An editorial commentary urged clinicians to have a high level of diagnostic suspicion and follow  WHO and CDC definitions to facilitate timely identification and treatment of cases.During July, suspected cases were being flagged and reported in Mumbai, in Delhi, Chennai, and elsewhere. In Pakistan, at least 24 children were said to have Kawasaki-like symptoms in Lahore, where 8 cases fulfilling WHO criteria were prospectively identified by 30 June. In Kazakhstan, 14 cases were confirmed by 20 August (among 2,357 children known to have been infected). Cases have been recorded in Israel, including one of a child who presented with severe central nervous system involvement and complement deficiency. In Turkey, four children with a Kawasaki-like disease probably associated with COVID-19 are reported to have been admitted to the childrens hospital of Hacettepe University in Ankara between 13 April and 11 July. In Algeria, a first case was recorded in June. In Egypt, on 10 July the authorities denied rumours of the existence of cases of Kawasaki-like disease in the country. In South Africa, the first 23 affected children were treated in Cape Town – the initial epicentre of the national COVID-19 epidemic – between 4 June and 24 July. In Ecuador, the Ministry of Health announced on 19 July the presence of 46 probable cases.
Most children who receive expert multidisciplinary care survive. In addition to respiratory distress, major complications that may need aggressive supportive care can include myocardial damage, acute kidney injury, and coagulopathy (thrombophilia). In some cases, sustained cardiac arrhythmias have led to haemodynamic collapse and need for extracorporeal membrane oxygenation (ECMO). Deaths have been recorded in a small minority (under 2%) of the cases reported. Occasionally, fatalities  have followed complications of ECMO. Some children exposed to COVID-19 also appear to have a less severe Kawasaki-like disease. Ventricular function often recovers before discharge from hospital (often after 6–10 days). Coronary artery aneurysms can develop even in the absence of Kawasaki-like features. Their frequency and severity is uncertain. So far, they have been recorded in 7% of reported cases. Long-term prognosis is unclear. Diagnosis
Diagnosis is by specialist clinical evaluation. Diagnostic suspicion may be raised by unexplained persistent fever and clinically concerning symptoms following exposure to COVID-19. Families need to seek immediate medical care, as the childs condition can deteriorate rapidly. Paediatricians first involvement is often in the emergency department. Early recognition and multidisciplinary referral to paediatric specialists (in intensive care, infectious diseases, cardiology, haematology, rheumatology, etc.) is essential. Examinations may include blood tests, chest x-ray, heart ultrasound (echocardiography), and abdominal ultrasound. Clinicians worldwide have been urged to consider this condition in children who display some or all the features of Kawasaki disease or toxic shock syndrome. Case definitions and guidance
A universally accepted case definition for this newly described syndrome has still not been agreed.