PMID- 32410760
OWN - NLM
STAT- MEDLINE
DCOM- 20200610
LR  - 20210324
IS  - 1474-547X (Electronic)
IS  - 0140-6736 (Print)
IS  - 0140-6736 (Linking)
VI  - 395
IP  - 10239
DP  - 2020 Jun 6
TI  - An outbreak of severe Kawasaki-like disease at the Italian epicentre of the 
      SARS-CoV-2 epidemic: an observational cohort study.
PG  - 1771-1778
LID - S0140-6736(20)31103-X [pii]
LID - 10.1016/S0140-6736(20)31103-X [doi]
AB  - BACKGROUND: The Bergamo province, which is extensively affected by the severe 
      acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural 
      observatory of virus manifestations in the general population. In the past month 
      we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and 
      features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 
      epidemic. METHODS: All patients diagnosed with a Kawasaki-like disease at our 
      centre in the past 5 years were divided according to symptomatic presentation 
      before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. 
      Kawasaki- like presentations were managed as Kawasaki disease according to the 
      American Heart Association indications. Kawasaki disease shock syndrome (KDSS) 
      was defined by presence of circulatory dysfunction, and macrophage activation 
      syndrome (MAS) by the Paediatric Rheumatology International Trials Organisation 
      criteria. Current or previous infection was sought by reverse-transcriptase 
      quantitative PCR in nasopharyngeal and oropharyngeal swabs, and by serological 
      qualitative test detecting SARS-CoV-2 IgM and IgG, respectively. FINDINGS: Group 
      1 comprised 19 patients (seven boys, 12 girls; aged 3.0 years [SD 2.5]) diagnosed 
      between Jan 1, 2015, and Feb 17, 2020. Group 2 included ten patients (seven boys, 
      three girls; aged 7.5 years [SD 3.5]) diagnosed between Feb 18 and April 20, 
      2020; eight of ten were positive for IgG or IgM, or both. The two groups differed 
      in disease incidence (group 1 vs group 2, 0.3 vs ten per month), mean age (3.0 vs 
      7.5 years), cardiac involvement (two of 19 vs six of ten), KDSS (zero of 19 vs 
      five of ten), MAS (zero of 19 vs five of ten), and need for adjunctive steroid 
      treatment (three of 19 vs eight of ten; all p<0.01). INTERPRETATION: In the past 
      month we found a 30-fold increased incidence of Kawasaki-like disease. Children 
      diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response 
      to the virus, were older, had a higher rate of cardiac involvement, and features 
      of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe 
      form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected 
      in countries involved in the SARS-CoV-2 epidemic. FUNDING: None.
CI  - Copyright (c) 2020 Elsevier Ltd. All rights reserved.
FAU - Verdoni, Lucio
AU  - Verdoni L
AD  - Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy.
FAU - Mazza, Angelo
AU  - Mazza A
AD  - Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy.
FAU - Gervasoni, Annalisa
AU  - Gervasoni A
AD  - Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy.
FAU - Martelli, Laura
AU  - Martelli L
AD  - Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy.
FAU - Ruggeri, Maurizio
AU  - Ruggeri M
AD  - Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy.
FAU - Ciuffreda, Matteo
AU  - Ciuffreda M
AD  - Paediatric Cardiology, Hospital Papa Giovanni XXIII, Bergamo, Italy.
FAU - Bonanomi, Ezio
AU  - Bonanomi E
AD  - Paediatric Intensive Care Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy.
FAU - D'Antiga, Lorenzo
AU  - D'Antiga L
AD  - Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy. Electronic 
      address: ldantiga@asst-pg23.it.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20200513
PL  - England
TA  - Lancet
JT  - Lancet (London, England)
JID - 2985213R
SB  - IM
CIN - Nat Rev Rheumatol. 2020 Aug;16(8):413-414. PMID: 32499548
CIN - Pediatr Infect Dis J. 2020 Aug;39(8):e213-e215. PMID: 32677813
CIN - Evid Based Nurs. 2021 Apr;24(2):35. PMID: 33262169
CIN - Nat Med. 2020 Dec;26(12):1807. PMID: 33288939
MH  - Betacoronavirus
MH  - COVID-19
MH  - Child
MH  - Child, Preschool
MH  - Coronavirus Infections/*epidemiology
MH  - Disease Outbreaks
MH  - Female
MH  - Humans
MH  - Italy
MH  - Male
MH  - Mucocutaneous Lymph Node Syndrome/*epidemiology
MH  - Pandemics
MH  - Pneumonia, Viral/*epidemiology
MH  - Retrospective Studies
MH  - SARS-CoV-2
PMC - PMC7220177
EDAT- 2020/05/16 06:00
MHDA- 2020/06/11 06:00
PMCR- 2020/05/13
CRDT- 2020/05/16 06:00
PHST- 2020/04/20 00:00 [received]
PHST- 2020/05/03 00:00 [revised]
PHST- 2020/05/04 00:00 [accepted]
PHST- 2020/05/16 06:00 [pubmed]
PHST- 2020/06/11 06:00 [medline]
PHST- 2020/05/16 06:00 [entrez]
PHST- 2020/05/13 00:00 [pmc-release]
AID - S0140-6736(20)31103-X [pii]
AID - 10.1016/S0140-6736(20)31103-X [doi]
PST - ppublish
SO  - Lancet. 2020 Jun 6;395(10239):1771-1778. doi: 10.1016/S0140-6736(20)31103-X. Epub 
      2020 May 13.