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In some children, #COVID19 takes the form of #KawasakiDisease-like symptoms. So what exactly is #KawasakiDisease? It's an illness caused by inflammation of the blood vessels in children < 5 yrs of age. The exact cause is unknown but here's what we do know. Thread (1/n)
The #KawasakiDisease was first described in Japan by Dr. Tomisaku Kawasaki in 1967. Although more prevalent in Asians, it affects children of all ethnic groups. Symptoms include fever, red eyes, strawberry tongue, red rashes on the palms and soles. (2/n) https://www.healthline.com/health/kawasaki-disease
The #KawasakiDisease causes inflammation of the medium sized arteries, including the coronary arteries. If untreated, this can lead to serious conditions - heart disease, heart attack and death. (3/n)
https://www.ncbi.nlm.nih.gov/pubmed/25907703
https://www.ncbi.nlm.nih.gov/pubmed/25907703
Even though the cause of #KawasakiDisease is unknown, infection is suspected due to the seasonality of this disease. Perhaps many different infections (including #SARSCoV2) can induce this disease in susceptible children. (4/n) https://onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.13211
Is #KawasakiDisease an autoimmune disease? That is still being debated. Key questions that we need answers to include; what is the autoantigen that triggers this disease? Do antibodies mediate vasculitis? If so what type (IgA)? (5/n) https://www.frontiersin.org/articles/10.3389/fimmu.2018.02974/full
This study compared the transcriptome of 146 #KawasakiDisease patients and found an overwhelming signature for acute disease involving IL-1 signaling pathway, implicating activation of #Inflammasomes. (6/n)
https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-014-0102-6
https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-014-0102-6
Treatment of #KawasakiDisease involves intravenous immunoglobulin (IVIG) therapy. IVIG is known to have a multitude of anti-inflammatory effects. (7/n)
https://www.annualreviews.org/doi/abs/10.1146/annurev.immunol.26.021607.090232
https://www.annualreviews.org/doi/abs/10.1146/annurev.immunol.26.021607.090232
Importantly, there are some differences between the typical #KawasakiDisease and #Covid_19 related inflammatory syndrome in children. The latter affects children much older than 5 yrs of age. Perhaps different autoantigens are involved? (8/n)
My tweets above are the results of a lively discussion with my wonderful colleagues, Drs. Jordan Pober, Ric Pierce, @aaronmring, @RMedzhitov, @lucasite_lab who all shared their expertise and insights with me. Very grateful to have such generous colleagues @YaleMed 
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