kawasaki-disease-and-covid-19

Context: Children with Covid-19 infection have often shown some symptoms similar to those associated with a rare illness called Kawasaki disease. 

More about news:

  • Rashes and inflammation symptoms have also shown in children who tested negative for Covid-19.
  • Last month, the World Health Organization (WHO) termed this new illness “multisystem inflammatory disorder”.

Kawasaki disease

Multisystem inflammatory syndrome (MIS)

The disease derives its name from a Japanese paediatrician, Tomisaku Kawasaki, who reported the first case in 1961 related to  a four-year-old boy.

This syndrome shares symptoms with other inflammatory syndromes in children like “Kawasaki disease, staphylococcal and streptococcal toxic shock syndromes, bacterial sepsis and macrophage activation syndromes. 

Kawasaki typically affects children aged under five.

It is seen in patients aged less than 19. Children may or may not test positive for Covid-19.

Symptoms are red eyes, rashes, and a swollen tongue with reddened lips which is called strawberry tongue and an inflamed blood vessel system all over the body. 

  • There is constant high fever for at least five days. 
  • The disease also affects coronary functions in the heart.

Causes of the disease: It is not yet known. It is an immunological reaction to an infection or a virus. 

Symptoms: Inflammation, abdominal pain, diarrhoea are common; heart attack and septic shock may happen along with persistent fever, single or multi-organ dysfunction. 

  • There is  a history of contact with a positive case of Covid-19.

 

Link of kawasaki disease with Covid-19

  • Children with Covid-19 are mostly asymptomatic or develop mild symptoms.
  • Few children had rashes and high fever like Kawasaki, but other symptoms like red eyes, red tongue were not present. 
    • Their hearts were swollen but coronary functions were not affected like in Kawasaki.The strawberry tongue may or may not be present in those with Covid-19.
  • But all were tested negative for Covid-19. But that does not rule out Covid-19 as  it is possible that by the time RT-PCR test was done for the throat sample, it came negative and antibodies had been developed.
  • In Covid-19 cases, even adolescents are presenting Kawasaki disease like symptoms. 

The treatment

  • Doctors use steroids to reduce inflammation, at a dosage 10 times higher than usual along with the drug Tocilizumab for Covid-19 management. 
    • Antivirals may not work in such cases.
  • Supportive therapy for each organ: Some children were kept on ventilator support due to septic shock and they were unable to breathe, their heart functions were poor, and they could not pass urine due to kidney problems. 
    • If lungs can’t work, we put them on a ventilator, if the kidney doesn’t work we give medication.
  • India is not maintaining any registry on Kawasaki-like disease or multisystem inflammatory syndrome to know how many children have it along with Covid-19.

Biological terms:

  • Staphylococcus (staph) is a group of bacteria. A type called Staphylococcus aureus causes most infections. Skin infections, which are the most common types of staph infections.
  • Streptococcal toxic-shock syndrome (streptococcal TSS) is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria.
    • Toxic shock syndrome can affect anyone, including men, children and postmenopausal women.
  • Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic disease that, for unknown reasons, occurs much more frequently in individuals with systemic juvenile idiopathic arthritis (SJIA) and in those with adult-onset Still disease. 

Human body’s immune system

  • Lymphocytes are one of the main types of immune cells.  Lymphocytes are divided mainly into B and T cells.
    • B lymphocytes produce antibodies - proteins (gamma globulins) that recognize foreign substances (antigen) and attach themselves to them. .
    • T lymphocytes are cells that are programmed to recognize, respond to and remember antigens.  
  • A macrophage is the first cell to recognize and engulf foreign substances (antigens).  Macrophages break down these substances and present the smaller proteins to the T lymphocytes.  
    • Macrophages also produce substances called cytokines that help to regulate the activity of lymphocytes.
  • Dendritic cells are known as the most efficient antigen-presenting cell type with the ability to interact with T cells and initiate an immune response.
  • White Blood Cells: There are different types of white blood cells that are part of the immune response.  
    • Neutrophils or granulocytes are the most common immune cells in the body.  With an infection, their number increases rapidly.  
    • Basophils and eosinophils are white blood cells that contain large granules inside the cell.