, the Health general management announced 125 Kawasaki cases have been reported in France these past few weeks. A genetic factor could explain the link between the two diseases.

This is a matter that worries many doctors in Ile-de-France and in France: many heart failure cases have been reported in children from 8 to 15 years old, in pediatric intensive cares in Paris and European hospitals.

All these children have tested positive for coronavirus (through antibodies research), without comorbidity nor symptoms for most of them. But other and more alarming symptoms have led three great units in Paris to meet and report about fifteen myocarditis cases, that is to say an inflammation of the heart muscle tissue leading to heart failures, respiratory shock states in children hospitalized.

At the Trousseau hospital, we have noticed three cases in ten days, instead of two or three per year on a usual basis. At Necker, a dozen and three or four at the Robert Debré hospital. In other words, this is absolutely not normal at that time” Trousseau hospital pediatric intensive care unit head Professor Pierre-Louis Léger says.

A document shared by the Center of rare congenital heart defects reports at least 25 cases in three weeks in Ile-de-France, “including nine at Necker these past two days”. This report also tells about “a growing number of children of all age hospitalized in a context of multi-systemic inflammation frequently paired with circulatory failure with elements leading to myocarditis”.

As of today, a the Health general management released a document saying they have "asked Santé Publique France to keep a close look on the active fashion atypical childhood systemic diseases confirmed or likely to be related to COVID-19 occur. These rare pictures, suggesting Kawasaki syndroms or myocarditis (heart failure, fever, digestive disorders, persistent inflammatory sydrome) mush be subject to report from the GP, pediatrician or the hospital taking care of the child". The Local Health Agencies (Agences Régionales de Santé) have reported 125 cases of Kawasaki disease "these past few weeks".

By the way, a link between coronavirus and the Kawasaki disease may have been found. As a matter of fact, most chilldren infected by the Kawasaki disease these past weeks come from Africa, Northern Africa and West Indies. The genetic lead is now studied by doctors.

"A request has been sent to the National Commission for Information and Liberties to get the ethnic origin, which is sensitive in France" Rhumatologist-pediatrician at the Lyon mother and children's hospital and searcher Alexandre Belot. "Two hypotheses are explored: the genetic lead associated to an excessive immune response that leads to inflammation and the pathogenic by studying viral strain identified in Kawasaki cases" he adds.

This Friday May 1th, La Provence reports a 9-year-old child has died of the Kawasaki disease in Marseilles. A tragic first in France. La Timone hospital pediatric intensive care unit head Fabrice Michel - where the child was taken care of - says this mortal end is "extremely rare". The child is said to have developed "what we think was myocarditis. We will look at his medical file to understand if there was no pre-existing pathology" La Timone hospital pediatric ENT unit head Richard Nicolas says.

For the record, doctors talk about very specific symptoms that let them think about a rare childhood illness (even though all symptoms are “not sticking”): the Kawasaki disease, well known by pediatricians and common in Asia. It consists in the inflammation of arteries, especially coronaries, likely to lead to myocardial infarction.

It can be described by feverish states, abdominal pains, digestive issues, sometimes skin rashes and a state of respiratory shock. In some cases, heart failure requires intensive care and specific medication” Professor Léger adds.

We still do not understand this influx of young patients is so delayed in comparison with the epidemic in Ile-de-France. We do not say there is a link between the Covid-19 infection and these clinical pictures. But the hypothesis would be a secondary Covid-19 disease, as a consequence of an infection often gone unseen. A delayed inflammatory phenomenon”.

Similar cases have been reported in Italy, Spain, Belgium and the United-Kingdom these past weeks. But professor Léger wants to be reassuring: “The evolution of the sick treated is rather favorable, even though they need to stay in intensive care and medications to support the heart. Children answer positively to the medications. As for the three patients in my unit at Trousseau, they all recovered. As of today, no patient has had serious consequences, even though it requires follow-up and an alert”.

Nothing to worry (too much) so far when thinking about sending your children back to school.

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