Missed or delayed diagnosis of Kawasaki disease during the 2019 novel coronavirus disease (COVID-19) pandemic.

To the Editor:

Due to “stay-at-home” orders and the risk of novel coronavirus disease 2019 (COVID-19), many parents now hesitate or fear seeking in-person consultations for their children. This has led to reductions in emergency department visits and hospital admissions for other critical illnesses. In addition, healthcare providers have focused on COVID-19 management during the pandemic. Because of Bayesian thinking, other diseases may be underdiagnosed or undergo delayed treatment.

Because COVID-19 now leads as the probable diagnosis for first-line providers encountering febrile patients, the potential for missed or late diagnosis and treatment of Kawasaki disease in children is particularly concerning. Prompt diagnosis of Kawasaki disease and treatment with intravenous immunoglobulin (IVIG) prevents coronary artery aneurysms (CAA). , Without timely treatment, CAAs could occur in up to 25% of children with Kawasaki disease.

We respectfully remind caregivers of the following principles for the care of children with suspected or definite Kawasaki disease: (1) Keep a high suspicion for Kawasaki disease in all children with prolonged fever, but especially in those younger than 1 year of age. (2) Administer IVIG within 10 days, and ideally within 7 days, from onset of fever. (3) In the presence of ongoing systemic inflammation, children with Kawasaki disease presenting with greater than 10 days of fever and/or CAA may warrant IVIG treatment. (4) Continue to obtain recommended echocardiograms according to published guidelines. (5) Watch for late manifestations of Kawasaki disease, review the clinical history, and seek pediatric cardiology consultation. , (6) In the case of delayed diagnosis, refer to the American Heart Association management guidelines or contact an expert in Kawasaki disease. (7) Offer telemedicine services, remote echocardiogram, and direct-to-consumer visits that allow for nonverbal communication when evaluating children with confirmed or suspected Kawasaki disease.6, 7, 8

With this, we hope to avoid a future surge in the prevalence of CAAs in patients due to missed or delayed diagnosis of Kawasaki disease.