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Barman P, Pilania RK, Cv G, Thangaraj A, Arora M, Singh S. Treatment intensification in Kawasaki disease - current perspectives. Expert Rev Clin Immunol 2024:1-13. [PMID: 38979573 DOI: 10.1080/1744666x.2024.2378900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/08/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Intravenous immunoglobulin is the standard of care in Kawasaki disease. However, a subset of patients exhibits resistance to intravenous immunoglobulin treatment, even when Kawasaki disease is promptly diagnosed and managed. While intravenous immunoglobulin reduces the occurrence of coronary artery abnormalities from 15-25% to 3-5%, it does not entirely eliminate the risk. Besides, management guidelines for non-coronary complications of Kawasaki disease, for instance, myocarditis, remain speculative. AREAS COVERED Recent literature suggests that a subset of patients with Kawasaki disease may benefit from treatment intensification with drugs, such as corticosteroids, infliximab, anakinra, and/or ciclosporin. In this manuscript, we have reviewed recent advances in the management of Kawasaki disease, especially with regard to preemptive intensification of therapy in children at high risk of cardiac complications. A comprehensive search was made using Web of Science, Scopus, and PubMed databases to gather English articles published from 1967 to 2023 on the treatment of Kawasaki disease. We incorporated the following words in the search strategy: 'Kawasaki disease,' 'intravenous immunoglobulin/IVIg,' 'intravenous immunoglobulin/IVIg-resistant Kawasaki disease,' 'treatment intensification,' or 'primary intensification of treatment/therapy.' EXPERT OPINION The 'high-risk' group in Kawasaki disease needs to be identified with early intensification of primary therapy for better coronary and myocardial outcomes.
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Affiliation(s)
- Prabal Barman
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gayathri Cv
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abarna Thangaraj
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Munish Arora
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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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 2024; 38:624-628. [PMID: 37897455 DOI: 10.1016/j.pedhc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Wu Y, Hu L, Xie X, Li W, Wang Y, Zhang L, Huang P, Li F, Li J, Xia S, Yuan J, Li M, Wang Z, Zhang X. Different dose aspirin plus immunoglobulin (DAPI) for prevention of coronary artery abnormalities in Kawasaki disease: Study protocol for a multi-center, prospective, randomized, open-label, blinded end-point, non-inferiority trial. Am Heart J 2024; 273:1-9. [PMID: 38508571 DOI: 10.1016/j.ahj.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Kawasaki disease is a pediatric acute systemic vasculitis that specifically involves the coronary arteries. Timely initiation of immunoglobulin plus aspirin is necessary for diminishing the incidence of coronary artery abnormalities (CAAs). The optimal dose of aspirin, however, remains controversial. The trial aims to evaluate if low-dose aspirin is noninferior to moderate-dose in reducing the risk of CAAs during the initial treatment of Kawasaki disease. METHODS This is a multi-center, prospective, randomized, open-label, blinded endpoint, noninferiority trial to be conducted in China. The planned study duration is from 2023 to 2026. Data will be analyzed according to intention-to-treat principles. Participants are children and adolescents under the age of 18 with Kawasaki disease, recruited from the inpatient units. A sample size of 1,346 participants will provide 80% power with a one-sided significance level of 0.025. Qualifying children will be randomized (1:1) to receive either intravenous immunoglobulin (2 g/kg) plus oral moderate-dose aspirin (30-50 mg·kg-1·d-1) until the patient is afebrile for at least 48 hours, or immunoglobulin plus low-dose aspirin (3-5 mg·kg-1·d-1) as initial treatment. The primary outcome will be the occurrence of CAAs at 8 weeks after immunoglobulin infusion. Independent blinded pediatric cardiologists will assess the primary endpoint using echocardiography. CONCLUSIONS There is a shortage of consensus on the dose of aspirin therapy for Kawasaki disease due to the lack of evidence. The results of our randomized trial will provide more concrete evidence for the efficacy and adverse events of low- or moderate-dose aspirin in the acute phase of Kawasaki disease. TRIAL REGISTRATION www.chictr.org.cn: ChiCTR2300072686.
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Affiliation(s)
- Yujian Wu
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China; Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lin Hu
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Xiaofei Xie
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Wei Li
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yanfei Wang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Li Zhang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Ping Huang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Fengxiang Li
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Jianbin Li
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Shuliang Xia
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Jia Yuan
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Ming Li
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Zhouping Wang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China; Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Xu Zhang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China; Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Wei K, Chen T, Fang H, Shen X, Tang Z, Zhao J. Mitochondrial DNA release via the mitochondrial permeability transition pore activates the cGAS-STING pathway, exacerbating inflammation in acute Kawasaki disease. Cell Commun Signal 2024; 22:328. [PMID: 38872145 PMCID: PMC11177463 DOI: 10.1186/s12964-024-01677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/21/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an immune vasculitis of unknown origin, characterized by transient inflammation. The activation of the cGAS-STING pathway, triggered by mitochondrial DNA (mtDNA) release, has been implicated in the onset of KD. However, its specific role in the progression of inflammation during KD's acute phase remains unclear. METHODS We measured mtDNA and 2'3'-cGAMP expression in KD patient serum using RT-qPCR and ELISA. A murine model of KD was induced by injecting Lactobacillus casei cell wall extract (LCWE), after which cGAS-STING pathway activation and inflammatory markers were assessed via immunohistochemistry, western blot, and RT-qPCR. Human umbilical vein endothelial cells (HUVECs) were treated with KD serum and modulators of the cGAS-STING pathway for comparative analysis. Mitochondrial function was evaluated using Mitosox staining, mPTP opening was quantified by fluorescence microscopy, and mitochondrial membrane potential (MMP) was determined with JC-1 staining. RESULTS KD patient serum exhibited increased mtDNA and 2'3'-cGAMP expression, with elevated levels of pathway-related proteins and inflammatory markers observed in both in vivo and in vitro models. TEM confirmed mitochondrial damage, and further studies demonstrated that inhibition of mPTP opening reduced mtDNA release, abrogated cGAS-STING pathway activation, and mitigated inflammation. CONCLUSION These findings indicate that mtDNA released through the mPTP is a critical activator of the cGAS-STING pathway, contributing significantly to KD-associated inflammation. Targeting mtDNA release or the cGAS-STING pathway may offer novel therapeutic approaches for KD management.
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Affiliation(s)
- Ke Wei
- Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China
- Research Institute of Comparative Medicine, Nantong University, Nantong, 226001, Jiangsu Province, China
| | - Tao Chen
- Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China
| | - Hao Fang
- Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China
| | - Xianjuan Shen
- Department of Clinical Laboratory, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China
| | - Zhiyuan Tang
- Department of Pharmacy, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China.
| | - Jianmei Zhao
- Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China.
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Alla N, Abdul-Hadi T, Litra F. Ileocecal Intussusception in the Era of Coronavirus Disease 2019 (COVID-19) Infection and Multisystem Inflammatory Syndrome in Children (MIS-C): A Case Report and Literature Review. Cureus 2024; 16:e62731. [PMID: 39036184 PMCID: PMC11260111 DOI: 10.7759/cureus.62731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
Ileocecal intussusception (ICI) is the most common abdominal emergency and cause of intestinal obstruction in young children, carrying a high risk of mortality and morbidity. Enteric viral infectious and inflammatory syndromes are known triggers for intussusception (ileoileal and ileocolic) by causing mesenteric lymphoid hyperplasia that may act as a leading point allowing the bowel to invaginate into itself. Gastrointestinal (GI) symptoms are common in children with coronavirus disease 2019 (COVID-19) infection, with a subset of patients solely having GI complaints at the time of presentation. COVID-19 as a trigger for intussusception in children has been hypothesized and suggested in multiple cases reported to date, both during the acute phase of illness and as a part of multisystem inflammatory syndrome in children (MIS-C). We present a seven-month-old male who developed ICI and became a diagnostic dilemma due to viral co-infections and the gradual emergence of MIS-C during the hospital stay. We are describing this presentation in an attempt to expand the understanding of the implications of COVID-19 and MIS-C in this young and unique age group.
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Affiliation(s)
- Niharika Alla
- Pediatrics, University of Florida, Pensacola, USA
- Pediatrics, Ascension Sacred Heart Pensacola, Pensacola, USA
| | | | - Florentina Litra
- Pediatrics, University of Florida, Pensacola, USA
- Pediatrics, Ascension Sacred Heart Pensacola, Pensacola, USA
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Molloy MJ, Auger KA, Hall M, Shah SS, Schondelmeyer AC, Parikh K, Kazmier KM, Katragadda H, Jacob SA, Jerardi KE, Ivancie R, Hartley D, Bryan MA, Bhumbra S, Arnold SD, Brady PW. Epidemiology and Severity of Illness of MIS-C and Kawasaki Disease During the COVID-19 Pandemic. Pediatrics 2023; 152:e2023062101. [PMID: 37791428 PMCID: PMC10598633 DOI: 10.1542/peds.2023-062101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Multisystem inflammatory syndrome in children (MIS-C) is a novel, severe condition following severe acute respiratory syndrome coronavirus 2 infection. Large epidemiologic studies comparing MIS-C to Kawasaki disease (KD) and evaluating the evolving epidemiology of MIS-C over time are lacking. We sought to understand the illness severity of MIS-C compared with KD and evaluate changes in MIS-C illness severity over time during the coronavirus disease 2019 pandemic compared with KD. METHODS We included hospitalizations of children with MIS-C and KD from April 2020 to May 2022 from the Pediatric Health Information System administrative database. Our primary outcome measure was the presence of shock, defined as the use of vasoactive/inotropic cardiac support or extracorporeal membrane oxygenation. We examined the volume of MIS-C and KD hospitalizations and the proportion of hospitalizations with shock over time using 2-week intervals. We compared the proportion of hospitalizations with shock in MIS-C and KD patients over time using generalized estimating equations adjusting for hospital clustering and age, with time as a fixed effect. RESULTS We identified 4868 hospitalizations for MIS-C and 2387 hospitalizations for KD. There was a higher proportion of hospitalizations with shock in MIS-C compared with KD (38.7% vs 5.1%). In our models with time as a fixed effect, we observed a significant decrease in the odds of shock over time in MIS-C patients (odds ratio 0.98, P < .001) but not in KD patients (odds ratio 1.00, P = .062). CONCLUSIONS We provide further evidence that MIS-C is a distinct condition from KD. MIS-C was a source of lower morbidity as the pandemic progressed.
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Affiliation(s)
- Matthew J. Molloy
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Katherine A. Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Samir S. Shah
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Amanda C. Schondelmeyer
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Hospital, and George Washington University School of Health Sciences, Washington, District of Columbia
| | | | - Harita Katragadda
- Division of Pediatric Hospital Medicine
- Department of Pediatrics, UT Southwestern, Dallas, Texas
| | | | - Karen E. Jerardi
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Rebecca Ivancie
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - David Hartley
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Mersine A. Bryan
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | - Samina Bhumbra
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Staci D. Arnold
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Patrick W. Brady
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
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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] [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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Robinson LA, Dale M, Gorelik M. Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: A Spectrum of Postinfectious Hyperinflammatory Disease. Rheum Dis Clin North Am 2023; 49:661-678. [PMID: 37331739 DOI: 10.1016/j.rdc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Kawasaki disease and multisystem inflammatory syndrome in children are hyperinflammatory conditions that share similar emerging pathophysiology hypotheses, clinical features, treatment strategies, and outcomes. Although both conditions have key differences, growing evidence suggests that both conditions might be closely related on a larger spectrum of postinfectious autoimmune responses.
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Affiliation(s)
- Lauren Ambler Robinson
- Department of Medicine, Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA; Department of Pediatric Rheumatology, 535 East 70th Street, New York, NY 10021, USA
| | - Marissa Dale
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Morgan Stanley Children's Hospital, 3959 Broadway Central 5th Floor, New York, NY 10032, USA
| | - Mark Gorelik
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Medical Center, College of Physicians and Surgeons Building, P&S 10-451, 630 West 168th Street, New York NY 10032, USA.
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Maglione M, Barlabà A, Grieco M, Cosimi R, Di Nardo G, Di Marco GM, Gelzo M, Castaldo G, Tucci C, Iodice RM, Lonardo MC, Tipo V, Giannattasio A. Incomplete Kawasaki Disease with Peripheral Facial Nerve Palsy and Lung Nodules: A Case Report and Literature Review. CHILDREN 2023; 10:children10040679. [PMID: 37189928 DOI: 10.3390/children10040679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
The diagnosis of Kawasaki disease (KD) is challenging and often delayed mainly in case of young infants and in presence of an incomplete disease and atypical features. Facial nerve palsy is one of the rare neurologic symptoms of KD, associated with a higher incidence of coronary arteries lesions and may be an indicator of a more severe disease. Here, we describe a case of lower motor neuron facial nerve palsy complicating KD and perform an extensive literature review to better characterize clinical features and treatment of patients with KD-associated facial nerve palsy. The patient was diagnosed at the sixth day of disease and presented extensive coronary artery lesions. A prompt treatment with intravenous immunoglobulins, aspirin and steroids obtained a good clinical and laboratory response, with resolution of facial nerve palsy and improvement of coronary lesions. The incidence of facial nerve palsy is 0.9–1.3%; it is often unilateral, transient, more frequent on the left and seemingly associated with coronary impairment. Our literature review showed coronary artery involvement in the majority of reported cases (27/35, 77%) of KD with facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should prompt consideration of echocardiography to exclude KD and start the appropriate treatment.
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Affiliation(s)
- Marco Maglione
- Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Annalisa Barlabà
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania L. Vanvitelli, 81100 Naples, Italy
| | - Michela Grieco
- Department of Pediatric Cardiology, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Rosaria Cosimi
- Department of Pediatric Cardiology, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Giangiacomo Di Nardo
- Department of Pediatric Cardiology, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Giovanni Maria Di Marco
- Department of Pediatric Cardiology, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80138 Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80138 Naples, Italy
| | - Celeste Tucci
- Department of Neuroscience, Pediatric Neurology, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | | | | | - Vincenzo Tipo
- Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
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Du Y, Lee PY. At the Heart of Treating Kawasaki Disease: The Search for New Approaches to Prevent Coronary Artery Aneurysms. Arthritis Rheumatol 2023; 75:149-152. [PMID: 36066560 PMCID: PMC9892198 DOI: 10.1002/art.42346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/01/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Yan Du
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pui Y. Lee
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Maccora I, Simonini G. Comment on: Distal coronary artery abnormalities in Kawasaki disease: experience on CT coronary angiography in 176 children. Rheumatology (Oxford) 2023; 62:e27-e28. [PMID: 35699464 DOI: 10.1093/rheumatology/keac348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Meyer Children's Hospital.,NeuroFARBA Department, University of Florence, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's Hospital.,NeuroFARBA Department, University of Florence, Florence, Italy
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El Miedany Y, Salah S, Lotfy HM, Abu-Zaid MH, Mohamed SS, Maher SE, El Gaafary M, Abdulhady H, Farag Y, Eissa M, Radwan A, Medhat BM, El Mikkawy DME, Hassan WA, Mosa DM, El Deriny G, Mortada M, Osman NS, Fouad NA, Amer YA, Nasef SI, Abushady H, Galal S, El-Latif EA, Maria D, Shabana AH, Tabra SA. Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023; 50:21. [PMCID: PMC10088797 DOI: 10.1186/s43166-023-00180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/10/2023] [Indexed: 09/02/2023] Open
Abstract
Background Kawasaki disease (KD) is an acute, self-limited febrile disease of unidentified cause that mostly affects children less than 5 years of age. This work aimed to provide an appropriate Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. The main objective of this study, which employed the Delphi method, was to reach a consensus among experts on a treat-to-target management approach for KD. Results The expert panel was confined to an online survey (n =26), and all the expert completed the three rounds. At the conclusion of round 3, a total of 17 recommendation items were gathered, which were divided into two sections. The range of respondents (ranks 7–9) who agreed with the recommendations was 92.3 to 100%. All 17 clinical standards identified by the scientific committee were written in the same way. There have been algorithms proposed for managing various KD conditions. Conclusion The developed evidence-based consensus recommendations for the diagnosis and management of KD represent an up-to-date document that focuses on clinical management questions which are generally posed to health care professionals involved in the management of KD. This guideline was developed considering experience with and availability of treatment and diagnostic options in Egypt.
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Affiliation(s)
- Yasser El Miedany
- Canterbury Christ Church University, Kent, England
- King’s College London, London, England
| | - Samia Salah
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Hala M. Lotfy
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | | | | | | | - Maha El Gaafary
- Community Medicine and Public Health, Ain Shams University, Cairo, Egypt
| | - Hala Abdulhady
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Yomna Farag
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Mervat Eissa
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Ahmed Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | - Basma M. Medhat
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | | | | | - Doaa Mosad Mosa
- Rheumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohamed Mortada
- Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | | | | | | | | | - Hend Abushady
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Salwa Galal
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | | | - Dina Maria
- Cardiology, Tanta University, Tanta, Egypt
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Aymonnier K, Amsler J, Lamprecht P, Salama A, Witko‐Sarsat V. The neutrophil: A key resourceful agent in immune‐mediated vasculitis. Immunol Rev 2022; 314:326-356. [PMID: 36408947 DOI: 10.1111/imr.13170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The term "vasculitis" refers to a group of rare immune-mediated diseases characterized by the dysregulated immune system attacking blood vessels located in any organ of the body, including the skin, lungs, and kidneys. Vasculitides are classified according to the size of the vessel that is affected. Although this observation is not specific to small-, medium-, or large-vessel vasculitides, patients show a high circulating neutrophil-to-lymphocyte ratio, suggesting the direct or indirect involvement of neutrophils in these diseases. As first responders to infection or inflammation, neutrophils release cytotoxic mediators, including reactive oxygen species, proteases, and neutrophil extracellular traps. If not controlled, this dangerous arsenal can injure the vascular system, which acts as the main transport route for neutrophils, thereby amplifying the initial inflammatory stimulus and the recruitment of immune cells. This review highlights the ability of neutrophils to "set the tone" for immune cells and other cells in the vessel wall. Considering both their long-established and newly described roles, we extend their functions far beyond their direct host-damaging potential. We also review the roles of neutrophils in various types of primary vasculitis, including immune complex vasculitis, anti-neutrophil cytoplasmic antibody-associated vasculitis, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu arteritis, and Behçet's disease.
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Affiliation(s)
- Karen Aymonnier
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Jennifer Amsler
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology University of Lübeck Lübeck Germany
| | - Alan Salama
- Department of Renal Medicine, Royal Free Hospital University College London London UK
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Gallego DF, Ruiz MEZ, Marshall DA. Oblivion: autopsy findings of a 31-year-old man with sudden cardiac arrest, a case report of a sequalae of Kawasaki disease. Autops Case Rep 2022; 12:e2021404. [PMID: 36312877 PMCID: PMC9613377 DOI: 10.4322/acr.2021.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
A 31-year-old man presented to the hospital after suffering a sudden cardiac arrest. Despite optimal therapy, the patient passed away. His medical history included febrile rash at age 2. At autopsy, there was aneurysmal dilation and severe coronary artery stenosis by atherosclerotic plaques and myocardial fibrosis. These findings were presumed to be due to complications of Kawasaki disease, given the remote history of severe febrile rash as a toddler and the presence of chronic coronary artery injury, recanalization, and thrombosis with ischemic heart disease leading to sudden cardiac collapse and death.
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Affiliation(s)
| | - Maria Eugenia Zuluaga Ruiz
- Universidad del Valle, Grupo de Investigación en Rehabilitación de la Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Desiree Ann Marshall
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
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Harrison M, Scalici P. Clinical guideline highlights for the hospitalist: Management of Kawasaki disease. J Hosp Med 2022; 17:829-831. [PMID: 35934950 DOI: 10.1002/jhm.12935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease RELEASE DATE: March 7, 2022 PRIOR VERSION (S): 2017 DEVELOPER: American College of Rheumatology and the Vasculitis Foundation FUNDING SOURCE: American College of Rheumatology and the Vasculitis Foundation TARGET POPULATION: Children with Kawasaki disease.
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Affiliation(s)
- Meghan Harrison
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Scalici
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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