Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study.
Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study.
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DOI：
10.1136/bmj.m2094
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发表时间：
2020-06-03
期刊：
影响因子：
--
通讯作者：
Allali S
中科院分区：
文献类型：
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作者：
Toubiana J;Poirault C;Corsia A;Bajolle F;Fourgeaud J;Angoulvant F;Debray A;Basmaci R;Salvador E;Biscardi S;Frange P;Chalumeau M;Casanova JL;Cohen JF;Allali S
描述川崎样多系统炎症综合征暴发的儿童和青少年的特点，并评估与严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的潜在时间相关性。前瞻性观察性研究。法国巴黎一所大学医院的普通儿科。21名具有川崎病特征的儿童和青少年(年龄≤18岁)，于2020年4月27日至5月11日入院，并随访至2020年5月15日出院。主要结果包括临床和生物学数据、影像和超声心动图表现、治疗和结果。用逆转录聚合酶链式反应(RT-PCR)前瞻性地检测鼻咽拭子中的SARS-CoV-2，并检测血液样本中的SARS-CoV-2抗体。21名儿童和青少年(平均年龄7.9岁(3.7-16.6岁))在15天内因川崎病入院，其中12人(57%)为非洲血统。川崎病休克综合征12例(57%)，心肌炎16例(76%)。17例(81%)需要重症监护支持。所有21名患者在疾病的早期都有明显的胃肠道症状和高水平的炎症标志物。19例(90%)有新近感染SARS-CoV-2的证据(8/21例RT-PCR阳性，19/21例抗体检测阳性)。所有21名患者都接受了静脉注射免疫球蛋白，10名(48%)还接受了皮质类固醇治疗。所有患者的临床结果均良好。在住院期间，有5名患者(24%)检测到中度冠状动脉扩张。到2020年5月15日，在住院8(5-17)天后，所有患者都出院了。巴黎地区儿童和青少年中持续爆发的川崎样多系统炎症综合征可能与SARS-CoV-2有关。在这项研究中，受影响的儿童和青少年中有胃肠道症状、川崎病休克综合征和非洲血统的比例异常高。
To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Prospective observational study. General paediatric department of a university hospital in Paris, France. 21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020. The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus. 21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home. The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.
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