Is the multisystem inflammatory syndrome in children Kawasaki disease- or is it a variant of Lemierre’s syndrome? I match symptom to symptom in these diseases.

There is a new complication in Covid19 patients, specially young children:

82 children with Kawasaki-like syndrome in New York City, an increase of 30 cases since yesterday.”  One should know “scientists haven’t found an exact cause for Kawasaki disease. It might be linked to genes, viruses, bacteria, and other things in the world around a child, such as chemicals and irritants.”

This is not Kawasaki as this article notes !

  1. shock — in which patients need medication to maintain blood pressure and intensive care unit treatment — may be the critical differentiator between this and traditional Kawasaki disease. Choueiter noted fewer than 5% of patients with Kawasaki disease present with shock.”
  2. These patients also have low lymphocyte counts, whereas traditional Kawasaki disease comes with a high count.

However, Lemierre’s syndrome is known to be caused by anaerobic bacteria, aided by Epstein Barr virus. And it affects young children.

And based on metagenomic sequencing data from 25+ Covid19 patients, I show that:

SARS-Cov2 enables anaerobic bacteria (Prevotella, et al) to colonize the lungs disrupting homeostasis – symptoms (ARDS, septic shock, blood clots, arterial stroke) finds resonance, with key differences, in the ‘forgotten disease’ Lemierre Syndrome, caused by anaerobic bacteria enabled by Epstein Barr Virus

 

A recent paper (May 13th) outlines An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study & notes the classical symptoms of Kawaski – each of these symptoms I have linked to Lemierre’s syndrome (click for a paper)

 

Patients presenting with the classic form had non-exudative conjunctivitis, hand and feet anomalies (ie, erythema or firm induration, or both), and polymorphic rash. Four (80%) of five patients had associated changes of the lips or oral cavity, or both; patient 7 also had laterocervical lymphadenopathy (table 1).”

 

Thus, considering the common anaerobic bacteria present in Covid19 and Lemierre’s syndrome, it is advised to test for anaerobic bacteria – and if possible for coinfection with EBV in children presenting with what is currently being assumed to be Kawasaki disease.

 

Image from Lemierre’s syndrome: A rare cause of septic emboli in a young adult

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