Kawasaki like disease in SARS-CoV-2 infected children – a key role for neutrophil and macrophage extracellular traps

Abstract

Less than 2% of children are reported to test positive for SARS-CoV-2. However, increasing reports have described COVID-positive children demonstrating symptoms like Kawasaki disease (KD), an acute vasculitis in medium sized vessels. Characteristic clinical features of KD include fever, conjunctivitis, mucosal alterations, rashes, and cervical lymphadenopathy. We searched PubMed with six keywords including neutrophil and macrophage extracellular traps (NETs/METs), Kawasaki disease, vasculitis, COVID-19 and SARS-CoV-2. We discussed here how SARS-CoV-2 infection is accompanied by activation of proinflammatory cytokines, specifically IL-1 beta and production of neutrophil and macrophage extracellular traps (NETs/METs), structures formed through specialized types of cell death. In this review, we propose that the KD-like pathogenesis observed in COVID-19infected children could arise from infection of resident macrophages resulting in activation of NLRP3 inflammasomes and release of IL-1 beta in a genetically predisposed subset of infected children, mediated via NET/MET dysregulation and overproduction. We also propose potential avenues of diagnosis and treatment that could be utilized to aid such patients.