Symptoms associated with Kawasaki disease, a rare blood vessel disorder, have appeared to cluster in COVID-19 hot spots, including New York City and the United Kingdom, and now, some Montreal doctors are seeing slightly more cases, too.
While pediatricians are used to encountering cases of Kawasaki disease, the clusters are calling for further investigation to determine any possible link to COVID-19.
“The pediatric networks are looking at this, and there have been cases identified (of Kawasaki in Canada), but they haven’t been verified to be linked to COVID-19 specifically,” said Canada’s chief medical officer, Dr. Theresa Tam, in a press conference on Wednesday.
“Those investigations are underway.”
New York City’s health department said on Monday at least 15 pediatric cases compatible with what doctors are calling “multi-system inflammatory syndrome” were identified in the city’s hospitals. The affected children, aged between two and 15 years, had persistent fever and symptoms of Kawasaki disease and/or toxic shock syndrome.
More than half of the patients had a rash, abdominal pain, vomiting or diarrhea. Respiratory symptoms were reported in less than half of these patients, New York health officials said, and five required medical ventilation.
Four kids tested positive for the novel coronavirus, and 11 patients tested negative. Out of the negative patients, six children’s blood work showed they had antibodies to the virus, suggesting they may have previously had exposure to the virus.
No children died from their illness among these New York cases.
Dr. Marie-Paule Morin, a pediatric rheumatologist at CHU Sainte-Justine hospital in Montreal, said doctors there are seeing a slight increase in what appears to be Kawasaki disease lately, but some patients have “atypical symptoms,” including more inflammation than usual.
All patients have all responded well to treatment, she said.
Morin stressed that it is too early to confirm the cases are linked to COVID-19, and experts still need to conduct more research. She said a Canadian study is currently underway.
“We do not know, actually, if there’s a causality or a link, but we’re curious about it,” Morin said.
Kawasaki disease is an inflammatory condition characterized by a constellation of symptoms, said Dr. Kevin Schwartz, an infectious disease physician at Unity Health Toronto.
Symptoms of Kawasaki disease include prolonged fever, bloodshot eyes, rash, red bumps on the tongue, stomach pain and peeling skin on the hands and feet.
KidsHealth says most kids with the illness recover “completely, especially when they are diagnosed and treated early.” According to the American Heart Association, about 75 per cent of people with the condition are under age five, and boys are more likely to develop the illness than girls.
Schwartz said there is no diagnostic test for Kawasaki disease, meaning the diagnosis is based on clinical criteria. More research is needed to understand if there is a clear connection between COVID-19 and Kawasaki disease before drawing conclusions, he said.
“We think there may be infectious triggers in some children with Kawasaki disease, however there is no specific virus or infection that has consistently been demonstrated to trigger Kawasaki disease,” Schwartz explained.
In late April, Britain’s Paediatric Intensive Care Society issued an alert to doctors noting there had been an increase in the number of children with “a multi-system inflammatory state requiring intensive care” across the country.
The group said there was “growing concern” that either a COVID-19-related syndrome was emerging in children or that a different, unidentified disease might be responsible.
Only some of the children in Britain tested positive for the coronavirus, so scientists were unsure if these rare symptoms are caused by the virus or by something else.
Dr. Ronald Cohn, president and CEO of Toronto’s Hospital for Sick Children, said that while the research out of the U.K. is interesting, it’s “too early to be alarmed as some of the patients reported did not in fact test positive for COVID-19.”
“What we do know from data in children around the world is that generally, individuals under 18 tend to have mild symptoms. However, a small percentage of children do develop more severe symptoms,” he said in a statement to Global News.
“At a time when we are still learning about this new virus that has only been detected in humans over the last few months, it is important to carefully analyze any data we have and put it in an evidence-based context.”
Questions about COVID-19? Here are some things you need to know:
Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.
For full COVID-19 coverage from Global News, click here.
— With files from Global News’ Hannah Jackson and the Associated Press
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