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Keshavarz P, Yazdanpanah F, Azhdari S, Kavandi H, Nikeghbal P, Bazyar A, Rafiee F, Nejati SF, Sadabad FE, Rezaei N. Coronavirus Disease 2019 (COVID-19): A Systematic Review of 133 Children Presented with Kawasaki-like Multisystem Inflammatory Syndrome. J Med Virol. 2021 May 10. doi: 10.1002/jmv.27067. Epub ahead of print. PMID: 33969513.

Background: Kawasaki-like disease (KLD) and multisystem inflammatory syndrome in children (MIS-C) are considered as challenges for pediatric patients under the age of 18 infected with coronavirus disease 2019 (COVID-19).

Methods: A systematic search was performed on July 2, 2020, and updated on December 1, 2020, to identify studies on KLD/MIS-C associated with COVID-19. The databases of Scopus, PubMed, Web of Science, Embase, and Scholar were searched. The hospitalized children with a presentation of Kawasaki disease (KD), KLD, MIS-C, or inflammatory shock syndromes were included.

Results: A total number of 133 children in 45 studies were reviewed. Seventy-four (55.6%) cases had been admitted to pediatric intensive care units (PICUs). As well, 49 (36.8%) patients had required respiratory supports, of whom 31 (23.3%) cases had been required mechanical ventilation/intubation, 18 (13.5%) cases had required other oxygen therapies. In total, 79 (59.4 %) cases had been discharged from hospitals, 3 (2.2%) had been readmitted, 9 (6.7%) had been hospitalized at the time of the study, and 9 (6.7%) patients had expired due to the severe heart failure, shock, brain infarction. The outcomes had not been reported in other patients.

Conclusion: Approximately two-thirds of the children with KLD associated with COVID-19 had been admitted to PICUs, around one-fourth of them had required mechanical ventilation/intubation, and even some of them had been required readmissions. Therefore, physicians are strongly recommended to monitor children presented with the characteristics of KD during the pandemic as they can be the dominant manifestations in children with COVID-19.

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