Kawasaki Disease in the Time of COVID-19 and MIS-C - The International Kawasaki Disease Registry


Ashraf S. Harahsheh, Division of Cardiology, Department of Pediatrics, Children's National Hospital; George Washington University School of Medicine & Health Sciences; 111 Michigan Ave, NW Washington, DC 20010, USA. Electronic address: aharahsh@childrensnational.org.
Samay Shah, Medical student at George Washington University School of Medicine & Health Sciences, Washington, DC.
Frederic Dallaire, Department of pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Cedric Manlhiot, Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, MD, USA.
Michael Khoury, Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Simon Lee, The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA.
Marianna Fabi, Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
Daniel Mauriello, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
Elif Seda Selamet Tierney, Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA.
Arash A. Sabati, Phoenix Children's Hospital, Phoenix, AZ, USA.
Audrey Dionne, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Nagib Dahdah, Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada.
Nadine Choueiter, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
Deepika Thacker, Nemours Children's Hospital, Wilmington, DE, USA.
Therese M. Giglia, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Dongngan T. Truong, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA.
Supriya Jain, New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
Michael Portman, Seattle Children's Hospital, Seattle, WA, USA.
William B. Orr, Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
Tyler H. Harris, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Jacqueline R. Szmuszkovicz, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Pedrom Farid, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
Brian W. McCrindle, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.

Document Type

Journal Article

Publication Date



The Canadian journal of cardiology




2019 novel coronavirus disease (COVID-19) pandemic; Kawasaki disease; Multisystem Inflammatory Syndrome in Children (MIS-C); Pediatric Multisystem Inflammatory Syndrome temporally associated with COVID-19 (PIMS); coronary artery abnormality


BACKGROUND: Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki disease (KD) have overlapping clinical features. We compared demographics/clinical presentation, management, and outcomes of patients by evidence of prior SARS-CoV-2 infection. METHODS: The International KD Registry (IKDR) enrolled KD and MIS-C patients from sites from North, Central and South America, Europe, Asia and Middle East. Evidence of prior infection was defined as: Positive (+ve household contact or positive PCR/serology), Possible (suggestive clinical features of MIS-C and/or KD with negative PCR or serology but not both), Negative (negative PCR and serology and no known exposure), and Unknown (incomplete testing and no known exposure). RESULTS: Of 2345 enrolled patients SARS-CoV-2 status was Positive for 1541 (66%) patients, Possible 89 (4%), Negative 404 (17%) and Unknown for 311 (13%) patients. Clinical outcomes varied significantly between the groups, with more patients in the Positive/Possible groups presenting with shock, having admission to Intensive Care, receiving inotropic support, and having longer hospital stays. Regarding cardiac abnormalities, patients in the Positive/Possible groups had a higher prevalence of left ventricular dysfunction, while patients in the Negative and Unknown groups had more severe coronary artery abnormalities. results CONCLUSION: : There appears to be a spectrum of clinical features from MIS-C to KD with a great deal of heterogeneity, and one primary differentiating factor is evidence for prior acute SARS CoV2 infection/exposure. SARS-CoV-2 Positive/Possible patients had more severe presentations and required more intensive management, with a greater likelihood of ventricular dysfunction but less severe coronary artery adverse outcomes, in keeping with MIS-C.