key: cord-0054642-tlwo6dds
authors: Giarola, Lucca G; Couto, Braulio Roberto Gonçalves Marinho; Starling, Carlos Ernesto Ferreira; de Carvalho, Handerson Dias Duarte
title: 385. Kawasaki’s Disease and Sars-Cov-2: an Unexpected Pediatric Global Crisis?
date: 2020-12-31
journal: Open Forum Infect Dis
DOI: 10.1093/ofid/ofaa439.580
sha: d94be6552cc5bc82bd60f5c53aa0e87f28f9a7bc
doc_id: 54642
cord_uid: tlwo6dds

BACKGROUND: Infection by SARS-CoV-2 can lead to dyspnea, edema, deposition of intra alveolar fibrin, thrombosis and hemorrhages. During the COVID-19. outbreak, several questions were raised about the risks for the pediatric population. Pediatric patients appeared to be relatively safe, with only minor symptoms and a quick recovery. However, there have been reports of a relationship between COVID 19 and a Kawasaki-like inflammatory disease in this population. Kawasaki’s disease (KD) is a rheumatological vasculitis prevalent in childhood characterized mainly by diffuse inflammation of the arteries associated with skin rash, changes in the mucosa and its main complication is coronary aneurysms. METHODS: A systematic literature review was performed in the PubMED database using the keywords “Kawasaki disease”, “COVID-19” and “Pediatrics”. The selected filters were “Case reports”, “Multicenter study”, “Clinical Study”, “Observational study”, “Human” and “English”. A total of 18 articles were seleted. RESULTS: There seems to be a convergence between the literature published so far, pointing to a greater propensity for pediatric patients infected with Sars-Cov-2 to develop KD. The number of patients with KD symptoms seen at a specific center increased from 2 to 17 in 11 days (MOREIRA, 2020). In a sample space of 21 patients diagnosed with KD, 91% had previous contact with SARS-CoV-2 (TOUBIANA, 2020) whereas other studies point to a 30-fold increase in the prevalence of KD since the beginning of 2020 (VERDONI, 2020). There is already an established relationship between DK and HCoV-NH, describing that 4.5% of patients with this infection develop KD. Therefore, it was suggested that infection with another Coronavirus strain could have a similar relationship. CONCLUSION: Despite the relationship described between pediatric patients infected with COVID-19 being more likely to develop KD, further studies are needed to prove a statistical relationship between both condition. DISCLOSURES: All Authors: No reported disclosures

Mariana Velez-Pintado, n/a 1 ; Mercedes Aguilar-Soto, n/a 1 ; Antonio Camiro, MD, MSc 2 ; Dalia Cuenca-Abruch, n/a 1 ; Renzo Alberto Pérez-Doramae, n/a 1 ; Brenda Crabtree-Ramirez, n/a 1 ; Moises Mercado-Atri, n/a 1 ; 1 Centro Medico ABC, Mexico City, Distrito Federal, Mexico; 2 Centro Médico ABC, Mexico City, Distrito Federal, Mexico ARMII study group Session: and Clinical Outcomes Background: An elevated incidence of invasive pulmonary aspergillosis (IPA) in patients with COVID-19 without traditional risk factors for IPA has been recently reported around the world. This co-infection has been described in patients requiring treatment in an intensive care unit. The risk factors for its development are still unclear.

Methods: We conducted a nested case-control study using the COVID-19 registry of the ARMII study group, based in the Centro Médico ABC, a private hospital in Mexico City. We included all patients that required admission to the intensive care unit (ICU) from March 12 to June 15, 2020, and excluded patients without serum galactomannan measurements or bronchial secretion cultures. We used the modified definition of IPA proposed by Schauwvlieghe et al for IPA in influenza patients. The control group was formed by patients with ruled-out IPA (negative galactomannan and secretion cultures). We compared both groups to identify risk factors for IPA using the chi-squared test or the Mann-Whitney U test as applicable.

Results: Out of a total 239 patients, 54 met the inclusion criteria. We identified 13 patients with IPA (24.07%) that met the definition of IPA (2 with positive cultures and 11 with positive galactomannan) and 41 without IPA. Only three patients with IPA had important comorbidities (COPD, chronic kidney disease, and HIV). Patients with IPA tended to have a higher median age (64.6 vs 53.59, p=0.075) and a higher serum glucose at their arrival (145 vs 119, p=0.028). All patients with IPA presented to the hospital with ARDS (100% vs 72.5%, p=0.034), but ultimately did not have a higher requirement for mechanical ventilation (100% vs 82.93%, p=0.110). There were no statistical significant differences in use of Tocilizumab, use of glucocorticoids, mortality (23.07% vs 17.50%, p=0.563) or length of stay.

Conclusion: It has been previously described that patients with acute respiratory disease syndrome triggered by viral infection, like the influenza virus, are prone to invasive aspergillosis even in the absence of underlying immunodeficiency. The use of antifungals to prevent aspergillosis in COVID-19 patients should be assessed because of the gravity presented in the patients with this co-infection. Infection by SARS-CoV-2 can lead to dyspnea, edema, deposition of intra alveolar fibrin, thrombosis and hemorrhages. During the COVID-19. outbreak, several questions were raised about the risks for the pediatric population. Pediatric patients appeared to be relatively safe, with only minor symptoms and a quick recovery. However, there have been reports of a relationship between COVID 19 and a Kawasaki-like inflammatory disease in this population. Kawasaki's disease (KD) is a rheumatological vasculitis prevalent in childhood characterized mainly by diffuse inflammation of the arteries associated with skin rash, changes in the mucosa and its main complication is coronary aneurysms.

Methods: A systematic literature review was performed in the PubMED database using the keywords "Kawasaki disease", "COVID-19" and "Pediatrics". The selected filters were "Case reports", "Multicenter study", "Clinical Study", "Observational study", "Human" and "English". A total of 18 articles were seleted.

Results: There seems to be a convergence between the literature published so far, pointing to a greater propensity for pediatric patients infected with Sars-Cov-2 to develop KD. The number of patients with KD symptoms seen at a specific center increased from 2 to 17 in 11 days (MOREIRA, 2020) . In a sample space of 21 patients diagnosed with KD, 91% had previous contact with SARS-CoV-2 (TOUBIANA, 2020) whereas other studies point to a 30-fold increase in the prevalence of KD since the beginning of 2020 (VERDONI, 2020).

There is already an established relationship between DK and HCoV-NH, describing that 4.5% of patients with this infection develop KD. Therefore, it was suggested that infection with another Coronavirus strain could have a similar relationship.

Conclusion: Despite the relationship described between pediatric patients infected with COVID-19 being more likely to develop KD, further studies are needed to prove a statistical relationship between both condition.

Disclosures: All Authors: No reported disclosures

Long-term Complications Associated with COVID-19 Infection Smitha Gudipati

Session: P-12. COVID-19 Complications, Co-infections, and Clinical Outcomes Background: In Michigan, 44,964 (68%) of the 66,269 COVID-19 patients have recovered. However, there is concern that COVID-19 infection may lead to long-term sequelae, including pulmonary defects, cardiac complications, blood clots, and neurocognitive impairment