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Asano S, Fukushima N, Yamada K. The efficacy and safety of intravenous immunoglobulin infusion in 12 h for the initial treatment of Kawasaki disease. Pediatr Neonatol 2024:S1875-9572(24)00003-2. [PMID: 38281860 DOI: 10.1016/j.pedneo.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/06/2023] [Accepted: 09/21/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Approximately 10-20 % of individuals develop a recrudescent or persistent fever after intravenous immunoglobulin (IVIG) infusion for the initial treatment of Kawasaki disease. The aim of this study was to evaluate the efficacy and safety of the initial IVIG treatment of Kawasaki disease based on duration of infusion. METHODS This retrospective, single-center study included 53 patients with Kawasaki disease who were initially treated with 2 g/kg of IVIG by means of a single infusion from June 2018 to August 2019. We classified patients into two groups based on the duration of the infusion: the 12-h group and the 24-h group. We compared the treatment response of the primary IVIG and its adverse events using the Mann-Whitney U test and Fisher's exact or Chi-square tests. RESULTS There were no significant differences in the response to initial IVIG treatment between the two groups. The duration from treatment onset to defervescence was shorter in the 12-h group than the 24-h group (7 h vs. 12 h, respectively, p = 0.07); however, this was not significant. There were no significant between-group differences regarding adverse events. CONCLUSION We concluded that the initial 12-h IVIG treatment was comparable to the 24-h treatment in terms of efficacy and safety. This will enable physicians to feel confident about pursuing a shorter course of treatment with similar results as conventional treatment and decide on administering additional therapy to their patients.
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Affiliation(s)
- Satoshi Asano
- Department of Pediatrics, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa-ken, Japan
| | - Naoya Fukushima
- Department of Pediatrics, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa-ken, Japan.
| | - Kenichiro Yamada
- Department of Pediatrics, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa-ken, Japan
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Cheon EJ, Oh JS. Hemolytic anemia associated with intravenous immunoglobulin in Kawasaki disease. BMC Pediatr 2024; 24:69. [PMID: 38245705 PMCID: PMC10799476 DOI: 10.1186/s12887-024-04546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The administration of high-dose intravenous immunoglobulin (IVIG) is a standard treatment for the management of Kawasaki disease (KD). IVIG is known to be a highly effective and safe treatment. CASE PRESENTATION We report the development of hemolytic anemia in seven children receiving repeated doses of IVIG. The children were aged 3-44 months and included 4 girls and 3 boys. All children received 10% IVIG and a second course of immunoglobulin because they did not respond to the first course of immunoglobulin. Two received high-dose aspirin (50 mg/kg), and five received low-dose aspirin (5 mg/kg). Two patients required additional methylprednisolone pulse therapy (30 mg/kg) after the second dose of immunoglobulin, and three patients received oral prednisolone therapy for defervescence. Three patients showed coronary artery dilation during hospitalization and normalized within two months. Pretreatment hemoglobin averaged 11.3-14.2 g/dL, and post-hemolytic anemia hemoglobin ranged from 7.4 to 9.6 g/dL, with a difference of 1.7-6.8 g/dL. Reticulocytes were increased to 3.3-13.2%. Peripheral blood smears showed normochromic normocytic anemia, and anisopoikilocytosis. All children were positive for warm-type antibodies with IgG+, C3d- in direct antiglobulin test, and the blood group was A + in five and B + in two. None of the patients received immunomodulatory therapy or red blood cell transfusions. They were followed for a year and all recovered. CONCLUSION Especially, in non-O blood group KD patients who are refractory to initial IVIG and require a second dose of IVIG or 10% formulation the possibility of immune hemolytic anemia should be carefully considered, and close follow-up should be maintained after therapy.
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Affiliation(s)
- Eun Jung Cheon
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea.
| | - Jun Suk Oh
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea, Republic of Korea
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Huang T, Peng Q, Zhang Y, Zhu Z, Fan X. The Systemic Immune-Inflammation Index (SII) and coronary artery lesions in Kawasaki disease. Clin Exp Med 2024; 24:4. [PMID: 38231301 PMCID: PMC10794328 DOI: 10.1007/s10238-023-01265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
Coronary artery lesions (CALs) are the most common complications of Kawasaki disease (KD) and play a crucial role in determining the prognosis of the disease. Consequently, the early identification of children with KD who are at risk of developing coronary artery damage is vitally important. We sought to investigate the relationship between the Systemic Immune-Inflammation Index (SII) and CALs in patients with KD and to assess its predictive value. We carried out a retrospective review and analysis of medical records for KD patients treated at the First Affiliated Hospital of Anhui Medical University between January 2017 and January 2023. We utilized single-variable tests, binary logistic regression analysis, ROC curve analysis, restricted cubic spline tests, and curve fitting to evaluate the association between SII and CALs. In our study, 364 patients were included, with 63 (17.3%) presenting with CALs at the time of admission. The binary logistic regression analysis indicated that SII was a significant risk factor for CALs at admission, evident in both unadjusted and models adjusted for confounders. The ROC curve analysis revealed an AUC (Area Under the Curve) value of 0.789 (95%CI 0.723-0.855, P < 0.001) for SII's predictive ability regarding CALs at admission. A consistent positive linear relationship between SII and the risk of CALs at admission was observed in both the raw and adjusted models. Our research findings suggest that SII serves as a risk factor for CALs and can be used as an auxiliary laboratory biomarker for predicting CALs.
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Affiliation(s)
- Tiantuo Huang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No.218 Ji-Xi Road, Hefei, Anhui Province, China
| | - Qi Peng
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No.218 Ji-Xi Road, Hefei, Anhui Province, China
| | - Yiyue Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No.218 Ji-Xi Road, Hefei, Anhui Province, China
| | - Zaifu Zhu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No.218 Ji-Xi Road, Hefei, Anhui Province, China
| | - Xiaochen Fan
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No.218 Ji-Xi Road, Hefei, Anhui Province, China.
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Lu G, Li X, Tang J, Jin Y, Wang Y, Zhou K, Li Y. Mycoplasma infection aggravates cardiac involvements in Kawasaki diseases: a retrospective study. Front Immunol 2024; 14:1310134. [PMID: 38304251 PMCID: PMC10832023 DOI: 10.3389/fimmu.2023.1310134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024] Open
Abstract
Background Mycoplasma pneumoniae (MP) infection serves as a substantial cofactor in Kawasaki disease (KD) among patients. Although the dominant issue triggering KD has recently focused on MP infection, the complete demonstration of the relationship between MP infection and KD remains elusive. This study endeavors to scrutinize and compare the clinical manifestations and cardiac involvement between MP-triggered KD and non-infection-associated KD. Method This retrospective study (2023-039, approved by the Institutional Review Board of West China Second University Hospital of Sichuan University) encompassed 247 consecutive patients diagnosed with KD between June 2017 and December 2022. Patients were categorized into two groups: the MP group (n = 38) and the non-MP group (n = 209). Univariable analysis was utilized to discern differences in clinical features, severity of inflammation, and initial or persistent cardiac complications between the two groups. Results The MP group exhibited a more intricate clinical profile compared with the non-MP group, characterized by prolonged hospital stays, a higher incidence of incomplete KD, and elevated comorbidities. In addition, MP infection correlated with severe hematological disorders, coagulation dysfunction, and myocardial injuries. Our findings revealed that MP infection led to prolonged inflammation after initial treatment with intravenous immunoglobulin. Although initial cardiac assessments failed to discern disparities between the two groups, MP infection notably exacerbated coronary artery aneurysms (CAAs), resulting in sustained dilation. Conclusions Recognizing MP infection as a significant infectious factor associated with KD is imperative. In patients with KD, MP infection significantly prolongs inflammation and causes hematological disturbances during the initial treatment phase. Moreover, the presence of MP infection exacerbates the progression of CAAs and myocardial injuries during the subacute phase of KD, consequently contributing to the persistence of CAAs.
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Affiliation(s)
| | | | | | | | - Yang Wang
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Fukunaga R, Ueda T, Matsui R, Itabashi T, Fukazawa R, Nagi-Miura N, Itoh Y. Human adipose tissue-derived stem cells inhibit coronary artery vasculitis in a mouse model of Kawasaki disease. J NIPPON MED SCH 2024:JNMS.2024_91-212. [PMID: 38233123 DOI: 10.1272/jnms.jnms.2024_91-212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Adipose tissue-derived mesenchymal stem cells (ADSCs) are used for the treatment of various diseases because of their rapid proliferation and high anti-inflammatory and tissue repair properties. Kawasaki disease is a systemic vasculitis with coronary arteritis and aneurysms occurring in pediatric patients. In this study, we examined serologically and pathologically whether the administration of human ADSCs (hADSCs) to a mouse model of Kawasaki disease could suppress vasculitis. METHODS Candida albicans water-soluble fractions were intraperitoneally injected into DBA/2 mice for 5 consecutive days to generate a mouse model of Kawasaki disease. The model mice were intravenously administered hADSCs or phosphate-buffered saline (PBS). Serum samples collected on days 15 and 29 were used to compare cytokine levels. Mouse hearts dissected on day 29 were subjected to hematoxylin and eosin and immunohistological staining using Galectin-1 (Gal-1), a protein involved in cardiovascular homeostasis, and CD44, a cell-surface marker of hADSCs. RESULTS Comparison of inflammation-related cytokines showed a significant decrease in IL-1α expression at day 15 (P<0.05) and IL-6 expression at day 29 (P<0.01) in the hADSCs-treated group compared to the PBS group. Evaluation by hematoxylin and eosin staining showed decreased inflammatory cell infiltration and a tendency towards increased Gal-1 expression in the hADSCs group. CD44 expression was not observed in both the groups. The survival curve showed that the hADSCs group had a significantly longer survival time (P<0.05). CONCLUSIONS The present experimental results indicate that hADSCs have an early anti-inflammatory effect, and that Gal-1 may be involved in preventing inflammation and reducing tissue damage.
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Affiliation(s)
| | | | | | | | | | - Noriko Nagi-Miura
- Laboratory for Immunopharmacology of Microbial Products, Tokyo University of Pharmacy and Life Sciences
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Huang YN, Lin CY, Chi H, Chiu NC, Huang DTN, Chang L, Kung YH, Huang CY. Jaundice-predominant manifestation of Kawasaki disease in children. Front Pediatr 2024; 11:1281909. [PMID: 38264503 PMCID: PMC10803413 DOI: 10.3389/fped.2023.1281909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
Background A jaundice-predominant presentation of Kawasaki disease (KD) is atypical. Methods A total of 12 children with KD with a predominant manifestation of jaundice at MacKay Children's Hospital were reviewed, along with 42 cases reported in the literature since 1990. Results The median age of the 12 patients was 1.85 years (range: 3 months-4 years), and 66.6% were male. All of the patients had elevated liver function at presentation, 50% had hydrops of the gallbladder, and almost 60% had gastrointestinal symptoms and signs. Complete KD was evident in 11 of the 12 patients (91.7%), and two patients (16.7%) had recurrent episodes. All of the patients received intravenous immunoglobulin (IVIG); however, one-third were refractory to treatment. Corticosteroids were used in five (41.7%) of the patients. Three (25%) of the patients had shock, and seven (58.3%) had coronary artery abnormalities, of whom one (8.3%) had persistent coronary artery aneurysm and the others recovered. A review of the 42 cases in the literature showed that the children with a jaundice-predominant presentation of KD had high rates of IVIG-refractory disease (25%), coronary artery abnormalities (25%), shock (13.2%), and corticosteroid treatment (24.2%). Conclusions Children with KD presenting with a jaundice-predominant manifestation are at a higher risk of IVIG-refractory disease, coronary artery abnormalities, and more recurrent episodes. Physicians should be aware of the risk of shock in this population.
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Affiliation(s)
- Ya-Ning Huang
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
| | - Hsin Chi
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Daniel Tsung-Ning Huang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Lung Chang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Tamshui MacKay Memorial Hospital, Taipei, Taiwan
| | - Yen-Hsin Kung
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Tamshui MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
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Shrestha S, Wiener HW, Kajimoto H, Srinivasasainagendra V, Ledee D, Chowdhury S, Cui J, Chen JY, Beckley MA, Padilla LA, Dahdah N, Tiwari HK, Portman MA. Pharmacogenomics of intravenous immunoglobulin response in Kawasaki disease. Front Immunol 2024; 14:1287094. [PMID: 38259468 PMCID: PMC10800400 DOI: 10.3389/fimmu.2023.1287094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Kawasaki disease (KD) is a diffuse vasculitis in children. Response to high dose intravenous gamma globulin (IVIG), the primary treatment, varies according to genetic background. We sought to identify genetic loci, which associate with treatment response using whole genome sequencing (WGS). Method We performed WGS in 472 KD patients with 305 IVIG responders and 167 non-responders defined by AHA clinical criteria. We conducted logistic regression models to test additive genetic effect in the entire cohort and in four subgroups defined by ancestry information markers (Whites, African Americans, Asians, and Hispanics). We performed functional mapping and annotation using FUMA to examine genetic variants that are potentially involved IVIG non-response. Further, we conducted SNP-set [Sequence] Kernel Association Test (SKAT) for all rare and common variants. Results Of the 43,288,336 SNPs (23,660,970 in intergenic regions, 16,764,594 in introns and 556,814 in the exons) identified, the top ten hits associated with IVIG non-response were in FANK1, MAP2K3:KCNJ12, CA10, FRG1DP, CWH43 regions. When analyzed separately in ancestry-based racial subgroups, SNPs in several novel genes were associated. A total of 23 possible causal genes were pinpointed by positional and chromatin mapping. SKAT analysis demonstrated association in the entire MANIA2, EDN1, SFMBT2, and PPP2R5E genes and segments of CSMD2, LINC01317, HIVEPI, HSP90AB1, and TTLL11 genes. Conclusions This WGS study identified multiple predominantly novel understudied genes associated with IVIG response. These data can serve to inform regarding pathogenesis of KD, as well as lay ground work for developing treatment response predictors.
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Affiliation(s)
- Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hidemi Kajimoto
- Division of Cardiology, Seattle Children’s and University of Washington Department of Pediatrics, Seattle, WA, United States
| | - Vinodh Srinivasasainagendra
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dolena Ledee
- Division of Cardiology, Seattle Children’s and University of Washington Department of Pediatrics, Seattle, WA, United States
| | - Sabrina Chowdhury
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jinhong Cui
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jake Y. Chen
- Informatics Institute, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mikayla A Beckley
- Division of Cardiology, Seattle Children’s and University of Washington Department of Pediatrics, Seattle, WA, United States
| | - Luz A. Padilla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nagib Dahdah
- CHU Ste-Justine, Universite de Montreal, Montreal, QC, Canada
| | - Hemant K. Tiwari
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael A. Portman
- Division of Cardiology, Seattle Children’s and University of Washington Department of Pediatrics, Seattle, WA, United States
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Shih WL, Yeh TM, Chen KD, Leu S, Kuo HC. Positive Echocardiographic Association between Carotid Artery and Coronary Artery Diameter and Z-Score in a Mouse Model of Kawasaki Disease. Diagnostics (Basel) 2024; 14:145. [PMID: 38248023 PMCID: PMC10814724 DOI: 10.3390/diagnostics14020145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/14/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Kawasaki disease (KD) occurs in young children, has an unknown etiology, and can cause such life-threatening complications as coronary artery aneurysm. A mouse model using Lactobacillus casei cell wall extract (LCWE) with intraperitoneal injection was established for KD years ago. Histological examination of coronary artery lesions indicated features similar to those of vascular lesions of patients with KD. Since animals must be sacrificed during histological examination, the longitudinal survey of coronary artery lesions (CALs) is difficult. The aim of this study was to survey the vasculitis status of the coronary artery and the carotid artery in a KD mouse model. METHOD LCWE was intraperitoneally injected into 5-week-old male C57BL/6 mice to induce CALs. We studied the longitudinal status of the carotid and coronary arteries and analyzed the Z-score of coronary artery diameter. RESULTS Carotid artery wall thickness (day 7) and diameter (day 14) significantly increased in the LCWE group with a dose-dependent effect (p < 0.05). Aortic diameter and wall thickness demonstrated significant increases on day 28 and day 7, respectively (p < 0.05). Carotid artery outer diameter and wall thickness were positively associated with coronary artery diameter on day 28 (p < 0.01). Coronary artery diameter significantly increased in the LCWE group after day 7 (p < 0.05). The percentage of Z > 3.0 indicated was more than 80% in the high-dose LCWE group and 0% in the control group. CONCLUSIONS This report is the first to use coronary artery Z-score in a mouse model of KD by echocardiography and to find a positive association between carotid artery and coronary artery diameter.
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Affiliation(s)
- Wen-Ling Shih
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Neipu 912301, Taiwan; (W.-L.S.); (T.-M.Y.)
- General Research Service Center, National Pingtung University of Science and Technology, Neipu 912301, Taiwan
| | - Tsung-Ming Yeh
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Neipu 912301, Taiwan; (W.-L.S.); (T.-M.Y.)
- General Research Service Center, National Pingtung University of Science and Technology, Neipu 912301, Taiwan
| | - Kuang-Den Chen
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Steve Leu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung 83301, Taiwan
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Chung C, Ko H, Byun JH, Kim TH, Kim H, Choi KH, Lee HD. The impact of inappropriate steroid exposure before the diagnosis of Kawasaki disease. Pediatr Neonatol 2024:S1875-9572(23)00246-2. [PMID: 38262814 DOI: 10.1016/j.pedneo.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/11/2023] [Accepted: 09/08/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a systemic inflammatory disease characterized by vasculitis. In South Korea, some pediatric doctors empirically prescribe steroids to control febrile pediatric patients. This study aimed to evaluate the clinical characteristics of patients with KD after steroid exposure. METHODS This was a single-center, retrospective, observational study. This study included patients (aged ≤15 years) between January 2020 and July 2022. We compared two groups, one group exposed to steroids and the other group who were not, using the Student's t-test or analysis of variance; otherwise, the Mann-Whitney U test or Kruskal-Wallis test was conducted. Statistical significance was set at p < 0.05. RESULTS In total, 190 patients with KD were enrolled; of these, 64 (33.7 %) had a history of steroid exposure, and 126 (66.3 %) had no history of steroid exposure. In the steroid exposure group, prolonged fever duration (6.72 ± 1.72 versus 5.61 ± 1.19, p-value = <0.001), a lower proportion of complete KD (29.69 % vs. 88.10 %, p-value = <0.001), and a significantly lower level of C-reactive protein were observed. However, no significant correlations were observed between the Transthoracic Echocardiography (TTE) results (coronary artery aneurysm, existence of pericardial effusion) and prognostic factors (days of hospitalization, the number of intravenous immunoglobulin administrations, and Kobayashi score) between the two groups. CONCLUSIONS Patients with KD and previous steroid exposure may exhibit an incomplete KD phenotype with prolonged fever. Although previous steroid exposure does not affect the prognosis of KD, including coronary artery aneurysms, it may mask the classic features of KD, resulting in a delayed diagnosis.
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Affiliation(s)
- Chanyoung Chung
- Department of Pediatrics, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hoon Ko
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Department of Pediatrics, Pusan National University School of Medicine, Republic of Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Department of Pediatrics, Pusan National University School of Medicine, Republic of Korea
| | - Tae Hong Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Department of Pediatrics, Pusan National University School of Medicine, Republic of Korea
| | - Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Republic of Korea
| | - Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Republic of Korea
| | - Hyoung-Doo Lee
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Department of Pediatrics, Pusan National University School of Medicine, Republic of Korea.
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Hashida Y, Mino Y, Okuno K, Uemasu H, Sakata S, Fujimoto M, Namba N. Thyroid hormone may predict treatment failure in Kawasaki disease. Pediatr Int 2024; 66:e15723. [PMID: 38326932 DOI: 10.1111/ped.15723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND In systemic inflammatory conditions, inflammatory cytokines can cause low thyroid hormone levels. There are no reports discussing the relation between thyroid hormone levels and response to treatment for Kawasaki disease. METHODS We investigated 67 patients who underwent treatment in the acute phase of Kawasaki disease. We divided patients into two groups based on their response to initial intravenous immunoglobulin (IVIG) treatment: the responder group (n = 40), and the non-responder group (n = 27). The serum levels of the thyroid hormones free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were compared before and after treatment in all patients, and between responder and non-responder groups. RESULTS The FT3, FT4, and TSH levels were low before the initial treatment and increased significantly after treatment (p < 0.05). The FT3, FT4, and TSH levels before treatment were significantly lower in the non-responder group than in the responder group (p < 0.05). Logistic regression analysis suggested that the addition of pre-treatment FT4 values to Gunma score was useful in predicting treatment failure. CONCLUSIONS Thyroid hormone and TSH levels were lower in the non-responder group than in the responder group in the initial IVIG treatment for Kawasaki disease. This study suggests that Kawasaki disease in the acute phase is associated with low thyroid hormone levels and TSH. It is possible that these hormone levels predict response to the initial IVIG.
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Affiliation(s)
- Yuichiro Hashida
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
- Department of Pediatrics, Tottori Prefectural Kousei Hospital, Kurayoshi, Japan
| | - Yoichi Mino
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Keisuke Okuno
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hitoshi Uemasu
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shinji Sakata
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masanobu Fujimoto
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Noriyuki Namba
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
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Zhang Y, Liu J. Clinical value of echocardiography combined with serum Cav-1, NFATc1, and PAI-1 in the diagnosis of Kawasaki disease complicated with coronary artery lesions. Heart Vessels 2024; 39:18-24. [PMID: 37758852 DOI: 10.1007/s00380-023-02315-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
To analyze the clinical value of echocardiography combined with serum lacuna protein-1 (Cav-1), activated T cell nuclear factor C1 (NFATc1), and plasminogen activator inhibitor-1 (PAI-1) in the diagnosis of Kawasaki disease (KD) complicated with coronary artery lesions (CAL). A total of 200 children with KD treated in our hospital from January 2019 to October 2021 were grouped as the KD alone group (n = 56) and the KD complicated with CAL group (n = 144) according to the results of coronary angiography. The levels of Cav-1, NFATc1, and PAI-1 were detected by enzyme-linked immunosorbent assay. Echocardiography was performed and the internal diameters of left and right coronary arteries were compared between the two groups. The area under the curve (AUC), sensitivity, and specificity of echocardiography combined with serum Cav-1, NFATc1, and PAI-1 in the diagnosis of KD complicated with CAL were analyzed with receiver operating characteristic (ROC) curve. Coronary angiography, as the gold standard, showed that the sensitivity of echocardiography in diagnosing KD with CAL was 88.19% (127/144), the specificity was 66.07% (37/56), and the accuracy was 82.00% (164/200). ROC curve analysis revealed that the AUC of KD complicated with CAL diagnosed by echocardiography, Cav-1, NFATc1, and PAI-1 was 0.819, 0.715, 0.688, and 0.663, respectively, and the AUC of combined diagnosis of the four was 0.896. The combination of echocardiography, Cav-1, NFATc1, and PAI-1 has high value in diagnosing KD complicated with CAL, which can be widely used in clinical practice.
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Affiliation(s)
- Yanxia Zhang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, Shanxi, China
| | - Jieqiong Liu
- Department of Ultrasonography, Children's Hospital of Shanxi Province (Shanxi Maternal and Child Health Care Hospital), Taiyuan, 030013, Shanxi, China.
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Suzuki T, Michihata N, Hashimoto Y, Yoshikawa T, Saito K, Matsui H, Fushimi K, Yasunaga H. Association between aspirin dose and outcomes in patients with acute Kawasaki disease: a nationwide retrospective cohort study in Japan. Eur J Pediatr 2024; 183:415-424. [PMID: 37917176 DOI: 10.1007/s00431-023-05302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/25/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023]
Abstract
This study aimed to identify the appropriate dose of aspirin to be prescribed to patients with acute Kawasaki disease (KD). Using a Japanese national inpatient database, we identified patients with KD treated with intravenous immunoglobulin between 2010 and 2021.The outcomes included the occurrence of coronary artery abnormalities and intravenous immunoglobulin resistance, length of hospital stay, and medical costs. Restricted cubic spline functions were performed to examine the association between aspirin dose and the outcomes. Data of 82,109 patients were extracted from the database. Non-linear associations were observed between aspirin dose and the outcomes. In comparison with an aspirin dose of 30 mg/kg/day, the odds ratio (95% confidence interval) for coronary artery abnormalities was 1.40 (1.13-1.75) at 5 mg/kg/day. An aspirin dose of ≥ 30 mg/kg/day did not significantly change the odds ratio for coronary artery abnormalities. Intravenous immunoglobulin resistance was significantly lower at a dose of 60 mg/kg/day or higher. CONCLUSION The results showed no significant association between aspirin escalation over standard-dose and coronary artery abnormalities in patients with acute KD. High-dose aspirin showed the potential to reduce hospital stay and medical costs without increasing complications. WHAT IS KNOWN • Aspirin is used as a standard treatment together with intravenous immunoglobulin for acute Kawasaki disease (KD). However, few studies have shown the most effective dosage of aspirin to prevent coronary artery abnormalities (CAAs). WHAT IS NEW • There was no significant association between aspirin dose escalation and CAAs in patients with acute KD.
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Affiliation(s)
- Takanori Suzuki
- Department of Pediatrics, Fujita Health University, Aichi, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Kazuyoshi Saito
- Department of Pediatrics, Fujita Health University, Aichi, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Mohan S, Mohan M, Mohan S. Ocular nodular fasciitis in Kawasaki disease. Oman J Ophthalmol 2024; 17:143-144. [PMID: 38524347 PMCID: PMC10957033 DOI: 10.4103/ojo.ojo_244_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/27/2023] [Accepted: 01/02/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Sashwanthi Mohan
- Department of Cornea, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Madhuvanthi Mohan
- Department of Cornea, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Sujatha Mohan
- Department of Cornea, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
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Gürses D, Yılmaz M, Oğuz M, Ufuk F, Baltalarlı A. Coronary artery bypass grafting in adolescent with myocardial infarction complicating undiagnosed Kawasaki disease. Cardiol Young 2024; 34:224-227. [PMID: 38038187 DOI: 10.1017/s1047951123004080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Although Kawasaki disease is often self-limiting, significant cardiovascular sequelae may occur in the acute or late stage. The most common late complication is persistent coronary artery aneurysm, which can lead to myocardial ischaemia and even myocardial infarction. We report a case of coronary artery bypass grafting in a 16-year-old boy with a history of undiagnosed Kawasaki disease. Increased awareness of Kawasaki disease, especially among children between the ages of 6 months and 5 years, can increase early treatment and prevent serious complications that may occur in the future.
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Affiliation(s)
- Dolunay Gürses
- Department of Pediatric Cardiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Münevver Yılmaz
- Department of Pediatric Cardiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Merve Oğuz
- Department of Pediatric Cardiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Furkan Ufuk
- Department of Pediatric Radiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ahmet Baltalarlı
- Department of Cardiovascular Surgery, Pamukkale Universitesi Tip Fakultesi, Denizli, Turkey
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Iwata H, Kobayashi S, Itoh M, Itoh S, Mesfin Ketema R, Tamura N, Miyashita C, Yamaguchi T, Yamazaki K, Masuda H, Ait Bamai Y, Saijo Y, Ito Y, Nakayama SF, Kamijima M, Kishi R. The association between prenatal per-and polyfluoroalkyl substance levels and Kawasaki disease among children of up to 4 years of age: A prospective birth cohort of the Japan Environment and Children's study. Environ Int 2024; 183:108321. [PMID: 38061246 DOI: 10.1016/j.envint.2023.108321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/25/2024]
Abstract
Kawasaki disease (KD) is common among pediatric patients and is associated with an increased risk of later cardiovascular complications, though the precise pathophysiology of KD remains unknown. Per- and polyfluoroalkyl substances (PFAS) have gathered notoriety as the causal pathogens of numerous diseases as well as for their immunosuppressive effects. The present epidemiological study aims to assess whether PFAS may affect KD risk. We evaluated research participants included in the ongoing prospective nationwide birth cohort of the Japan Environment and Children's Study (JECS). Among the over 100,000 pregnant women enrolled in the JECS study, 28 types of PFAS were measured in pregnancy in a subset of participants (N = 25,040). The JECS followed their children born between 2011 and 2014 (n total infants = 25,256; n Kawasaki disease infants = 271), up to age four. Among the 28 types of PFAS, those which were detected in >60 % of participants at levels above the method reporting limit (MRL) were eligible for analyses. Multivariable logistic regressions were implemented on the seven eligible PFAS, adjusting for multiple comparison effects. Finally, we conducted Weighted Quantile Sum (WQS) and Bayesian kernel machine regression (BKMR) to assess the effects of the PFAS mixture on KD. Therefore, we ran the BKMR model using kernel mechanical regression equations to examine PFAS exposure and the outcomes of KD. Upon analysis, the adjusted multivariable regression results did not reach statistical significance for the seven eligible substances on KD, while odds ratios were all under 1.0. WQS regression was used to estimate the mixture effect of the seven eligible PFAS, revealing a negative correlation with KD incidence; similarly, BKMR implied an inverse association between the PFAS mixture effect and KD incidence. In conclusion, PFAS exposure was not associated with increased KD incidence.
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Affiliation(s)
- Hiroyoshi Iwata
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Division of Epidemiological Research for Chemical Disorders, Research Center for Chemical Information and Management, National Institute of Occupational Safety and Health, 6-21-1, Nagao, Tama-ku, Kawasaki 214-8585, Japan
| | - Mariko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Rahel Mesfin Ketema
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Faculty of Health Sciences, Hokkaido University, North-12, West-5, Kita-ku, Sapporo 060-0812, Japan
| | - Naomi Tamura
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Takeshi Yamaguchi
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Keiko Yamazaki
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Hideyuki Masuda
- Pharmaceutical Sciences, Musashino University, 1-1-20 Shinmachi, Nishitokyo, Tokyo 202-8585, Japan
| | - Yu Ait Bamai
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Department of Pharmaceutical Sciences, University of Antwerp, University Square 1, 2610 Wilrijk, Belgium
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1 Midorigaoka-higashi-2-jo, Asahikawa 078-8510, Japan
| | - Yoshiya Ito
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, 664-1 Akebono-cho, Kitami 090-0011, Japan
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Japan
| | - Michihiro Kamijima
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan.
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Inada Y, Sonoda M, Mizuno Y, Yamamura K, Motomura Y, Takuma A, Murata K, Furuno K, Tezuka J, Sakai Y, Ohga S, Kishimoto J, Hosaka K, Sakata S, Hara T. CD14 down-modulation as a real-time biomarker in Kawasaki disease. Clin Transl Immunology 2023; 13:e1482. [PMID: 38162960 PMCID: PMC10757666 DOI: 10.1002/cti2.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/19/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives The objectives of this study were to investigate the pathophysiology of Kawasaki disease (KD) from immunological and oxidative stress perspectives, and to identify real-time biomarkers linked to innate immunity and oxidative stress in KD. Methods We prospectively enrolled 85 patients with KD and 135 patients with diverse conditions including immune, infectious and non-infectious diseases for this investigation. Flow cytometry was used to analyse the surface expression of CD14, CD38 and CD62L on monocytes, along with a quantitative assessment of CD14 down-modulation. Additionally, oxidative stress levels were evaluated using derivatives of reactive oxygen metabolites (d-ROMs) and antioxidant capacity measured by a free radical elective evaluator system. Results During the acute phase of KD, we observed a prominent CD14 down-modulation on monocytes, reflecting the indirect detection of circulating innate immune molecular patterns. Moreover, patients with KD showed a significantly higher CD14 down-modulation compared with infectious and non-infectious disease controls. Notably, the surface expression of CD14 on monocytes was restored concurrently with responses to intravenous immunoglobulin and infliximab treatment in KD. Furthermore, d-ROM levels in patients with KD were significantly elevated compared with patients with infectious and non-infectious diseases. Following intravenous immunoglobulin treatment, oxidative stress levels decreased in patients with KD. Conclusion Monitoring CD14 down-modulation on monocytes in real-time is a valuable strategy for assessing treatment response, distinguishing KD relapse from concomitant infections and selecting second-line therapy after IVIG treatment in KD patients. The interplay between inflammation and oxidative stress likely plays a crucial role in the development of KD.
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Affiliation(s)
- Yutaro Inada
- Kawasaki Disease CenterFukuoka Children's HospitalFukuokaJapan
| | - Motoshi Sonoda
- Department of Hematology and ImmunologyFukuoka Children's HospitalFukuokaJapan
- Department of Pediatrics, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yumi Mizuno
- Kawasaki Disease CenterFukuoka Children's HospitalFukuokaJapan
| | - Kenichiro Yamamura
- Department of Cardiology and Intensive CareFukuoka Children's HospitalFukuokaJapan
| | - Yoshitomo Motomura
- Department of Pediatrics, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Aoba Takuma
- Kawasaki Disease CenterFukuoka Children's HospitalFukuokaJapan
| | - Kenji Murata
- Kawasaki Disease CenterFukuoka Children's HospitalFukuokaJapan
| | - Kenji Furuno
- Kawasaki Disease CenterFukuoka Children's HospitalFukuokaJapan
| | - Junichiro Tezuka
- Department of Allergy and Respiratory MedicineFukuoka Children's HospitalFukuokaJapan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Junji Kishimoto
- Department of Research and Development of Next Generation Medicine, Faculty of Medical SciencesKyushu UniversityFukuokaJapan
| | - Koki Hosaka
- Department of Clinical LaboratoryFukuoka Children's HospitalFukuokaJapan
| | - Satomi Sakata
- Department of Clinical LaboratoryFukuoka Children's HospitalFukuokaJapan
| | - Toshiro Hara
- Kawasaki Disease CenterFukuoka Children's HospitalFukuokaJapan
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Shu Z, Deng F, Yang S. Early Clinical Evaluation of Coronary Artery Lesions in Kawasaki Disease. Clin Pediatr (Phila) 2023:99228231219501. [PMID: 38135926 DOI: 10.1177/00099228231219501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
The purpose of this study is to analyze the early clinical features of coronary artery lesion (CAL) in Kawasaki disease (KD), evaluate systemic inflammation indicators, and enhance early recognition of CAL in the acute phase of KD. A total of 314 children with KD were divided into those with CAL (CAL group) and without CAL (NCAL group) using echocardiographic results, and their clinical data were retrospectively analyzed. For KD patients, male, children aged 3 to 9 years, and those with fever longer than 6 days before intravenous immunoglobulin (IVIG) use were more likely to have CAL. There were significant differences in sex, age, and fever time (P < .05). Moreover, some laboratory indicator test results revealed there was a significant difference between N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and interleukin-6 (IL-6), and the CAL (P < .05). This study has certain guiding significance for early clinical evaluation.
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Affiliation(s)
- Zhongyu Shu
- Department of Pediatrics, Affiliated Provincial Children's Hospital, Anhui Medical University, Hefei, China
- Department of Internal Medicine, Children's Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Fang Deng
- Department of Pediatrics, Affiliated Provincial Children's Hospital, Anhui Medical University, Hefei, China
| | - Shuxinying Yang
- The Southern District Laboratory Department, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
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Wang W, Zhu L, Li X, Liu Z, Lv H, Qian G. Emerging evidence of microbial infection in causing systematic immune vasculitis in Kawasaki disease. Front Microbiol 2023; 14:1313838. [PMID: 38188572 PMCID: PMC10771848 DOI: 10.3389/fmicb.2023.1313838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Kawasaki disease (KD) is a systematic vasculitis that is often complicated by coronary artery lesions and is a leading cause of acquired heart disease in developed countries. Previous studies have suggested that genetic susceptibility, together with an inducing infectious agent, could be involved in KD pathogenesis; however, the precise causative agent of this disease remains unknown. Moreover, there are still debates concerning whether KD is an infectious disease or an autoimmune disease, although many studies have begun to show that various pathogens functioning as critical inducers could activate different kinds of immune cells, consequently leading to the dysfunction of endothelial cells and systematic vasculitis. Here in this review, we attempt to summarize all the available evidence concerning pathogen infections associated with KD pathogenesis. We also discuss the related mechanisms, present a future perspective, and identify the open questions that remain to be investigated, thereby providing a comprehensive description of pathogen infections and their correlations with the host immune system in leading to KD.
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Affiliation(s)
- Wang Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Liyan Zhu
- Department of Experimental Center, Medical College of Soochow University, Suzhou, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiheng Liu
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guanghui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
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Zhou Y, Wu Y, Yuan C, Yin W, Wang B, Ding Y. The expression of autophagy markers in IVIG-resistant Kawasaki disease and the establishment of prediction model. BMC Pediatr 2023; 23:642. [PMID: 38114939 PMCID: PMC10729374 DOI: 10.1186/s12887-023-04386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The aim of this study was to find early predictors of Intravenous Immunoglobulin (IVIG)-Resistant Kawasaki Disease. METHODS Patients diagnosed with Kawasaki disease were enrolled in this study. Univariate analysis and multiple logistic regression were used to analyze the clinical characteristics and laboratory findings of patients in both groups before IVIG treatment. Independent predictors of Intravenous Immunoglobulin-Resistant Kawasaki Disease were analyzed, and a prediction model for children with Intravenous Immunoglobulin-Resistant Kawasaki Disease was constructed. RESULTS A total of 108 children (67 males and 41 females) with IVIG-sensitive Kawasaki disease and 31 children (20 males and 11 females) with IVIG-resistant Kawasaki disease participated in this study. Compared with the IVIG-sensitive group, the duration of hospitalization, ALT, AST, GLB, r-GT, IgG, PCT, and ESR was elevated in the IVIG-resistant KD group, and ATG16L1, LC3II, BECN1, RBC, HGB, ALB, A/G, and CK were significantly lower (P < 0.05). mRNA expression of ESR, BECN1, and LC3II were independent risk factors for IVIG-resistant Kawasaki disease. A logistic regression model and scoring system were established, and the cut-off values of independent risk factors were derived from ROC curves: ESR ≥ 79.5 mm/h, BECN1 ≤ 0.645, LC3II ≤ 0.481. A new scoring system was established according to the respective regression coefficients as follows: ESR ≥ 79.5 mm/h (1 point), BECN1 ≤ 0.645 (1 point). LC3II ≤ 0.481 (2 points), 0-1 as low risk for IVIG non-response, and ≥ 2 as high risk. Applied to this group of study subjects, the sensitivity was 87.10%, specificity 83.33%, Youden index 0.70, AUC 0.9. CONCLUSIONS Autophagy markers ATG16L1, BECN1, and LC3II are down-regulated in the expression of IVIG -resistant KD. ESR, BECN1, and LC3II mRNAs are independent risk factors for IVIG-resistant KD and may be involved in the development of IVIG-resistant KD. This study established a new model that can be used to predict IVIG-resistant KD, and future validation in a larger population is needed.
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Affiliation(s)
- Yang Zhou
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Yali Wu
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Chunhui Yuan
- Department of Laboratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Wei Yin
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Baoxiang Wang
- Department of Digestive System, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
| | - Yan Ding
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
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Aggarwal R, Pilania RK, Sharma S, Kumar A, Dhaliwal M, Rawat A, Singh S. Kawasaki disease and the environment: an enigmatic interplay. Front Immunol 2023; 14:1259094. [PMID: 38164136 PMCID: PMC10757963 DOI: 10.3389/fimmu.2023.1259094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
Kawasaki disease (KD) is a common systemic vasculitis of childhood. Although it has been almost 6 decades since Dr. Tomisaku Kawasaki reported the first case series of KD, the underlying cause remains a mystery. KD is a self-limiting disease. However, a dreaded complication is development of coronary artery abnormalities (CAAs). KD is the most common cause of acquired heart disease in children in the developed world and is being increasingly reported from developing countries too. Over the years, significant observations have been made about epidemiology of KD. It usually affects children below 5, has male preponderance and has significantly higher incidence in North East Asian countries. While several hypotheses have been proffered for etiology of KD, none have been conclusive. These include associations of KD epidemics in Japan and the United Stated with changes in tropospheric wind patterns suggesting wind-borne agents, global studies showing peaks of incidence related to season, and increased rates in populations with a higher socioeconomic profile related to hygiene hypothesis and vaccination. Furthermore, the self-limiting, febrile nature of KD suggests an infectious etiology, more so with sudden decline noted in cases in Japan with onset of COVID-19 mitigation measures. Finally, single nucleotide polymorphisms have been identified as possible risk alleles in patients with KD and their significance in the pathogenesis of this disease are also being defined. The purpose of this review is to elucidate the puzzling associations of KD with different environmental factors. Looking at patterns associated with KD may help us better predict and understand this disease.
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Affiliation(s)
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Center for Diagnosis and Treatment of Kawasaki Disease/Children's Hospital of Shaanxi Provincial People's Hospital, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Children's Hospital,Shanghai Jiao Tong University School of Medicine, National Regional Medical Center/Shengjing Hospital of China Medical University, National Clinical Key Specialty/Department of Intensive Care Medicine, Shanghai Children'sHospital, Hospital; General Pediatric Group of Pediatrician Branch of Chinese Medical Doctor Association, Expert Committee of Advanced Training for Pediatrician, China Maternal and Children's Health Association;, National Health Commission Key Laboratory for Tropical Disease Prevention and Control, Yan'an University Affiliated Hospital, Editorial Department of Chinese Journal of Contemporary Pediatrics. [Evidence-based guidelines for the diagnosis and treatment of Kawasaki disease in children in China (2023)]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:1198-210. [PMID: 38112136 DOI: 10.7499/j.issn.1008-8830.2309038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/09/2023] [Indexed: 12/20/2023]
Abstract
Kawasaki disease (KD) is an acute self-limiting vasculitis, and it is the most common cause of acquired heart disease in children under 5 years old. One of the improvement goals in pediatric quality control work for the year 2023, as announced by the National Health Commission, is to reduce the incidence of cardiac events and KD-related mortality in children with KD. In order to standardize the diagnosis, treatment, and long-term management practices of KD in China, and effectively prevent and reduce the incidence of coronary artery lesions and long-term adverse effects, the guideline working group followed the principles and methods outlined by the World Health Organization and referenced existing evidence and experiences to develop the "Evidence-based guidelines for the diagnosis and treatment of Kawasaki disease in children in China (2023)". The guidelines address the clinical questions regarding the classification and definition of KD, diagnosis of different types of KD, treatment during the acute phase of KD, application of echocardiography in identifying complications of KD, and management of KD combined with macrophage activation syndrome. Based on the best evidence and expert consensus, 20 recommendations were formulated, aiming to provide guidance and decision-making basis for healthcare professionals in the diagnosis and treatment of KD in children.
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72
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Murayama Y, Hamada H, Shiko Y, Onouchi Y, Kakimoto N, Ozawa Y, Hanaoka H, Hata A, Suzuki H. Risk factors for coronary artery abnormalities and resistance to immunoglobulin plus ciclosporin A therapy in severe Kawasaki disease: subanalysis of the KAICA trial, randomized trial for cicrosporin A as the first-line treatment. Front Pediatr 2023; 11:1321533. [PMID: 38161433 PMCID: PMC10755003 DOI: 10.3389/fped.2023.1321533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
Background To investigate risk factors for coronary arterial abnormalities (CAAs) and resistance to treatment in patients with Kawasaki disease (KD) receiving intravenous immunoglobulin (IVIG) plus ciclosporin A (CsA) as the first-line treatment, we performed a subanalysis of baseline data of participants in the KAICA trial, a phase 3, randomized study (JMA-ILA00174). Methods All data of the patients enrolled in the KAICA trial, who had a Gunma score ≥5 at diagnosis and had been randomly assigned to either IVIG (2 g/kg/24 h) plus CsA (5 mg/kg/day for 5 days) (n = 86) or IVIG alone (n = 87), were subjected to this study. CAA was defined by a Z score ≥2.5 observed within 4 weeks after treatment initiation. Baseline data including genotypes of KD susceptibility genes were compared between subgroups of patients for CAA or treatment response for each treatment group. Backword-forward stepwise logistic regression analyses were performed. Results Pre-Z-max, defined as the maximum among Z scores on four coronary artery branches before treatment, was higher in patients with CAA in both treatment groups and was associated with CAA in IVIG plus CsA treatment group [odds ratio (OR) = 17.0]. High serum total bilirubin level was relevant to treatment resistance only in the IVIG plus CsA group (OR = 2.34). Conclusions Coronary artery enlargement before treatment is a major determinant of CAA even in KD patients treated with initial IVIG treatment intensified by addition of CsA. Baseline serum total bilirubin level was a risk factor associated with resistance to IVIG plus CsA.
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Affiliation(s)
- Yuri Murayama
- Department of Pediatrics, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshihito Ozawa
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Akira Hata
- Department of Public Health, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, School of Medicine, Wakayama Medical University, Wakayama, Japan
- Division of Pediatrics, Tsukushi Medical and Welfare Center, Iwade, Japan
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73
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薛 燕, 尹 晶, 许 俐, 党 利, 王 朝, 崔 亚, 张 新, 李 崇. [Predictive value of peripheral blood lymphocyte subsets for children with intravenous immunoglobulin-resistant Kawasaki disease]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:1211-1218. [PMID: 38112137 PMCID: PMC10731968 DOI: 10.7499/j.issn.1008-8830.2305067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/24/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Based on peripheral blood lymphocyte subsets and common laboratory test indexes, this study aimed to construct a predictive scoring system for intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD). METHODS Children hospitalized in Tianjin Children's Hospital from January 2021 to March 2023 were included in the study (185 cases of IVIG-sensitive KD and 41 cases of IVIG -resistant KD). Forty-six healthy children matched for age and gender were selected as controls. The relative percentage and absolute counts of peripheral lymphocyte subsets were measured by flow cytometry. Multivariate logistic regression was used to identify the predictive factors for IVIG-resistant KD and to construct a predictive scoring system for predicting IVIG-resistant KD. RESULTS The multivariate logistic regression analysis showed that CD4+ T cell absolute count, natural killer cell absolute count, serum sodium level, globulin level, and total bilirubin level were identified as predictive factors for IVIG-resistant KD (P<0.05). The predictive scoring system based on these factors achieved a sensitivity of 70.7% and a specificity of 83.8% in predicting IVIG-resistant KD. CONCLUSIONS Peripheral blood lymphocyte subsets can serve as predictive indicators for IVIG-resistant KD in children. The introduction of this indicator and the establishment of a scoring system based on it can provide a higher accuracy in predicting IVIG-resistant KD in children.
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Affiliation(s)
| | - 晶 尹
- 天津市儿童医院(天津大学儿童医院)风湿免疫科天津300134
| | | | | | | | | | | | - 崇巍 李
- 天津市儿童医院(天津大学儿童医院)风湿免疫科天津300134
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74
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李 燕, 袁 晨, 蔡 艾, 周 博, 黄 腾. [Platelet-to-lymphocyte ratio as a biomarker for predicting coronary artery lesions in Chinese children with Kawasaki disease: a Meta analysis]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:1219-1226. [PMID: 38112138 PMCID: PMC10731965 DOI: 10.7499/j.issn.1008-8830.2306097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/12/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES To systematically evaluate the value of the platelet-to-lymphocyte ratio (PLR) in predicting coronary artery lesions (CAL) in Chinese children with Kawasaki Disease (KD). METHODS A comprehensive search was conducted in databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, and China Science and Technology Journal Database from inception to December 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale, and a Meta analysis was performed using Stata 15.1. RESULTS A total of ten published reports, involving 3 664 Chinese children with KD, were included in this Meta analysis, of whom 1 328 developed CAL. The Meta analysis revealed a sensitivity of 0.78 (95%CI: 0.71-0.83), specificity of 0.71 (95%CI: 0.61-0.80), overall diagnostic odds ratio of 8.69 (95%CI: 5.02-15.06), and an area under the curve of the summary receiver operating characteristic of 0.82 (95%CI: 0.78-0.85) for PLR in predicting CAL in the children with KD. The sensitivity, specificity, and area under the curve of summary receiver operating characteristic were lower for PLR alone compared to PLR in combination with other indicators. Sensitivity analysis demonstrated the stability of the Meta analysis results with no significant changes upon excluding individual studies. However, a significant publication bias was observed (P<0.001). CONCLUSIONS PLR demonstrates certain predictive value for CAL in Chinese children with KD.
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75
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曹 越, 高 帅, 罗 刚, 赵 水, 唐 雅, 杜 占, 泮 思. [Role and mechanisms of CHI3L1 in coronary artery lesions in a mouse model of Kawasaki disease-like vasculitis]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:1227-1233. [PMID: 38112139 PMCID: PMC10731963 DOI: 10.7499/j.issn.1008-8830.2309080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES To explore the role and potential mechanisms of chitinase-3-like protein 1 (CHI3L1) in coronary artery lesions in a mouse model of Kawasaki disease (KD)-like vasculitis. METHODS Four-week-old male SPF-grade C57BL/6 mice were randomly divided into a control group and a model group, with 10 mice in each group. The model group mice were intraperitoneally injected with 0.5 mL of lactobacillus casei cell wall extract (LCWE) to establish a mouse model of KD-like vasculitis, while the control group mice were injected with an equal volume of normal saline. The general conditions of the mice were observed on the 3rd, 7th, and 14th day after injection. Changes in coronary artery tissue pathology were observed using hematoxylin-eosin staining. The level of CHI3L1 in mouse serum was measured by enzyme-linked immunosorbent assay. Immunofluorescence staining was used to detect the expression and localization of CHI3L1, von Willebrand factor (vWF), and α-smooth muscle actin (α-SMA) in coronary artery tissue. Western blot analysis was used to detect the expression of CHI3L1, vWF, vascular endothelial cadherin (VE cadherin), Caspase-3, B cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax), nuclear factor κB (NF-κB), and phosphorylated NF-κB (p-NF-κB) in coronary artery tissue. RESULTS The serum level of CHI3L1 in the model group was significantly higher than that in the control group (P<0.05). Compared to the control group, the expression of CHI3L1 in the coronary artery tissue was higher, while the expression of vWF was lower in the model group. The relative expression levels of CHI3L1, Bax, Caspase-3, NF-κB, and p-NF-κB were significantly higher in the model group than in the control group (P<0.05). The relative expression levels of vWF, VE cadherin, and Bcl-2 were lower in the model group than in the control group (P<0.05). CONCLUSIONS In the LCWE-induced mouse model of KD-like vasculitis, the expression levels of CHI3L1 in serum and coronary arteries increase, and it may play a role in coronary artery lesions through endothelial cell apoptosis mediated by inflammatory reactions.
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76
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董 明, 王 喜, 焦 富, 张 维. [Research advances in genetic polymorphisms in Kawasaki disease]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:1234-1238. [PMID: 38112140 PMCID: PMC10731961 DOI: 10.7499/j.issn.1008-8830.2308073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
Kawasaki disease (KD) is a systemic inflammatory vascular disorder that predominantly affects children and is the leading cause of acquired heart disease in children. Although the etiology of this disease remains unclear, genome-wide association and genome-wide linkage studies have shown that some susceptible genes and chromosomal regions are associated with the development and progression of KD. With the advancement of high-throughput DNA sequencing techniques, more and more genomic information related to KD is being discovered. Understanding the genes involved in the pathogenesis of KD may provide novel insights into the diagnosis and treatment of KD. By analyzing related articles and summarizing related research advances, this article mainly discusses the T cell activation-enhancing genes that have been confirmed to be closely associated with the development and progression of KD and reveals their association with the pathogenesis of KD and coronary artery lesions.
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Affiliation(s)
| | | | - 富勇 焦
- 陕西省川崎病诊疗中心/陕西省人民医院 儿童病院,陕西西安710068
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77
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Bakir M, Iqbal U, Gazal AN, Robertson D. Case Report: Acute abdomen and large mesenteric mass as another face of multisystem inflammatory syndrome in an adolescent child: measure twice, act once! Front Pediatr 2023; 11:1324670. [PMID: 38143532 PMCID: PMC10739509 DOI: 10.3389/fped.2023.1324670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction During the Covid-19 era, acute abdomen and mesenteric lymphadenopathy were encountered as frequent mimic of appendicitis. This phenomenon can further complicate the diagnosis of acute abdominal conditions, not solely due to bacterial or viral intestinal infections but also attributable to post-infectious acute inflammatory states resulting in either undertreatment of inflammatory conditions or unnecessary surgery. Case presentation In this case study, we present the case of an 11-year-old female who initially presented with fever and right lower quadrant abdominal pain, raising concerns of appendicitis. However, upon further investigation, it was revealed that she harbored a sizable mesenteric mass. Subsequent biopsy results unveiled a significant necrotic mesenteric lymphadenitis. Notably, this patient fulfilled the criteria for Multisystem Inflammatory Syndrome in Children (MIS-C), a condition that manifested following persistent postoperative fever. Remarkably, the patient exhibited a highly favorable response to the treatment administered. This clinical scenario presents an atypical manifestation of MIS-C, as the patient displayed a substantial mesenteric mass alongside symptoms mimicking appendicitis, within the context of an acute abdomen. Conclusion Clinicians should consider MIS-C and other post-infectious inflammatory conditions in mind when diagnosing acute abdominal cases. The presented case underscores the importance of recognizing atypical presentations of MIS-C that can mimic appendicitis, sometimes necessitating surgical resection of a large lymph node. We propose diagnostic flow chart to aid in the differentiation of acute bacterial appendicitis from MIS-C.
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Affiliation(s)
- Mustafa Bakir
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
| | - Umair Iqbal
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
| | - Ayoolamide N. Gazal
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
| | - Daniel Robertson
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
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78
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Mohankumar SP, Das S, Likitha P, Naranje P, Jana M, Gupta SK, Bagri NK. Kawasaki disease or polyarteritis nodosa: coronary involvement, a diagnostic conundrum. Rheumatol Int 2023; 43:2327-2331. [PMID: 37430128 DOI: 10.1007/s00296-023-05388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
Polyarteritis nodosa (PAN) is a medium-vessel vasculitis presenting with cutaneous and multisystem involvement with considerable morbidity. The necrotizing vasculitis in PAN typically involves renal, celiac, and mesenteric vascular beds. Coronary artery involvement is a characteristic feature of Kawasaki disease, another medium-vessel vasculitis; however, it has been rarely reported with PAN. Here, we present 2 cases with PAN involving coronaries mimicking Kawasaki disease. A 3.5-year-old boy with classical features of Kawasaki disease with giant coronary aneurysm refractory to IVIg, methylprednisolone, infliximab presented with persistent rise in inflammatory markers and gastrointestinal bleeding. Digital subtraction angiography (DSA) revealed celiac artery branches stenosis and beading suggestive of PAN. Another 2-year-old girl presented with persistent fever, abdominal pain, and distension. She had hypertension, hepatomegaly, and splenomegaly on examination. Echocardiography revealed multiple coronary aneurysms and DSA revealed numerous renal artery aneurysms. Coronary aneurysm although is a rare presentation of childhood PAN, and can mimic Kawasaki disease. Although both are medium-vessel vasculitis differentiation between these two entities is pivotal, as there are differences in treatment modalities, duration of immunomodulatory therapy, and the outcome. This manuscript describes the salient differences which can help differentiate PAN masquerading as Kawasaki disease at initial presentation.
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Affiliation(s)
| | - Samannay Das
- Department of Paediatrics, AIIMS, New Delhi, India
| | - P Likitha
- Department of Paediatrics, AIIMS, New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | | | - Narendra Kumar Bagri
- Division of Pediatric Rheumatology and Immunology, Department of Paediatrics, AIIMS, New Delhi, India.
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79
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Gamez-Gonzalez LB, Ulloa-Gutierrez R, Yamazaki-Nakashimada MA. Notes on cutaneous manifestations of Kawasaki disease and multisystem inflammatory syndrome in children. Int J Rheum Dis 2023; 26:2596-2598. [PMID: 37439535 DOI: 10.1111/1756-185x.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Affiliation(s)
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
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80
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Chen L, Shangguan Z, Dong Z, Deng Q, Ding Y, Yang S. NFIL3 aggravates human coronary artery endothelial cell injury by promoting ITGAM transcription in Kawasaki disease. Hematology 2023; 28:2277502. [PMID: 37933872 DOI: 10.1080/16078454.2023.2277502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE High expression of nuclear factor interleukin-3 (NFIL3) and integrin Alpha M (ITGAM) was found in serum samples from Kawasaki disease (KD) patients through bioinformatics analysis. Hence, this study aimed to explore the biological functions of NFIL3 and ITGAM in KD serum-stimulated human coronary artery endothelial cells (HCAECs). METHODS The differentially-expressed genes in KD were analyzed through bioinformatics analysis. Serum samples were obtained from 18 KD patients and 18 healthy volunteers, followed by detection of NFIL3 and ITGAM levels in KD serum. After HCAECs were transfected with sh-NFIL3, sh-ITGAM, or sh-NFIL3 + oe-ITGAM and underwent 24-h KD serum stimulation, cell viability and apoptosis and the levels of inflammation-related factors were measured. The binding between NFIL3 and ITGAM was validated by dual-luciferase and chromatin immunoprecipitation (ChIP) assays. RESULTS NFIL3 and ITGAM were up-regulated in serum from KD patients and KD serum-stimulated HCAECs. Down-regulation of NFIL3 or ITGAM inhibited KD serum-induced cell apoptosis and inflammatory response of HCAECs and promoted cell viability. Mechanistically, NFIL3 promoted ITGAM transcription level. Up-regulation of ITGAM reversed the improvement of NFIL3 down-regulation on KD serum-induced HCAEC injury. CONCLUSION NFIL3 aggravated KD serum-induced HCAEC injury by promoting ITGAM transcription, which provided new insights into the treatment of KD.
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Affiliation(s)
- Li Chen
- Clinical College, Fuzhou Medical College, Nanchang University, Fuzhou, People's Republic of China
| | - Zhiyang Shangguan
- Basic Medicine College, Fuzhou Medical College, Nanchang University, Fuzhou, People's Republic of China
| | - Zeya Dong
- Clinical College, Fuzhou Medical College, Nanchang University, Fuzhou, People's Republic of China
| | - Qunfan Deng
- Department of Pediatrics, First People's Hospital of Fuzhou, Fuzhou, People's Republic of China
| | - Yunyun Ding
- Department of Pediatrics, First People's Hospital of Fuzhou, Fuzhou, People's Republic of China
| | - Shulong Yang
- Department of Physiology, Fuzhou Medical College of Nanchang University, Fuzhou, People's Republic of China
- Key Laboratory of Chronic Diseases, Fuzhou Medical University, Fuzhou, People's Republic of China
- Technology Innovation Center of Chronic Disease Research in Fuzhou CityFuzhou, People's Republic of China
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81
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Zheng S, Liu Z, Zhang S, Xie Q. Episode of ventricular fibrillation in patient with coronary artery ectasia during coronary angiography. Clin Case Rep 2023; 11:e8151. [PMID: 38046800 PMCID: PMC10692313 DOI: 10.1002/ccr3.8151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
There was an 83-year-old man having coronary artery disease associated with coronary artery ectasia who occurred ventricular fibrillation suddenly during coronary artery angiography. As Kawasaki disease was suspected to the most likely reason which led to coronary artery lesion.
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Affiliation(s)
- Shujiao Zheng
- The School of Clinical MedicineFujian Medical UniversityFuzhouChina
| | - Zuheng Liu
- The School of Clinical MedicineFujian Medical UniversityFuzhouChina
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
| | - Shaofeng Zhang
- The School of Clinical MedicineFujian Medical UniversityFuzhouChina
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
| | - Qiang Xie
- The School of Clinical MedicineFujian Medical UniversityFuzhouChina
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
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82
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Yilmaz D, Ekemen Keles Y, Emiroglu M, Duramaz BB, Ugur C, Aldemir Kocabas B, Celik T, Ozdemir H, Bayturan S, Turel O, Erdeniz EH, Cakici O, Cakmak Taskin E, Erbas İC, Genceli M, Sari EE, Caymaz C, Kizil MC, Sutcu M, Demirbuga A, Alkan G, Bagcı Z, Timurtas Dayar G, Ozkan EA, Tekin Yilmaz A, Akca M, Yesil E, Kara SS, Akturk H, Yasar B, Umit Z, Uygun H, Erdem N, Buyukcam A, Karadag Oncel E, Tuter Oz SK, Cetin HS, Anil AB, Yilmaz R, Zengin N, Uzuner S, Albayrak H, Borakay O, Topal S, Arslan G, Yazar A, Ozer A, Kendirli T, Kara EM, Demirkol D, Battal F, Kosker M, Metin Akcan O, Kihtir HS, Gul D, Zararci K, Alakaya M, Kula N, Celik E, Petmezci E, Evren G, Kara Aksay A, Konca C, Sert A, Arslan D, Bornaun H, Tekeli O, Bal A, Sahin IO, Demir S, Sap F, Akyol MB, Tanidir IC, Donmez YN, Ucar T, Coban S, Arga G, Hancerli Torun S, Karpuz D, Celik SF, Varan C, Elmali F, Oncel S, Belet N, Hatipoglu N, Dalgic Karabulut N, Turgut M, Somer A, Kuyucu N, Dinleyici EC, Ciftci E, Kara A. Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study). Eur J Pediatr 2023; 182:5531-5542. [PMID: 37782350 DOI: 10.1007/s00431-023-05207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU). METHODS This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented. RESULTS A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × μL, platelet count 153 vs. 212 cells × 103/ μL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 μg/L, ferritin 644 vs. 334 μg/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log D-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively. Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care. WHAT IS KNOWN • Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not. WHAT IS NEW • A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay.
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Affiliation(s)
| | - Yildiz Ekemen Keles
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey.
| | | | | | - Cuneyt Ugur
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | - Talyan Celik
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Ozden Turel
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Emine Ergul Sari
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Canan Caymaz
- Başakşehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | | | - Murat Sutcu
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Zafer Bagcı
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | | | | | | | | | | | | | - Belma Yasar
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Hatice Uygun
- Adıyaman Research and Training Hospital, Adiyaman, Turkey
| | | | - Ayse Buyukcam
- Ankara Gulhane Research and Training Hospital, Ankara, Turkey
| | - Eda Karadag Oncel
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | | | | | - Ayse Berna Anil
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
- Pediatric Intensive Care, Health Sciences University Tepecik Training and Research Hospital, Izmir, Izmir, Turkey
| | | | | | - Selcuk Uzuner
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | - Sevgi Topal
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gazi Arslan
- Dokuz Eylül University Hospital, Izmir, Turkey
| | - Abdullah Yazar
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Arife Ozer
- Health Sciences University Van Training and Research Hospital, Van, Turkey
| | - Tanil Kendirli
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Intensive Care, Ankara University Hospital, Ankara, Turkey
| | | | | | - Fatih Battal
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | | | | | | | - Doruk Gul
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Nilgun Kula
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Elif Celik
- Aydin Adnan Menderes University Hospital, Aydin, Turkey
| | - Ercument Petmezci
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ahu Kara Aksay
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | - Capan Konca
- Adiyaman University Hospital, Adiyaman, Turkey
| | - Ahmet Sert
- Selcuk University Hospital, Konya, Turkey
| | - Derya Arslan
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | - Helen Bornaun
- Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Onur Tekeli
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Alkan Bal
- Celal Bayar University Hospital, Manisa, Turkey
| | | | - Selcan Demir
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Fatih Sap
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Mehmet Bedir Akyol
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | | | | | - Tayfun Ucar
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Cardiology, Ankara University Hospital, Ankara, Turkey
| | - Senay Coban
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | | | | | - Celal Varan
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | - Selim Oncel
- Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Nevin Hatipoglu
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Nazan Dalgic Karabulut
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ayper Somer
- Istanbul University Hospital, Istanbul, Turkey
| | | | | | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ates Kara
- Hacettepe University Hospital, Ankara, Turkey
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Wang H, Pancheri JM, Appleton RS, Tremoulet AH, Burns JC, Dummer KB. Coronary Sinus Thrombosis and Post-Myocardial Infarction Syndrome in Kawasaki Disease: Rare Causes of Pericardial Effusion. JACC Case Rep 2023; 26:102077. [PMID: 38094174 PMCID: PMC10715962 DOI: 10.1016/j.jaccas.2023.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 12/23/2023]
Abstract
The hypercoagulable state in Kawasaki disease (KD) may lead to complex cardiovascular sequelae. We present the case of a 2-month-old infant with complete KD complicated by giant coronary artery aneurysms, coronary sinus thrombosis, and post-myocardial infarction syndrome (Dressler syndrome), resulting in 2 distinct episodes of pericardial effusion. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Hao Wang
- University of California San Diego, La Jolla, California, USA
| | - Joan M. Pancheri
- University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital-San Diego, San Diego, California, USA
| | | | - Adriana H. Tremoulet
- University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital-San Diego, San Diego, California, USA
| | - Jane C. Burns
- University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital-San Diego, San Diego, California, USA
| | - Kirsten B. Dummer
- University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital-San Diego, San Diego, California, USA
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84
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She X, Chen J, Zhou YN, Guo J, Zhao FH, Yi C. Kawasaki Disease Associated Acute Abdomen: Most Require No Surgery. J Inflamm Res 2023; 16:5157-5162. [PMID: 38026259 PMCID: PMC10644836 DOI: 10.2147/jir.s434982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To summarize the clinical features and treatment experiences of patients with Kawasaki disease (KD)-associated acute abdomen (KD-AA). Methods We conducted a retrospective case-control study of patients with KD-AA treated at our hospital between January 2006 and November 2022. Results Of the 917 children with KD, 43 (4.7%) presented with AA. Of these, 33 with complete information were included in the KD-AA group. Patients with KD-AA were significantly older, with higher neutrophil rate, C-reactive protein, procalcitonin, and alanine transaminase levels and lower hemoglobin, albumin, and serum sodium levels. Additionally, more patients with KD-AA presented with aseptic meningitis and KD shock syndrome than those with KD alone (all p<0.05). The two groups did not differ in the incidence of intravenous immunoglobulin (IVIG) resistance, incomplete KD, or coronary artery abnormalities. All patients received aspirin and IVIG therapy, with nine receiving a second dose of IVIG and 11 receiving corticosteroids. Only two patients with KD-AA underwent surgery, and the prognosis of all patients with KD-AA was good. Conclusion KD-AA should be suspected in febrile children with abdominal symptoms. Prompt diagnosis of KD-AA is important for early effective treatment to avoid unnecessary surgical harm. KD, complicated by acute abdomen, has a good prognosis.
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Affiliation(s)
- Xiang She
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Jia Chen
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Yu-Neng Zhou
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Jun Guo
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Feng-Hua Zhao
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Cong Yi
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
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85
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Kondo Y, Kawamura Y, Hattori F, Nakai H, Saito K, Suzuki D, Kozawa K, Yoshikawa T. Serological analysis of severe acute respiratory syndrome coronavirus 2 infection in children with Kawasaki disease. J Med Virol 2023; 95:e29274. [PMID: 38009251 DOI: 10.1002/jmv.29274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) was reported as a severe complication of coronavirus disease 2019; an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and was suggested to be associated with Kawasaki disease (KD) in terms of severe systemic inflammation and mucocutaneous symptoms. Because severe gastrointestinal symptoms and systemic shock are more frequently observed with MIS-C, patients with mild MIS-C might have been diagnosed with KD. In this study, titers of IgG antibodies against the SARS-CoV-2 S (S-IgG) and N proteins (N-IgG) were measured in 99 serum samples collected from patients with KD treated between January 2020 and December 2021 to evaluate the relationship between KD and SARS-CoV-2 infection. S-IgG were detected in only one patient out of 99 patients. This patient had coronavirus disease 2019 (COVID-19) 10 months before KD onset, and was unlikely MIS-C. According to characters of S-IgG and N-IgG, the patients was unlikely infected with SARS-CoV-2 just before the onset of KD. In addition to this study, the 26th Nationwide Survey and previous studies showed an association between KD and SARS-CoV-2 to be unlikely. In conclusion, SARS-CoV-2 infection was not observed in patients with KD until Delta predominance in Japan by the method of detecting SARS-CoV-2 IgG.
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Affiliation(s)
- Yotaro Kondo
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Pediatrics, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Fumihiko Hattori
- Department of Pediatrics, Kariya Toyota General Hospital, Kariya, Japan
- Department of Pediatrics, Toyokawa City Hospital, Toyokawa, Japan
| | - Hidetaka Nakai
- Department of Pediatrics, Toyokawa City Hospital, Toyokawa, Japan
| | - Kazuyoshi Saito
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daijiro Suzuki
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Pediatrics, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Kei Kozawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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86
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Chen J, Li J, Yue Y, Liu Y, Xie T, Peng J, Deng Z, Cao Y. Nomogram for predicting coronary artery lesions in patients with Kawasaki disease. Clin Cardiol 2023; 46:1434-1441. [PMID: 37540643 PMCID: PMC10642325 DOI: 10.1002/clc.24113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Coronary artery lesions are the most important complications of Kawasaki disease. Approximately 25-30% of untreated patients develop coronary artery disease, which can lead to long-term cardiovascular sequelae. AIM The aim of this study is to evaluate the risk factors for coronary artery lesions in Kawasaki disease and to construct a nomogram for predicting the likelihood of developing such lesions. METHODS Data from 599 patients between January 2012 and June 2020 were reviewed retrospectively. Patients were randomly assigned to the training set (n = 450) and the validation set (n = 149). A comparison of clinical features and laboratory data was performed, followed by multivariate logistic regression analysis to identify independent risk factors and develop the nomogram. The predictive efficiency of the nomogram was evaluated using the calibration curve, area under the receiver operating characteristic curve (AUC), C-index, and decision curve analysis (DCA). RESULTS Intravenous immunoglobulin (IVIG) resistance, delayed IVIG treatment, C-reactive protein, and neutrophil/lymphocyte ratio were identified as independent risk factors for the development of coronary artery lesions. The nomogram was constructed based on these four variables. The calibration curve of the nomogram showed a high degree of agreement between the predicted probability and the actual probability. The AUC of the nomogram in the training and validation set was 0.790 and 0.711, respectively. In addition, DCA revealed that the nomogram provided a significant net benefit, further supporting its clinical utility. CONCLUSIONS The constructed nomogram demonstrates a strong and reliable performance in predicting coronary artery lesions, which enables clinicians to make timely and tailored clinical decisions.
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Affiliation(s)
- Jie Chen
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Jing Li
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Yang‐hua Yue
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Yu Liu
- Department of Infectious DiseasesYouxian People's HospitalZhuzhouChina
| | - Tian Xie
- Department of Pediatrics, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Jian‐qiao Peng
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Zhong‐hua Deng
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - You‐de Cao
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
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87
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Gao Y, Tang X, Qian G, Huang H, Wang N, Wang Y, Zhuo W, Jiang J, Zheng Y, Li W, Liu Z, Li X, Xu L, Zhang J, Huang L, Liu Y, Lv H. Identification of hub biomarkers and immune-related pathways participating in the progression of Kawasaki disease by integrated bioinformatics analysis. Immunobiology 2023; 228:152750. [PMID: 37837870 DOI: 10.1016/j.imbio.2023.152750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/25/2023] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is a systemic vasculitis that commonly affects children and its etiology remains unknown. Growing evidence suggests that immune-mediated inflammation and immune cells in the peripheral blood play crucial roles in the pathophysiology of KD. The objective of this research was to find important biomarkers and immune-related mechanisms implicated in KD, along with their correlation with immune cells in the peripheral blood. MATERIAL/METHODS Gene microarray data from the Gene Expression Omnibus (GEO) was utilized in this study. Three datasets, namely GSE63881 (341 samples), GSE73463 (233 samples), and GSE73461 (279 samples), were obtained. To find intersecting genes, we employed differentially expressed genes (DEGs) analysis and weighted gene co-expression network analysis (WGCNA). Subsequently, functional annotation, construction of protein-protein interaction (PPI) networks, and Least Absolute Shrinkage and Selection Operator (LASSO) regression were performed to identify hub genes. The accuracy of these hub genes in identifying KD was evaluated using the receiver operating characteristic curve (ROC). Furthermore, Gene Set Variation Analysis (GSVA) was employed to explore the composition of circulating immune cells within the assessed datasets and their relationship with the hub gene markers. RESULTS WGCNA yielded eight co-expression modules, with one hub module (MEblue module) exhibiting the strongest association with acute KD. 425 distinct genes were identified. Integrating WGCNA and DEGs yielded a total of 277 intersecting genes. By conducting LASSO analysis, five hub genes (S100A12, MMP9, TLR2, NLRC4 and ARG1) were identified as potential biomarkers for KD. The diagnostic value of these five hub genes was demonstrated through ROC curve analysis, indicating their high accuracy in diagnosing KD. Analysis of the circulating immune cell composition within the assessed datasets revealed a significant association between KD and various immune cell types, including activated dendritic cells, neutrophils, immature dendritic cells, macrophages, and activated CD8 T cells. Importantly, all five hub genes exhibited strong correlations with immune cells. CONCLUSION Activated dendritic cells, neutrophils, and macrophages were closely associated with the pathogenesis of KD. Furthermore, the hub genes (S100A12, MMP9, TLR2, NLRC4, and ARG1) are likely to participate in the pathogenic mechanisms of KD through immune-related signaling pathways.
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Affiliation(s)
- Yang Gao
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Pediatrics, the First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Xuan Tang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Pediatrics, Jiangyin People's Hospital of Nantong University, Wuxi, Jiangsu, China
| | - Guanghui Qian
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hongbiao Huang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Nana Wang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yan Wang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wenyu Zhuo
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jiaqi Jiang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yiming Zheng
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wenjie Li
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiheng Liu
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuan Li
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lei Xu
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jiaying Zhang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Li Huang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ying Liu
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Haitao Lv
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
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Cardenas-Brown C, Lucas RD, Buttery J, Britton PN, Wood N, Singh-Grewal D, Burgner D. Live vaccines following intravenous immunoglobulin for Kawasaki disease: Are we vaccinating appropriately? J Paediatr Child Health 2023; 59:1217-1222. [PMID: 37664891 DOI: 10.1111/jpc.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/05/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023]
Abstract
AIM Australian and New Zealand guidelines recommend that live vaccines be postponed for 11 months after treatment of Kawasaki disease (KD) with intravenous immunoglobulin (IVIG). We aimed to describe patterns of live-vaccine administration after KD treatment, focusing on the measles-mumps-rubella/measles-mumps-rubella-varicella (MMR/MMRV) vaccines, and to compare real-world practice with current recommendations. METHODS We combined data from inpatient Electronic Health Records and the Australian Immunisation Register for all children who received IVIG for the treatment of KD under the age of 5 years at two Australian tertiary children's hospitals over a 12-year period. Children who received IVIG <11 months before a scheduled MMR/MMRV were deemed 'at risk' of breaching the guidelines, and those whose subsequent vaccination occurred <11 months after the IVIG were deemed to have 'breached' the guidelines. RESULTS Of those at risk, three-quarters (76%) breached the guidelines for their first MMR/MMRV. Findings were similar (50%-80%) for the second MMR/MMRV dose. CONCLUSIONS The majority of Australian children treated for KD with IVIG may not be optimally protected by MMRV vaccination. Immunisation systems should address this avoidable risk.
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Affiliation(s)
- Cassandra Cardenas-Brown
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Ryan D Lucas
- Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Jim Buttery
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne Medical School, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Health Analytics, Melbourne Children's Campus, Melbourne, Victoria, Australia
| | - Philip N Britton
- Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- National Centre for Immunisation Research & Surveillance, Sydney, New South Wales, Australia
- Department of Infectious Diseases, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Nicholas Wood
- Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- National Centre for Immunisation Research & Surveillance, Sydney, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - David Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne Medical School, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Umeda M, Okanishi T, Ohta K, Muroga C, Maegaki Y. Restricted Diffusion in the Bilateral Subcortical Motor Areas Associated with Status Epilepticus in an Infant with Kawasaki Disease. Yonago Acta Med 2023; 66:471-473. [PMID: 38028266 PMCID: PMC10674058 DOI: 10.33160/yam.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
Status epilepticus (SE) often causes neuronal death in the cerebrum and consequent long-term sequelae. Acute encephalopathy with biphasic seizures and late reduced diffusion is clinically characterized by SE associated with fever and seizure clusters that occur 3-9 days after symptom onset. MRI reveals reduced diffusion in the frontal or frontoparietal subcortical white matter, with sparing of the perirolandic region following seizure clusters. Kawasaki disease (KD) is an acute self-limited vasculitis secondary to activation of the immune system; KD is rarely complicated by acute encephalopathy. We report the case of a male infant who developed SE associated with KD and showed late reduced diffusion in the subcortical white matter beneath the bilateral motor cortices (primary motor, premotor and supplementary motor areas) and the right frontal cortex. The patient had characteristic neurological sequelae in the chronic phase, including clumsiness of fingers and forearms, impaired discrimination of tactile sensation and position sense on digits in his hands and feet, corresponding to the lesions with reduced diffusion at the acute phase.
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Affiliation(s)
- Masahiro Umeda
- Division of Child Neurology, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Kento Ohta
- Division of Child Neurology, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Chika Muroga
- Division of Perinatology and Pediatrics, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
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Tang Y, Yang D, Ma J, Wang N, Qian W, Wang B, Qin Y, Lu M, Lv H. Bioinformatics analysis and identification of hub genes of neutrophils in Kawasaki disease: a pivotal study. Clin Rheumatol 2023; 42:3089-3096. [PMID: 37394620 DOI: 10.1007/s10067-023-06636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is considered the main contributor to acquired heart diseases in developed countries. However, the precise pathogenesis of KD remains unclear. Neutrophils play roles in KD. This study aimed to select hub genes in neutrophils in acute KD. METHODS mRNA microarray of neutrophils from four acute KD patients and three healthy controls was performed to screen differentially expressed mRNAs (DE-mRNAs). DE-mRNAs were analyzed and predicted by Gene Ontology (GO), Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathways, and protein-protein interaction networks. Real time-PCR was finally conducted to confirm the reliability and validity of the expression level of DE-mRNAs from blood samples of healthy controls and KD patients in both acute and convalescent stage. RESULTS A total of 1950 DE-mRNAs including 1287 upregulated and 663 downregulated mRNAs were identified. GO and KEGG analyses revealed the DE-mRNAs were mainly enriched in the regulation of transcription from RNA polymerase II promoter, apoptotic process, intracellular signal transduction, protein phosphorylation, protein transport, metabolic pathways, carbon metabolism, lysosome, apoptosis, pyrimidine metabolism, alzheimer disease, prion disease, sphingolipid metabolism, huntington disease, glucagon signaling pathway, non-alcoholic fatty liver disease, pyruvate metabolism, sphingolipid signaling pathway, and peroxisome. Twenty hub DE-mRNAs were selected including GAPDH, GNB2L1, PTPRC, GART, HIST2H2AC, ACTG1, H2AFX, CREB1, ATP5A1, ENO1, RAC2, PKM, BCL2L1, ATP5B, MRPL13, SDHA, TLR4, RUVBL2, TXNRD1, and ITGAM. The real-time PCR results showed that BCL2L1 and ITGAM mRNA were upregulated in acute KD and were normalized in the convalescent stage. CONCLUSIONS These findings may improve our understanding of neutrophils in KD. Key Points • Neutrophilic BCL2L1 and ITGAM mRNA were first reported to be correlated with the pathogenic mechanism of KD.
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Affiliation(s)
- Yunjia Tang
- Department of Cardiology, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, People's Republic of China
| | - Daoping Yang
- Department of Cardiology, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, People's Republic of China
| | - Jin Ma
- Department of Pharmacy, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, People's Republic of China
| | - Nana Wang
- Department of Cardiology, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, People's Republic of China
| | - Weiguo Qian
- Department of Cardiology, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, People's Republic of China
| | - Bo Wang
- Department of Cardiology, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, People's Republic of China
| | - Yiming Qin
- Department of Pediatrics, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No 6, Huanghe Road, Changshu, People's Republic of China
| | - Meihua Lu
- Department of Pediatrics, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No 6, Huanghe Road, Changshu, People's Republic of China.
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, People's Republic of China.
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Guo Y, Yang L, Shao S, Zhang N, Hua Y, Zhou K, Ma F, Liu X. Coronary artery dilation in children with febrile illnesses other than Kawasaki disease: A case report and literature review. Heliyon 2023; 9:e21385. [PMID: 37954359 PMCID: PMC10637972 DOI: 10.1016/j.heliyon.2023.e21385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
Background Coronary artery dilation (CAD) had rarely been described as a cardiac complication of febrile disease other than Kawasaki disease (KD). There are rare cases complicated by CAD reported in patients with Mycoplasma pneumoniae (MP) infection. Case presentation A 6-year-old boy with severe Mycoplasma pneumoniae pneumonia (MPP) was transferred to our hospital due to significant respiratory distress on the 11th day from disease onset. Nadroparin, levofloxacin, and methylprednisolone followed by oral prednisone were aggressively prescribed. His clinical condition gradually achieved remission, and the drugs were withdrawn on the 27th day. Regrettably, the recurrent fever attacked him again in the absence of infection-toxic manifestations. Necrotizing pneumonia (NP) was found on chest CT. And echocardiography revealed right CAD (diameter, 3.40mm; z-score, 3.8), however, his clinical and laboratory findings did not meet the diagnostic criteria of KD. CAD was proposed to result from MP infection, and aspirin was prescribed. Encouragingly, the CAD regressed one week later (diameter, 2.50mm; z-score, 1.4). Additionally, the child defervesced seven days after the initiation of prednisone and Nadroparin treatment. The patient was ultimately discharged home on the 50th day. During follow-up, the child was uneventful with normal echocardiography and fully resolved chest CT lung lesions. Conclusions CAD can develop in patients with severe MP infection. Pediatricians should be alert to the possibility of CAD in patients with severe MP infection and recognize that CAD might also develop in febrile disease rather than KD.
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Affiliation(s)
- Yafei Guo
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lixia Yang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuran Shao
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Nanjun Zhang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fan Ma
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Bhatta M, Baniya A, Koirala D, Bhattarai K, Shah A. Dilemma in diagnosing incomplete Kawasaki disease in a resource limited setting. Ann Med Surg (Lond) 2023; 85:5809-5812. [PMID: 37915681 PMCID: PMC10617906 DOI: 10.1097/ms9.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/24/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Kawasaki disease (KD) is an acute febrile systemic vasculitis that predominantly affects small to medium sized vessels and mostly occurs in children below 5 years of age. The morbidity and mortality mostly occur due to cardiac involvement. Case presentation The authors present a case of a 5-year-old male child from hilly region of Nepal who presented with fever for 7 days along with strawberry tongue and non-exudative conjunctivitis without rashes, extremity changes or lymphadenopathy. A suspicion of incomplete KD (IKD) was made. The notable investigation findings were increased erythrocyte sedimentation rate, C-reactive protein, leucocyte count and platelets. Echocardiography showed normal findings. Based on the clinical features and supplemental laboratory findings, a diagnosis of IKD was made. The patient improved after intravenous immunoglobulin and Aspirin. Clinical discussion The main learning objective that the authors get from this case is the challenges in the diagnosis of IKD in the resource limited setting like Nepal. Whether or not to start intravenous immunoglobulin is a dilemma for the physician in most of the cases of suspected IKD, due to the high cost and poor availability of intravenous immunoglobulin in this setting. Hence, the use of inflammatory markers, supplemental laboratory findings together with the few diagnostic criteria met by the patient helps in making a diagnosis and institute timely treatment with intravenous immunoglobulin and aspirin. Conclusion Diagnosis of KD in difficult in resource limited setting.
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Zeng L, Wang C, Song Z, Liu Q, Chen D, Yu X. Prokineticin 2 as a potential biomarker for the diagnosis of Kawasaki disease. Clin Exp Med 2023; 23:3443-3451. [PMID: 37188888 DOI: 10.1007/s10238-023-01078-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
Kawasaki disease is a pressing acute self-limiting inflammatory disorder disease which lack of specific biomarkers. Our research aims to investigate the serum expression of a novel immune regulator PK2 in children with Kawasaki disease and to evaluate the ability of PK2 to predict Kawasaki disease. A total of 70 children with Kawasaki disease in the Children's Hospital of Chongqing Medical University who were first diagnosed, 20 children with common fever admitted to hospital due to bacterial infection during the same period, and 31 children underwent physical examination were included in this study. Venous blood was collected for complete blood count, CRP, ESR, PCT, and PK2 before clinical intervention. The predictive potential of PK2 as a biomarker for the diagnosis of Kawasaki disease was judged by correlation analysis, the receiver operating characteristic (ROC) and combined score. Compared with healthy children and children with common fever, children diagnosed with Kawasaki disease had significantly lower serum PK2 concentrations (median 28,503.7208 ng/ml, 26,242.5484 ng/ml, and 16,890.2452 ng/ml, respectively, Kruskal-Wallis test: p < 0.0001). Analysis of the existing indicators in other laboratories showed that WBC (Kruskal-Wallis test: p < 0.0001), PLT (Kruskal-Wallis test: p = 0.0018), CRP (Mann-Whitney U: p < 0.0001), ESR (Mann-Whitney U: p = 0.0092), NLR (Kruskal-Wallis test: p < 0.0001), and other indicators were significantly increased compared with healthy children and children with common fever, RBC (Kruskal-Wallis test: p < 0.0001), and Hg (Kruskal-Wallis test: p < 0.0001) were significantly decreased in children with Kawasaki disease conversely. In the analysis of the Spearman correlation, it was found that serum PK2 concentration and NLR ratio were significantly negatively correlated in children with Kawasaki disease (rs = -0.2613, p = 0.0301). In the analysis of the ROC curves, it was found that the area under the PK2 curve was 0.782 (95% confidence interval 0.683-0.862; p < 0.0001), the ESR was 0.697 (95% confidence interval 0.582-0.796; p = 0.0120), the CRP was 0.601 (95% confidence interval 0.683-0.862; p = 0.1805), and the NLR was 0.735 (95% confidence interval 0.631-0.823; p = 0.0026). PK2 can significantly predict Kawasaki disease independently of CRP and ESR (p < 0.0001). The combined score of PK2 and ESR can significantly improve the diagnostic performance of PK2 (AUC = 0.827, 95% CI 0.724-0.903, p < 0.0001). The sensitivity was 87.50%, the sensitivity was 75.81%, the positive likelihood ratio was 6.0648, and the Youden index was 0.6331. PK2 has the potential to be a biomarker for early diagnosis of Kawasaki disease, and the combined use of ESR can further improve its diagnostic performance. Our study identifies PK2 as an important biomarker for Kawasaki disease and provides a potential new diagnostic strategy for Kawasaki disease.
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Affiliation(s)
- Li Zeng
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, PR China
| | - Cai Wang
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, PR China
| | - Zhixin Song
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, PR China
| | - Qian Liu
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, PR China
| | - Dapeng Chen
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, PR China.
| | - Xiaoyan Yu
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, PR China.
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Maeda K, Marutani S, Nishi K, Ueshima K, Imaoka N, Sugimoto K, Inamura N. Two Cases of Adult-onset Kawasaki Disease with a Difficult Diagnosis. Intern Med 2023; 62:3157-3161. [PMID: 36889710 PMCID: PMC10686738 DOI: 10.2169/internalmedicine.1204-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/21/2022] [Indexed: 03/09/2023] Open
Abstract
We encountered two consecutive cases of adult-onset Kawasaki disease (AKD) that were difficult to diagnose. In both cases, Kawasaki disease was not considered as a differential diagnosis in the early stages. However, it was possible to make a diagnosis by citing the disease as a differential diagnosis and introducing the patients to the pediatrics department. AKD has a minimal incidence rate and may have a clinical course different from that of childhood-onset Kawasaki disease. Therefore, it is necessary to incorporate Kawasaki disease into the differentiation of an adult fever and to consult with a pediatrician for its diagnosis.
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Affiliation(s)
- Kana Maeda
- Department of Pediatrics, Kindai University, Faculty of Medicine, Japan
| | - Satoshi Marutani
- Department of Pediatrics, Kindai University, Faculty of Medicine, Japan
| | - Kohsuke Nishi
- Department of Pediatrics, Kindai University, Faculty of Medicine, Japan
| | - Kazushi Ueshima
- Department of Pediatrics, Kindai University, Faculty of Medicine, Japan
| | - Nori Imaoka
- Department of Pediatrics, Kindai University, Faculty of Medicine, Japan
| | - Keisuke Sugimoto
- Department of Pediatrics, Kindai University, Faculty of Medicine, Japan
| | - Noboru Inamura
- Department of Pediatrics, Kindai University, Faculty of Medicine, Japan
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Si F, Zhou C, Yang Y, Huang L. Study of the relationship between occurrence of Kawasaki disease and air pollution in Chengdu by parametric and semi-parametric models. Environ Sci Pollut Res Int 2023; 30:117706-117714. [PMID: 37872336 DOI: 10.1007/s11356-023-30533-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
Kawasaki disease (KD) is a pediatric vasculitis of unknown etiology which is mainly associated with the development of coronary artery aneurysms. The etiology of KD seems to be multifactorial, but there is rare research on the association between KD and potential environmental risk factors. So, we would like to examine the correlation between KD and potential environmental risk factors in West China. We included KD patients in Chengdu from 2015 to 2021 and analyzed the correlation between air pollution indexes and climate condition indexes. The autocorrelation of the data was eliminated by first-order difference, the risk factors were screened by stepwise regression with AIC criterion, and the multiple regression model was established. Random forest and Winsorize were used to test the robustness of the screening results, and it was found that particulate matter with a diameter less than or equal to 2.5 μm (PM2.5) had a significant positive effect on the incidence of KD. In addition, several variables were positively correlated with KD incidence, but not statistically significant. The GAM model was used to explore the nonlinear correlation between PM2.5 and KD incidence. The results showed that PM2.5 concentration was positively correlated with KD incidence, and the effects varied among different concentration levels of PM2.5. Fisher's exact test was used to explore the influence of PM2.5 on the incidence of coronary tumors. It is found that PM2.5 may be a risk factor for it. This study suggested that exposure to high concentrations of PM2.5 may significantly increase the risk of KD. The evidence for the association between other environmental factors and KD incidence, as well as the association between PM2.5 and coronary tumors, was limited and needed further verification.
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Affiliation(s)
- Feifei Si
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Chifeng Zhou
- Department of Statistics, School of Mathematics, Southwest Jiaotong University, Chengdu, 611756, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Lei Huang
- Department of Statistics, School of Mathematics, Southwest Jiaotong University, Chengdu, 611756, China.
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Fabi M, Dondi A, Andreozzi L, Frazzoni L, Biserni GB, Ghiazza F, Dajti E, Zagari RM, Lanari M. Kawasaki disease, multisystem inflammatory syndrome in children, and adenoviral infection: a scoring system to guide differential diagnosis. Eur J Pediatr 2023; 182:4889-4895. [PMID: 37597046 PMCID: PMC10640425 DOI: 10.1007/s00431-023-05142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
Children with Kawasaki disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C), and Adenovirus infections (AI) of the upper respiratory tract show overlapping features. This study aims to develop a scoring system based on clinical or laboratory parameters to differentiate KD or MIS-C from AI patients. Ninety pediatric patients diagnosed with KD (n = 30), MIS-C (n = 26), and AI (n = 34) admitted to the Pediatric Emergency Unit of S.Orsola University Hospital in Bologna, Italy, from April 2018 to December 2021 were enrolled. Demographic, clinical, and laboratory data were recorded. A multivariable logistic regression analysis was performed, and a scoring system was subsequently developed. A simple model (clinical score), including five clinical parameters, and a complex model (clinic-lab score), resulting from the addition of one laboratory parameter, were developed and yielded 100% sensitivity and 80% specificity with a score ≥2 and 98.3% sensitivity and 83.3% specificity with a score ≥3, respectively, for MIS-C and KD diagnosis, as compared to AI. CONCLUSION This scoring system, intended for both outpatients and inpatients, might limit overtesting, contribute to a more effective use of resources, and help the clinician not underestimate the true risk of KD or MIS-C among patients with an incidental Adenovirus detection. WHAT IS KNOWN • Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C) and adenoviral infections share overlapping clinical presentation in persistently febrile children, making differential diagnosis challenging. • Scoring systems have been developed to identify high-risk KD patients and discriminate KD from MIS-C patients. WHAT IS NEW • This is the first scoring model based on clinical criteria to distinguish adenoviral infection from KD and MIS-C. • The score might be used by general pediatricians before referring febrile children to the emergency department.
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Affiliation(s)
- Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy.
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Laura Andreozzi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Leonardo Frazzoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Elton Dajti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rocco Maurizio Zagari
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
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Teramoto Y, Akagawa S, Hori SI, Tsuji S, Higasa K, Kaneko K. Dysbiosis of the gut microbiota as a susceptibility factor for Kawasaki disease. Front Immunol 2023; 14:1268453. [PMID: 38022552 PMCID: PMC10644744 DOI: 10.3389/fimmu.2023.1268453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Gut microbial imbalance (dysbiosis) has been reported in patients with acute Kawasaki disease (KD). However, no studies have analyzed the gut microbiota while focusing on susceptibility to KD. This study aimed to evaluate whether dysbiosis elevates susceptibility to KD by assessing children with a history of KD. Methods Fecal DNA was extracted from 26 children with a history of KD approximately 1 year prior (KD group, 12 boys; median age, 32.5 months; median time from onset, 11.5 months) and 57 age-matched healthy controls (HC group, 35 boys; median age, 36.0 months). 16S rRNA gene analysis was conducted with the Illumina Miseq instrument. Sequence reads were analyzed using QIIME2. Results For alpha diversity, Faith's phylogenetic diversity was significantly higher in the KD group. Regarding beta diversity, the two groups formed significantly different clusters based on Bray-Curtis dissimilarity. Comparing microbial composition at the genus level, the KD and HC groups were significantly different in the abundance of two genera with abundance over 1% after Benjamini-Hochberg false discovery rate correction for multiple comparisons. Compared with the HC group, the KD group had higher relative abundance of Ruminococcus gnavus group and lower relative abundance of Blautia. Discussion and conclusion Ruminococcus gnavus group reportedly includes pro-inflammatory bacteria. In contrast, Blautia suppresses inflammation via butyrate production. In the predictive functional analysis, the proportion of gut microbiota involved in several pathways was lower in the KD group. Therefore, dysbiosis characterized by distinct microbial diversity and decreased abundance of Blautia in parallel with increased abundance of Ruminococcus gnavus group might be a susceptibility factor for KD.
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Affiliation(s)
- Yoshiki Teramoto
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shohei Akagawa
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shin-ichiro Hori
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shoji Tsuji
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Koichiro Higasa
- Department of Genome Analysis, Institute of Biomedical Science, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
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Shi H, Qiu JL, Xu Y, Yang LL. Experience of IVIG Treatment in an Overweight 14-year-old Child With Kawasaki Disease: A Case Report. J Pediatr Health Care 2023:S0891-5245(23)00287-0. [PMID: 37897455 DOI: 10.1016/j.pedhc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
Kawasaki disease, or mucocutaneous lymph node syndrome, is an acute systemic vasculitis involving small and medium-sized vessels. It can be complicated by varying degrees of cardiac damage, especially coronary artery disease. The disease mainly occurs in children aged < 5 years, with rarer cases in older children and adults. Intravenous immunoglobulin combined with aspirin is the widely accepted treatment regimen in the acute phase, but the dosage recommended by the American Heart Association guidelines is not suitable for heavier children. This article reports the successful management of an overweight 14-year-old child with Kawasaki disease.
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Sun Y, Liu L, Yang R. PTX3 promotes IVIG resistance-induced endothelial injury in Kawasaki disease by regulating the NF-κB pathway. Open Life Sci 2023; 18:20220735. [PMID: 37941784 PMCID: PMC10628575 DOI: 10.1515/biol-2022-0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 11/10/2023] Open
Abstract
Intravenous immunoglobulin (IVIG) resistance leads to serious complications in Kawasaki disease (KD) with no effective treatment. This study aimed to investigate the effects of pentraxin 3 (PTX3) on human coronary artery endothelial cells (HCAECs). PTX3 levels were measured using quantitative real-time PCR (qRT-PCR), enzyme-linked immunosorbent assay, and western blotting. Cell viability was detected using the MTT assay. Biological functions were analyzed using CCK-8, EdU, flow cytometry, TUNEL, and qRT-PCR. The levels of factors of the NF-κB pathway were examined using western blotting. The results demonstrated that PTX3 expression was highest in patients and HCAECs with IVIG-resistance. Knockdown of PTX3 promoted proliferation and suppressed apoptosis and inflammation of IVIG-resistant HCAECs, whereas PTX3 overexpression produced the opposite results. Moreover, PTX3 activated the NF-κB pathway in IVIG-resistant HCAECs. A rescue study showed that PTX3 modulated biological behaviors by regulating the NF-κB pathway. Overall, our findings demonstrate that PTX3 promotes IVIG resistance-induced endothelial injury by activating the NF-κB pathway, suggesting that PTX3 may become a novel therapeutic target for patients with IVIG-resistant KD.
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Affiliation(s)
- Ye Sun
- Children’s Hospital of Shanxi (Women Health Center of Shanxi), No. 65, Jinxi Street, Taiyuan, Shanxi 030025, China
| | - Lihua Liu
- Children’s Hospital of Shanxi (Women Health Center of Shanxi), No. 65, Jinxi Street, Taiyuan, Shanxi 030025, China
| | - Ruihua Yang
- Children’s Hospital of Shanxi (Women Health Center of Shanxi), No. 65, Jinxi Street, Taiyuan, Shanxi 030025, China
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Huang XB, Zhao S, Liu ZY, Xu YY, Deng F. Serum amyloid A as a biomarker for immunoglobulin resistance in Kawasaki disease. Ann Med 2023; 55:2264315. [PMID: 37870383 PMCID: PMC10836278 DOI: 10.1080/07853890.2023.2264315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) resistance is of prime importance in Kawasaki disease (KD). In this study, we examined the value and mechanism of serum amyloid A (SAA) level in predicting IVIG resistance in patients with KD. METHODS SAA levels were measured in 497 consecutive patients with KD before IVIG therapy in the training set. The patients were divided into two groups (IVIG-responsive and IVIG-resistant) according to the American Heart Association (AHA) definition of IVIG resistance. Demographic, echocardiographic, and laboratory data were also retrospectively analyzed and tabulated to predict IVIG resistance. The predictive value of SAA was validated on test sets of prospective data. Cytokine microarrays were analyzed from 4 patients with resistant to IVIG, 4 patients with responsive to IVIG and 4 healthy volunteers. RESULTS During the training set, 409 patients with KD were enrolled, of whom 43 (10.5%) were resistant to initial IVIG treatment and 47 (11.49%) had coronary artery lesions (CALs). Serum levels of SAA were higher in the IVIG resistant group compared to the IVIG responsive group, (380.00 [204.40-547.25] vs 230.85 [105.40-490.00] mg/L; p = .008). The values of total bilirubin, C-reactive protein, neutrophils, alanine aminotransferase, aspartate aminotransferase, interleukin-6(IL-6), and procalcitonin were significantly higher in the IVIG-resistant group than in the IVIG-responsive group (p < .05); however, the lymphocytes, platelets, serum sodium levels, and duration of fever before IVIG therapy were significantly lower (p < .05). There was no significant difference in SAA levels between patients with KD with and without CALs. Binary logistic regression analysis showed that SAA (p = .008), neutrophils (p < .001), total bilirubin (p = .001), platelet count (p = .004), and serum sodium level (p = .019) were independent factors influencing IVIG resistance. The optimal cutoff value of SAA for IVIG resistance prediction was 252.45 mg/L, with a corresponding clinical sensitivity of 69.8% and specificity of 54.4%. Based on receiver operating characteristic (ROC) curve analyses, the area under the curve (AUC) of combined detection with these five indicators was 0.800, clinical sensitivity was 69.8%, and specificity was 76.2%. In the prospective data, the sensitivity, specificity, and accuracy of SAA for identifying IVIG resistance KD were 77.8%,69.0%, and 70.0%, respectively. Compared with IVIG- responsive group and healthy children, the levels of IL-6 was upregulated significantly in IVIG-resistant group through cytokine microarrays. CONCLUSIONS SAA may be a potential biomarker for predicting IVIG responsiveness to KD, Combined detection of SAA levels, total bilirubin, neutrophil count, platelet count, and serum sodium levels is superior to that of any other single indicator for predicting IVIG resistance in KD. And elevated SAA may accompany with IL-6 in KD patients, its use in clinical practice may be helpful for treatment management.
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Affiliation(s)
- Xiao-bi Huang
- Department of Pediatric Nephrology, Children’s Hospital of Anhui Medical University (Anhui Provincial Children’s Hospital), Hefei, China
- Department of Pediatric Cardiology, Children’s Hospital of Anhui Medical University (Anhui Provincial Children’s Hospital), Hefei, China
| | - Sheng Zhao
- Department of Pediatric Cardiology, Children’s Hospital of Anhui Medical University (Anhui Provincial Children’s Hospital), Hefei, China
| | - Zhi-yuan Liu
- Department of Pediatric Cardiology, Children’s Hospital of Anhui Medical University (Anhui Provincial Children’s Hospital), Hefei, China
| | - Yan-yan Xu
- Department of Pediatric Cardiology, Children’s Hospital of Anhui Medical University (Anhui Provincial Children’s Hospital), Hefei, China
| | - Fang Deng
- Department of Pediatric Nephrology, Children’s Hospital of Anhui Medical University (Anhui Provincial Children’s Hospital), Hefei, China
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