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Diagnostic criteria for KD and incomplete KD, proposed by AHA
| Kawasaki Disease (KD) | Incomplete Kawasaki Disease |
|---|---|
| Fever ≥5 days + 4 from 5 criteria: | Fever ≥5 days + <4 criteria of classic KD |
| • Bilateral aseptic conjunctivitis | And CRP ≥30 mg/dl, ESR ≥40 mm/h |
| • Erythema and cracking lips, strawberry tongue | With positive echocardiography |
| • Rash, erythroderma, erythema multiform like | Or 3 from the following: |
| • Unilateral lymphadenopathy | • Anemia |
| • Erythema and edema of the hands and feet | • WBC ≥ 15.000/mm3 |
| • Thrombocytes ≥450.000/mm3 after 7 days | |
| • Albumin ≤3 g/dl | |
| • ALT elevated | |
| • Urine ≥10 WBC/hpf |
Cardiac biomarkers, IL6 and Soluble receptor IL2 in our cohort
| Patient nr. | NT-proBNP | cTroponin T | cTroponin I | CK MB | IL6 | Soluble receptor |
|---|---|---|---|---|---|---|
| 1. | 339.4 | 4.59 | 0.6 | 0.49 | 3.06 | - |
| 2. | 468.8 | 8.39 | - | - | 38.41 | - |
| 3. | 3101 | 34 | 36.2 | 2.15 | 162.3 | 11000 |
| 4. | 131 | 30.31 | 19.9 | 1.41 | - | - |
| 5. | 124 | 40.49 | 27.4 | - | 4.27 | - |
| 6. | 27408 | 92.36 | 190.7 | <0.18 | 44.44 | 6599 |
| 7. | 7188 | 9.24 | 7.4 | <0.18 | 251.56 | 11383 |
| 8. | 14922 | 81 | 186 | - | 403 | - |
| 9. | 6437 | 64.62 | 147.6 | 0.57 | 51.93 | 4842 |
| 10. | 11972 | 18.7 | 25 | 0.58 | 74 | 9689 |
| 11. | - | - | - | - | 468275 | 8749 |
| 12. | 11043 | - | 848 | - | 13.96 | - |
| 13. | 74 | 4.5 | 3 | - | 12.51 | 1543 |
| 14. | 67 | <3 | <0.1 | - | 29.04 | - |
Clinical features and laboratory findings in Kawasaki Disease children compared with PIMS patients
| Clinical feature/Lab | Kawasaki Disease | PIMS |
|---|---|---|
| Age of child at presentation | <5 years old | 7–8 years old |
| Gastro-intestinal symptoms | +/− | +++ |
| Cardiac dysfunction | + | ++ |
| Coagulopathy | +/− | ++ |
| Macrophage activation syndrome (MAS) | +/− | ++ |
| Shock | +/− | ++ |
| CRP | ++ | ++++ |
| Ferritin | +/− | ++ |
| DDimers | + | ++ |
| Cardiac biomarkers: NT-proBNP, Troponin I | + | ++ |
| Thrombocytopenia | Rare | ++ |
Laboratory investigations related with treatment
| Patient | CRP < 5 mg/dl | Ferritin 20–200 ng/ml | D-dimer < 250 ng/ml | Fibrinogen 200–400 mg/dl | IgG Antibody against SARS-CoV-2 < 33 BAU | IVIG | Steroids | Anticoagulant | Inotrope medication |
|---|---|---|---|---|---|---|---|---|---|
| 1. | 128 | 895 | 6215 | 633 | 0.13 | + | + | ||
| 2. | 78 | 132 | 3578 | 310 | 0.54 | + | |||
| 3. | 260 | 792 | 8657 | 529 | − | + | + | + | + |
| 4. | 17 | 67 | 209 | 240 | 0.61 | + | + | ||
| 5. | 3.43 | 98 | 278 | 238 | 60 | + | + | + | |
| 6. | 107 | 651 | 3228 | 279 | 14.4 | + | |||
| 7. | 165.59 | 980 | 3080 | 148 | 8.4 | + | + | + | |
| 8. | 232 | 1870 | 3347 | 509 | 4.84 | + | + | + | + |
| 9. | 143 | 1612 | 409 | 362 | 76 | + | + | + | |
| 10. | 258 | 1314 | 660 | 162 | 251 | + | + | + | |
| 11. | 72.63 | 100000 | 3404 | 23 | 0,2 | + | + | + | |
| 12. | 0.6 | 17105 | 11987 | 107 | 716 | + | + | + | |
| 13. | 159 | 330859 | 69000 | 100 | 5 | + | + | ||
| 14. | 73.73 | 143 | 992 | 169 | 1420 | + | + |
Comparison between the definitions of PIMS-TS established by RCPCH and CPSP and MIS-C defined by CDC and WHO
| Organization | RCPCH | CPSP | CDC | WHO |
|---|---|---|---|---|
| Name | PIMS-TS | PIMS-TS | MIS-C | MIS-C |
| Age of child | Child | < 18 years | < 21 years | 0–19 years |
| Fever-duration | Not specified | > 3 days | > 24 h | > 3 days |
| Inflammation | + | + | + | + |
| Organs affected | 1 or multiple | Not specified, but affected | ≥ 2 | ≥ 2 |
| Exclusion of other causes | Must | Must | Must | Must |
| Proof of the SARS-CoV-2 infection | Not necessary | Not necessary | Necessary | Necessary |