Kawasaki disease epidemic: pitfalls
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COMMENTARY
Open Access
Kawasaki disease epidemic: pitfalls Romina Gallizzi1* , Giovanni Corsello2 and Giovanni Battista Pajno1
Abstract Recent reports have described in the pediatric population a new type of hyperinflammatory response manifested following contact with SARS-CoV-2, with some of the clinical features attributable to Kawasaki disease (KD). The purpose of this commentary is to remark on a possible recent association between SARS-CoV-2 and KD. Although today little is known about the etiology of KD, the most accepted hypothesis is that of a probable viral etiology, therefore, even the SARS-CoV-2 virus could trigger, in genetically predisposed subjects, an exaggerated inflammatory response that is clinically evident like the one described in KD. Keywords: Kawasaki disease, SARS-CoV-2, Hyperinflammatory response, Pediatric population
Background Kawasaki disease (KD) is a vasculitis of the small and medium caliber vessels with a preference for coronary arteries and it is the most common cause of heart disease acquired in children [1]. The diagnosis of KD remains clinical and there are no specific laboratory tests; the American Heart Association (AHA) criteria and guidelines reviewed in 2017 are used [2]. The cause of KD remains unknown. A careful study connects the seasonality of KD to tropospheric wind patterns, that provides the transportation of an agent which, if inhaled by genetically sensitive children, it triggers the KD immunological cascade. Another study suggests new RNA virus infection that enters the upper respiratory tract [2]. Activation of the innate immune system is an initial event, with evidence of the activation of the interleukin signal pathway (IL-1, IL-6 and TNF-alpha) [3]. The self-limited nature of the disease combined with a low rate of recurrence suggests the rotation of T and B memory cells which are protective against future encounters with the agent of KD [4]. KD has been reported from more than 60 countries across the world, around the equator to areas near the poles and is seen in both hot and cold areas. This confirms that several * Correspondence: [email protected] 1 Department of Human Pathology of Adulthood and Childhood Gaetano Barresi, Gaetano Martino University Hospital, UOC Pediatria, University of Messina, Via Consolare Valeria, 98125 Messina, Italy Full list of author information is available at the end of the article
infectious agents may trigger the disease in different geographical areas and seasons [5]. Indeed Turnier et al. in 2015 described that 28% of the positive results were attributable to rhinovirus/enterovirus, 8.7% due to parainfluenza and the remaining pathogens: respiratory syncytial virus, influenza, adenovirus and human coronavirus (strains 229E, HKU1, NL63, OC43) were each positive less than 5% of the time [6].
Main text Following the outbreak of SARS-CoV-2 infection, COVID-19 pandemic is emerging as a global health issue. In this context the scientific community is wondering about a possible correlation between SARS-CoV-2 virus infection and
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