LAHORE: Cases of an ailment like Kawasaki Disease (KD), which is believed to be a post-infection complication among the children infected with Covid-19 have started surfacing in various parts of the country, causing an alarm among experts.

The Institute of Child Health/Children Hospital Lahore has received three such cases while some others have been reported in Karachi, Islamabad and Rawalpindi. These cases have alarmed “unprepared” paediatric experts all over the country.

Also known as Kawasaki syndrome, KD is an acute febrile illness of unknown etiology that primarily affects children under five years of age. The disease was first discovered in Japan by Tomisaku Kawasaki in 1967. The first cases outside of Japan were reported in Hawaii in 1976.

The experts say the clinical signs of the KD include fever, rashes, swelling of the hands and feet, irritation and redness of the white portion of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips, and throat.

“It is a very worrying for us that three children have been admitted to the Children’s Hospital Lahore with KD-like syndrome and other such cases are also being reported from Rawalpindi/Islamabad and Karachi”, the hospital Dean Prof Dr Masood Sadiq told Dawn on Tuesday.

The ICH Lahore is the biggest facility in the public sector in Pakistan for treatment of minors suffering from rare and complicated diseases.

He said an outbreak of Kawasaki-like disease might occur in countries like Pakistan which had been affected by the SARS-CoV-2 pandemic, commonly called coronavirus 2 responsible forCOVID-19.

He said that paediatrics have been alerted all over the country to deal this new emergency to secure lives of children.

“The paediatrics and cardiologists should be aware of this new disease which resembles KD but has an acute severe course and is most likely related to SARS-CoV-2 infection”, Prof Sadiq said.

He said that an early diagnosis, appropriate referral and management could lead to favorable outcome, using established therapies.

His statement came after first death of a child in Punjab (at Children’s Hospital Lahore) caused by Covid-19.

He said Covid-19 caused by coronavirus 2 had also been reported among children, however, there were relatively fewer such cases as compared to incidence of the disease among adults.

“The children [as per international medical criterion] below 19 years of age constitute 7.28 per cent (12,858 out of 176,617) of the total reported confirmed cases of Covid-19 in Pakistan with a mortality ratio of 0.46pc (16 out of 3,501 of under 15 years)”, he said quoting federal government’s statistics.

He said the ratio is one of the highest reported so far in the world during the coronavirus pandemic.

“In US, 2pc of the confirmed cases of Covid-19 were reported among persons aged below 18 years, followed by 2.2pc in China,1.2pc in Italy and 0.8pcin Spain,” Prof Dr Masood Sadiq said.

Fortunately, he said, the impact of Covid-19 among children had generally been mild.

Majority is either asymptomatic or mildly symptomatic. Quoting data, he said 4pc of the cases were asymptomatic (no clinical signs or symptoms with normal chest imaging), 51pc weremild cases with symptoms, including fever, fatigue, myalgia, cough, 39pc moderate having pneumonia with symptoms or subclinical disease with abnormal chest imaging. The figures showed five pc severe cases (dyspnea, central cyanosis, hypoxia), while only 0.6pc critical cases with acute respiratory distress syndrome [ARDS], respiratory failure, shock, or multi-organ dysfunction.

He said although children with Covid-19 usually don’t get serious form of the disease, they became carriers and could spread it to their grandparents and other people at home.

However, he said, the children with co-morbid conditions like chronic renal failure, congenital heart disease (CHD), chronic liver disease, those on steroids, lung disease like TB or suffering from asthma etc could get seriously sick and could even die.

“The centres across Europe and USA have recently been reporting a multi-system inflammatory syndrome affecting children associated with Covid-19. In children (MIS-C) and young people (below 19 years), temporally associated with the SARS-CoV-2 pandemic, elevated serologic inflammatory markers and cytokine levels, in which major cardiovascular compromise is a key feature”, he said.

Prof Sadiq, who is also one of the leading paediatric cardiologists of Pakistan, said that affected children were showing multi-system involvement with significant inflammation that resembled Kawasaki Disease.

“These patients manifested features of atypical Kawasaki disease together with cardiac inflammation overlapping with toxic shock syndrome and Kawasaki disease shock syndrome”, he said.

“This is most-likely a post-infection complication of SARS-CoV-2 and its incidence is 1out of 1,000 children affected by Covid-19”, he said.

This was a condition where different body parts could become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs, he said.

Many children with MIS-C had the virus that had Covid-19 or had been around someone with Covid-19.

“The MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care”, he said.

The typical symptoms are fever (below 38.0°C for 3 days, or report of subjective fever lasting more than 3 days), multisystem (more than 2 days) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological) and positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; orCovid-19 exposure within the 4 weeks prior to the onset of symptoms.

Prof Sadiq concluded that most of the affected children could require mechanical ventilation for cardiovascular stabilisation.

Published in Dawn, July 1st, 2020