After experiencing a lull during the COVID-19 pandemic, clinicians at Rady Children’s Hospital were somewhat surprised by the number of young children diagnosed with Kawasaki disease in the new year.
In January, said Dr. Jane Burns, director of the Kawasaki Disease Clinic in Rady, 15 children were diagnosed with KD, which, because it causes severe inflammation of blood vessels, is the leading cause of the disease. cardiac acquired in American children.
While that’s not much compared to the hundreds and thousands of cases of flu that affect children each year, 15 diagnoses in January is a lot more than is usually the case.
“Normally we see about 10 in January,” Burns said, adding that while complete nationwide numbers are not available, anecdotal reports from colleagues in other major cities across the country indicate a similar trend .
“The feeling is that KD is booming all over the United States,” Burns said.
The end of the pandemic probably has something to do with the current KD trend. During the pandemic, Burns noted, the number of diagnoses among most children dropped by 50 percent, likely due to masking and social distancing rules and school closures. Now that these interventions are largely complete, the disease is reappearing, reinforcing the idea that it is something in the environment, something as yet unidentified in the air children breathe, that causes persistent high fevers , bloodshot eyes, red rash, swelling. hands and feet and, sometimes, a “strawberry” tongue.
Joanne and Leon Pisa of National City noticed many of these symptoms in their 8-month-old daughter Ellie, causing them to rush her to urgent care with a fever of 104 degrees on Sunday, February 4. When the fever and rash refused to resolve, she was admitted to Rady through the hospital’s emergency department on Wednesday, February 7.
The signs were clear enough that the infant’s medical team, supervised by Burns, gave him intravenous immunoglobulin, a concoction of human antibodies often used to help many types of patients fight infections. In this case, Burns explained, the proteins in the infusion, more commonly known as “IVIG,” are able to calm things down, especially when it comes to neutrophils, white blood cells that KD, for some reason, provokes into a noxious frenzy.
“It kills the neutrophils, and these guys are bad actors in this disease, like gasoline on a fire,” Burns said. “And the stem structure of the molecule (IVIG) is chewed and presented to the immune system, which strengthens the body’s natural anti-inflammatory system.”
Most children who receive IVIG early enough after symptoms appear – usually within a few days – are able to avoid lasting cardiovascular damage. Hospitals use sound wave imaging – an echocardiogram – to examine the heart after inflammation has subsided, looking for telltale signs of weakened regions that could cause a fatal aneurysm in the future.
On Friday, Burns walked into Ellie’s room, clipboard in hand, and announced that the first echocardiogram looked normal. A second scan carried out in a few weeks would still be necessary to ensure this, but the odds were largely in the young woman’s favor.
Relief was immediately visible on Joanne Pisa’s face.
“It was really, really scary, especially since it was my first child,” she said. “You just don’t know what to expect when something like this happens.”
For other parents, Pisa recommends watching their hands and feet. They’re known to show signs of KD, and they were definitely screaming “it’s more than a fever and rash” when Ellie got sick.
“His hands were quite purple and red, and they were swollen; that’s a sign that’s really good to look for,” Pisa said.
Being of Filipino and Laotian descent, Ellie is at greater risk of developing Parkinson’s disease than the general population, as are all people of Asian and Pacific Islander descent.
But the question everyone has wanted to know since 1976 remains unanswered.
Burns, who also directs the Kawasaki Disease Research Center at UC San Diego, and his colleagues have traveled the world over the past four decades trying to determine what exactly triggers this cascade of damage that so profoundly affects disproportionately children.
Recent research, including a paper authored by Burns’ group with climate experts from the Scripps Institution of Oceanography, has hypothesized that part of the cause may be dust born from strong winds from agricultural areas of China. Other, even older hypotheses that Burns explored suggest that carpeting in homes could be a trigger.
Here, COVID-19 turned out to be something of an unwitting laboratory. While the incidence of childhood Parkinson’s disease has decreased by 50 percent in older children, diagnosis rates in very young infants have remained stable.
“The findings are that babies, young infants, are being exposed at home because they were not wearing masks,” Burns said. “They were too small to wear masks.”
But, at the same time, there also seems to be something that triggers older children. Today, pre-COVID-19 KD rates are returning as masks and other pandemic protocols have fallen off.
Burns and Scripps recently collaborated with Japanese colleagues to analyze the entire record of diagnosed cases of KD in that country, dating back to the 1970s, and discovered some interesting trends, including examining how the disease affected children of different ages .
Researchers found that although the incidence of KD increased in all age groups, the rate was significantly faster among people aged 3 and older. While incidence has doubled overall since the 1990s, there has been a “five-fold increase” in Japan for children aged 3 and older since 1990.
Older children, the researchers note, have much more complex social lives, leaving home for daycare, school and other activities not yet practiced by younger cohorts.
The researchers say that “the remarkable increase and spatial consistency in the incidence of Parkinson’s disease among children and adolescents aged 3 years and older suggests that environmental factors were associated with increased exposure to a trigger of Parkinson’s disease.” Parkinson disease “.
Daniel Cayan, a climate scientist at Scripps and one of the paper’s co-authors, said that while there is still strong reason to believe that whatever triggers Parkinson’s disease probably happens in the respiratory system, Differences between infants and children during the pandemic are the cause. rethink how these triggers are encountered.
“It’s not a resounding signal, but it has led to reconsideration of the possibility that there could be an element of human-to-human transmission,” Cayan said.
Of course, older children, those who wore masks during the pandemic, also suggest an environmental trigger.
“It kind of leads you to explore the fact that maybe there’s not just one source or one agent but, you know, a variety of provocations that result in that reaction that we’re looking for with KD ” Cayan said.
The scientist said he doesn’t think research efforts are yet close to answering the nearly 50-year-old riddle. But, he added, patterns gleaned from looking at decades of diagnostics in Japan can help guide further research, including more closely studying and monitoring what is being breathed and where.
“I think things have come a long way in the last 10 years, but I think there’s still a way to go,” Cayan said.
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