意大利乔瓦尼二十三世医院Lorenzo D'Antiga团队发现，意大利SARS-CoV-2流行地区贝加莫省爆发了严重川崎样疾病。相关论文于2020年5月13日发表在《柳叶刀》杂志上。

贝加莫省受SARS-CoV-2流行病的影响最广，是普通人群中病毒表现的自然观测站。在过去的一个月中，研究组记录了川崎病的爆发。为了评估在SARS-CoV-2流行期间诊断出的川崎样疾病患者的发病率和特征，研究组根据SARS-CoV-2流行病开始之前（第1组）或之后（第2组）的症状表现，对过去5年来被诊断为川崎样疾病的所有患者进行了分类。

根据美国心脏协会指南，川崎病样表现被视为川崎病。川崎病休克综合征（KDSS）定义为存在循环功能障碍，巨噬细胞活化综合征（MAS）根据国际风湿病儿科试验组织标准来定义。研究组通过鼻咽拭子和口咽拭子以及血清学来诊断患者是否感染或曾经感染过SARS-CoV-2。

第1组包括2015年1月1日至2020年2月17日确诊的19例患者，包括7个男孩和12个女孩，平均年龄为3.0岁。第2组包括2020年2月18日至4月20日确诊的10名患者，包括7名男孩和3名女孩，平均年龄为7.5岁，有8例IgG或IgM或两者均为阳性。两组患儿在发病率、平均年龄、心脏受累、KDSS、MAS以及是否需要辅助类固醇治疗等方面均有显著差异。

总之，在过去的一个月中，研究组发现川崎样疾病的发病率增加了30倍。SARS-CoV-2开始流行后确诊的儿童对该病毒有免疫反应，年龄较大，心脏受累率较高，并有MAS的特征。SARS-CoV-2的流行与严重川崎病的高发病率有关，应当引起重视。

附：英文原文

Title: An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study

Author: Lucio Verdoni, Angelo Mazza, Annalisa Gervasoni, Laura Martelli, Maurizio Ruggeri, Matteo Ciuffreda, Ezio Bonanomi, Lorenzo DAntiga

Issue&Volume: 2020-05-13

Abstract: Background

The Bergamo province, which is extensively affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic.

Methods

All patients diagnosed with a Kawasaki-like disease at our centre in the past 5 years were divided according to symptomatic presentation before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. Kawasaki- like presentations were managed as Kawasaki disease according to the American Heart Association indications. Kawasaki disease shock syndrome (KDSS) was defined by presence of circulatory dysfunction, and macrophage activation syndrome (MAS) by the Paediatric Rheumatology International Trials Organisation criteria. Current or previous infection was sought by reverse-transcriptase quantitative PCR in nasopharyngeal and oropharyngeal swabs, and by serological qualitative test detecting SARS-CoV-2 IgM and IgG, respectively.

Findings

Group 1 comprised 19 patients (seven boys, 12 girls; aged 3·0 years [SD 2·5]) diagnosed between Jan 1, 2015, and Feb 17, 2020. Group 2 included ten patients (seven boys, three girls; aged 7·5 years [SD 3·5]) diagnosed between Feb 18 and April 20, 2020; eight of ten were positive for IgG or IgM, or both. The two groups differed in disease incidence (group 1 vs group 2, 0·3 vs ten per month), mean age (3·0 vs 7·5 years), cardiac involvement (two of 19 vs six of ten), KDSS (zero of 19 vs five of ten), MAS (zero of 19 vs five of ten), and need for adjunctive steroid treatment (three of 19 vs eight of ten; all p<0·01).

Interpretation

In the past month we found a 30-fold increased incidence of Kawasaki-like disease. Children diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected in countries involved in the SARS-CoV-2 epidemic.

DOI: 10.1016/S0140-6736(20)31103-X

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31103-X/fulltext