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Yilmaz Ciftdogan D, Ekemen Keles Y, Karbuz A, Cetin BS, Elmas Bozdemir S, Kepenekli Kadayifci E, Metin Akcan O, Ozer A, Erat T, Sutcu M, Buyukcam A, Belet N, Erdeniz EH, Dalgic Karabulut N, Hancerli Torun S, Oncel S, Orbak Z, Turel O, Gayretli Aydin ZG, Kilic O, Yahsi A, Kara Aksay A, Ergenc Z, Petmezci MT, Oflaz MB, Sarikaya R, Otar Yener G, Ozen S, Gul D, Arslan G, Kara SS, Demirkol D, Yazici Ozkaya P, Yozgat Y, Varan C, Kara M, Arga G, Yakut N, Kilic AO, Cakici O, Kucuk M, Kaba O, Karaoglu Asrak H, Bursal Duramaz B, Dalkiran T, Berna Anil A, Turgut M, Karapinar B, Somer A, Elmali F, Dinleyici EC, Ciftci E, Kara A. Multisystem inflammatory syndrome in children associated with COVID-19 in 101 cases from Turkey (Turk-MISC study). J Paediatr Child Health 2022; 58:1069-1078. [PMID: 35199895 PMCID: PMC9115147 DOI: 10.1111/jpc.15913] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/19/2021] [Accepted: 02/06/2022] [Indexed: 12/11/2022]
Abstract
AIM Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey. METHODS The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis. RESULTS The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died. CONCLUSION The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.
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Affiliation(s)
- Dilek Yilmaz Ciftdogan
- Department of Pediatric Infectious Diseases, Faculty of MedicineIzmir Katip Celebi UniversityIzmirTurkey
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Yildiz Ekemen Keles
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Adem Karbuz
- Department of Pediatric Infectious DiseasesIstanbul Professor Doctor Cemil Tascioglu City HospitalIstanbulTurkey
| | - Benhur Sirvan Cetin
- Department of Pediatric Infectious Diseases, Faculty of MedicineErciyes UniversityKayseriTurkey
| | - Sefika Elmas Bozdemir
- Department of Pediatric Infectious DiseasesBursa Dortcelik Children's HospitalBursaTurkey
| | - Eda Kepenekli Kadayifci
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Ozge Metin Akcan
- Department of Pediatric Infectious Diseases, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Arife Ozer
- Division of Pediatric Infectious Diseases, Van Training and Research HospitalUniversity of Health SciencesVanTurkey
| | - Tugba Erat
- Division of Pediatric Infectious DiseasesSanliurfa Training and Research HospitalSanliurfaTurkey
| | - Murat Sutcu
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstinye University HospitalIstanbulTurkey
| | - Ayse Buyukcam
- Division of Pediatric Infectious DiseasesGaziantep CG Obstetrics and Children's HospitalGaziantepTurkey
| | - Nursen Belet
- Department of Pediatric Infectious Diseases, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Emine Hafize Erdeniz
- Department of Pediatric Infectious DiseasesOndokuz Mayis University HospitalSamsunTurkey
| | - Nazan Dalgic Karabulut
- Division of Pediatric Infectious DiseasesHealth Sciences University Sisli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Selim Oncel
- Department of Pediatric Infectious Diseases, Faculty of MedicineKocaeli University HospitalKocaeliTurkey
| | - Zerrin Orbak
- Department of Pediatrics, Faculty of Dentistry and MedicineAtatürk UniversityErzurumTurkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Zeynep Gokce Gayretli Aydin
- Department of Pediatric Infectious Diseases, Faculty of MedicineKaradeniz Teknik University HospitalTrabzonTurkey
| | - Omer Kilic
- Department of Pediatric Infectious Diseases, Faculty of MedicineOsmangazi University HospitalEskisehirTurkey
| | - Aysun Yahsi
- Division of Pediatric Infectious Diseases, Samsun Training and Research HospitalUniversity of Health SciencesSamsunTurkey
| | - Ahu Kara Aksay
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Zeynep Ergenc
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Mey Talip Petmezci
- Department of Intensive CareIstanbul Professor Doctor Cemil Tascioglu City HospitalIstanbulTurkey
| | - Mehmet Burhan Oflaz
- Department of Pediatric Cardiology, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Remzi Sarikaya
- Division of Cardiology, Van Training and Research HospitalUniversity of Health SciencesVanTurkey
| | - Gülcin Otar Yener
- Division of Pediatric RomatologySanliurfa Training and Research HospitalSanliurfaTurkey
| | - Seval Ozen
- Department of Pediatric Infectious Diseases, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Doruk Gul
- Department of Pediatrics, Faculty of MedicineIstinye University HospitalIstanbulTurkey
| | - Gazi Arslan
- Department of Pediatric Intensive Care, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Faculty of MedicineAydin Adnan Menderes UniversityAydinTurkey
| | - Demet Demirkol
- Department of Pediatric Intensive Care, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Pinar Yazici Ozkaya
- Department of Pediatric Intensive Care, Faculty of MedicineEge University HospitalIzmirTurkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Celal Varan
- Department of Pediatric Cardiology, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Manolya Kara
- Division of Pediatric Infectious DiseasesNecip Fazil City HospitalKahramanmarasTurkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of MedicineAnkara University HospitalAnkaraTurkey
| | - Nurhayat Yakut
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Ahmet Osman Kilic
- Department of Pediatrics, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Ozlem Cakici
- Department of Pediatric Infectious Diseases, Faculty of MedicineKocaeli University HospitalKocaeliTurkey
| | - Mehmet Kucuk
- Division of Pediatric Cardiolgy, Samsun Training and Research HospitalUniversity of Health SciencesSamsunTurkey
| | - Ozge Kaba
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Hatice Karaoglu Asrak
- Department of Pediatric Infectious Diseases, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Tahir Dalkiran
- Division of Pediatric Intensive CareNecip Fazil City HospitalKahramanmarasTurkey
| | - Ayse Berna Anil
- Department of Pediatric Intensive Care, Faculty of MedicineIzmir Katip Celebi UniversityIzmirTurkey
| | - Mehmet Turgut
- Department of Pediatric Infectious Diseases, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Bulent Karapinar
- Department of Pediatric Intensive Care, Faculty of MedicineEge University HospitalIzmirTurkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Ferhan Elmali
- Department of BiostatisticsIzmir Katip Celebi UniversityIzmirTurkey
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of MedicineEskisehir Osmangazi UniversityEskisehirTurkey
| | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of MedicineAnkara University HospitalAnkaraTurkey
| | - Ates Kara
- Department of Pediatric Infectious Diseases, Faculty of MedicineHacettepe University HospitalAnkaraTurkey
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Is Short-Term Exposure to PM 2.5 Relevant to Childhood Kawasaki Disease? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030924. [PMID: 33494415 PMCID: PMC7908497 DOI: 10.3390/ijerph18030924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
Background: Kawasaki disease (KD) is an acute febrile vascular disease of unknown cause that affects the whole body. KD typically occurs in infants under the age of five and is found mainly in East Asian countries. Few studies have reported on the relationship between the pollutant PM2.5 and KD, and the evidence remains irrelevant or insufficient. Objectives: We investigated the relationship between short-term exposure to PM2.5 and KD hospitalizations using data from Ewha Womans University Mokdong Hospital, 2006 to 2016. Methods: We obtained data from the hospital EMR (electronic medical records) system. We evaluated the relationship between short-term exposure to PM2.5 and KD hospitalizations using a case-crossover design. We considered exposures to PM2.5 two weeks before the date of KD hospitalization. We analyzed the data using a conditional logistic regression adjusted for temperature and humidity. The effect size was calculated as a 10 μg/m3 increase in PM2.5 concentration. We performed a subgroup analysis by sex, season, age group, and region. In the two-pollutants model, we adjusted SO2, NO2, CO, and O3, but the effect size did not change. Results: A total of 771 KD cases were included in this study. We did not find any statistically significant relationship between PM2.5 and children’s KD hospitalization (two-day moving average: odds ratio (OR) = 1.01, 95% confidence intervals (CI) = 0.95, 1.06; seven-day moving average: OR = 0.98, CI = 0.91, 1.06; 14-day moving average: OR = 0.93, CI = 0.82, 1.05). A subgroup analysis and two pollutant analysis also found no significant results. Conclusion: We did not find a statistically significant relationship between PM2.5 and children’s KD hospitalizations. More research is needed to clarify the association between air pollution, including PM2.5, and KD.
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Granzymes in cardiovascular injury and disease. Cell Signal 2020; 76:109804. [PMID: 33035645 DOI: 10.1016/j.cellsig.2020.109804] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
Chronic inflammation and impaired wound healing play important roles in the pathophysiology of cardiovascular diseases. Moreover, the aberrant secretion of proteases plays a critical role in pathological tissue remodeling in chronic inflammatory conditions. Human Granzymes (Granule secreted enzymes - Gzms) comprise a family of five (GzmA, B, H, K, M) cell-secreted serine proteases. Although each unique in function and substrate specificities, Gzms were originally thought to share redundant, intracellular roles in cytotoxic lymphocyte-induced cell death. However, an abundance of evidence has challenged this dogma. It is now recognized, that individual Gzms exhibit unique substrate repertoires and functions both intracellularly and extracellularly. In the extracellular milieu, Gzms contribute to inflammation, vascular dysfunction and permeability, reduced cell adhesion, release of matrix-sequestered growth factors, receptor activation, and extracellular matrix cleavage. Despite these recent findings, the non-cytotoxic functions of Gzms in the context of cardiovascular disease pathogenesis remain poorly understood. Minimally detected in tissues and bodily fluids of normal individuals, GzmB is elevated in patients with acute coronary syndromes, coronary artery disease, and myocardial infarction. Pre-clinical animal models have exemplified the importance of GzmB in atherosclerosis, aortic aneurysm, and cardiac fibrosis as animals deficient in GzmB exhibit reduced tissue remodeling, improved disease phenotypes and increased survival. Although a role for GzmB in cardiovascular disease is described, further work to elucidate the mechanisms that underpin the remaining human Gzms activity in cardiovascular disease is necessary. The present review provides a summary of the pre-clinical and clinical evidence, as well as emerging areas of research pertaining to Gzms in tissue remodeling and cardiovascular disease.
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Biesalski HK. Vitamin D deficiency and co-morbidities in COVID-19 patients – A fatal relationship? NFS JOURNAL 2020. [PMCID: PMC7276229 DOI: 10.1016/j.nfs.2020.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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van Stijn D, Slegers A, Zaaijer H, Kuijpers T. Lower CMV and EBV Exposure in Children With Kawasaki Disease Suggests an Under-Challenged Immune System. Front Pediatr 2020; 8:627957. [PMID: 33585370 PMCID: PMC7873854 DOI: 10.3389/fped.2020.627957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Kawasaki Disease (KD) is a pediatric vasculitis of which the pathogenesis is unclear. The hypothesis is that genetically pre-disposed children develop KD when they encounter a pathogen which remains most often unidentified or pathogen derived factors. Since age is a dominant factor, prior immune status in children could influence their reactivity and hence the acquisition of KD. We hypothesized that systemic immune responses early in life could protect against developing KD. With this study we tested whether the incidence of previous systemic cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infection is lower in children with KD compared to healthy age-matched controls. Methods and Results: We compared 86 KD patients with an age-matched control group regarding CMV and EBV VCA IgG measurements (taken before or 9 months after IVIG treatment). We found that both CMV and EBV had an almost 2-fold lower seroprevalence in the KD population than in the control group. Conclusions: We suggest that an under-challenged immune system causes an altered immune reactivity which may affect the response to a pathological trigger causing KD in susceptible children.
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Affiliation(s)
- Diana van Stijn
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Annemarie Slegers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Hans Zaaijer
- Laboratory of Clinical Virology, Department of Medical Microbiology, Center for Infection and Immunity Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Taco Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Sanchez AA, Sexson Tejtel SK, Almeida-Jones ME, Feagin DK, Altman CA, Pignatelli RH. Comprehensive left ventricular myocardial deformation assessment in children with Kawasaki disease. CONGENIT HEART DIS 2019; 14:1024-1031. [PMID: 31099489 DOI: 10.1111/chd.12787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/09/2019] [Accepted: 05/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Children with Kawasaki disease (KD) with persistent coronary artery aneurysms (CAAs) can develop chronic vasculopathy and subsequent myocardial ischemia. Early detection of this process is challenging. Myocardial deformation analysis can detect early alterations in myocardial performance. We aim to determine whether there are differences in myocardial deformation between KD patients with and without CAAs. DESIGN This is a cross-sectional study of 123 echocardiograms performed on 103 children with KD. Myocardial deformation was measured with two-dimensional speckle tracking (2DSTE). The echocardiograms were divided into groups according to the KD phase in which they were performed: acute, subacute, and convalescent/chronic. The convalescent/chronic phase group was then divided based on the presence or absence of CAAs. Left ventricular (LV) global longitudinal strain (GLS), global longitudinal strain rate (GLSSR), global circumferential strain (GCS), global circumferential systolic strain rate (GCSSR), peak torsion, and torsion rate were measured. RESULTS The numbers of echocardiograms analyzed in each of the KD phase groups were: 31 acute, 25 subacute, and 67 convalescent/chronic. Myocardial deformation was within normal limits in all groups. However, GLSSR, GCSSR, peak torsion, and torsion rate were lower in the convalescent/chronic phase group than in the acute phase group (mean, -1.37 ± 0.24 vs -1.55 ± 0.21 1/s; -1.63 ± 0.27 vs -1.84 ± 0.35 1/s; 2.49 ± 1.13 vs 3.41 ± 2.60 °/cm, and 21.97 ± 8.36 vs 26.69 ± 10.86 °/cm/s; P < .05 for all). The convalescent/chronic phase subgroup with CAAs had lower GLSSR and GCSSR than the subgroup without CAAs (mean, -1.23 ± 0.22 vs -1.42 ± 0.22 1/s; -1.46 ± 0.25 vs -1.68 ± 0.26 1/s, P < .05 for both). CONCLUSIONS Children in the convalescent/chronic phase of KD have a subtle decrease in strain rate when compared to the acute phase, although within the normal range. This decrease is more pronounced in children with CAAs than those without CAAs. Longitudinal studies are needed to discern whether low-normal strain rate predicts decreased myocardial function in the long term.
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Affiliation(s)
- Aura A Sanchez
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.,Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Sara K Sexson Tejtel
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Myriam E Almeida-Jones
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.,Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Douglas K Feagin
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carolyn A Altman
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ricardo H Pignatelli
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Gharebaghi N, Aghdashi M, Mokhtari SAS. Postsplenectomy Kawasaki disease in a 17-year-old male. Int Med Case Rep J 2018; 11:287-292. [PMID: 30464648 PMCID: PMC6214339 DOI: 10.2147/imcrj.s173605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Kawasaki disease (KD) is characterized with an acute systemic vasculitis of the medium- and small-sized vessels. This disease mainly involves children within the age of 6 months to 5 years and it is often self-limited and patients seem to recover well; however, it may lead to devastating and fatal cardiovascular complications such as coronary artery aneurysm. Thus, early diagnosis and appropriate management of this disease have a significant effect on improving the prognosis and preventing its serious complications. Adult-onset KD (AKD) is rare and often misdiagnosed. Here we report a rare case of KD that occurred in a 17-year-old young adult who presented 4 weeks post splenectomy, with clinical signs and symptoms consistent with AKD. This may potentially highlight the association of AKD with infectious etiologies.
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Affiliation(s)
- Naser Gharebaghi
- Department of Infectious Disease, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran
| | - Miramir Aghdashi
- Department of Rheumatology and Internal Medicine, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran,
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Kim HJ, Yun SW, Yu JJ, Yoon KL, Lee KY, Kil HR, Kim GB, Han MK, Song MS, Lee HD, Ha KS, Sohn S, Ebata R, Hamada H, Suzuki H, Kamatani Y, Kubo M, Ito K, Onouchi Y, Hong YM, Jang GY, Lee JK. Identification of LEF1 as a Susceptibility Locus for Kawasaki Disease in Patients Younger than 6 Months of Age. Genomics Inform 2018; 16:36-41. [PMID: 30304924 PMCID: PMC6187808 DOI: 10.5808/gi.2018.16.2.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/11/2018] [Indexed: 01/25/2023] Open
Abstract
Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (LEF1) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; pcombined = 1.10 × 10-5), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the LEF1 gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the LEF1 gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.
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Affiliation(s)
- Hea-Ji Kim
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Jeong Jin Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Kyung Lim Yoon
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Kyung-Yil Lee
- Department of Pediatrics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Korea
| | - Hong-Ryang Kil
- Department of Pediatrics, Chungnam National University Hospital, Daejeon 35015, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Myung-Ki Han
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan 47392, Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Pusan National University Hospital, Busan 49241, Korea
| | - Kee Soo Ha
- Department of Pediatrics, Korea University Ansan Hospital, Ansan 15355, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University Hospital, Seoul 07985, Korea
| | - Ryota Ebata
- Department of Pediatrics, Chiba-University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Tokyo Women's Medical University Yachivo Medical Center, Yachivo 276-8524, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Kaoru Ito
- Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Yoshihiro Onouchi
- Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University Hospital, Seoul 07985, Korea
| | - Gi Young Jang
- Department of Pediatrics, Korea University Ansan Hospital, Ansan 15355, Korea
| | - Jong-Keuk Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea
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Satoh K, Wakejima Y, Gau M, Kiguchi T, Matsuda N, Takasawa R, Takasawa K, Nishioka M, Shimohira M. Risk of coronary artery lesions in young infants with Kawasaki disease: need for a new diagnostic method. Int J Rheum Dis 2017; 21:746-754. [DOI: 10.1111/1756-185x.13223] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Kaoru Satoh
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Yoko Wakejima
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Maki Gau
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Tomoyuki Kiguchi
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Nozomi Matsuda
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Reiko Takasawa
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Kei Takasawa
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
- Department of Pediatrics and Developmental Biology; Tokyo Medical and Dental University; Tokyo Japan
| | - Masato Nishioka
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Masayuki Shimohira
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
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Kim M, Kim SY. Anterior Uveitis Associated with Kawasaki Disease-and the Ophthalmologist's Role. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.2.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Ophthalmology, The Catholic University of Korea Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
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Jaundice as an Unusual Presentation of Kawasaki Disease: A Case Report. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2015. [DOI: 10.5812/pedinfect.27594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yin S, Liubao P, Chongqing T, Xiaomin W. The first case of Kawasaki disease in a 20-month old baby following immunization with rotavirus vaccine and hepatitis A vaccine in China: A case report. Hum Vaccin Immunother 2015; 11:2740-3. [PMID: 26158590 DOI: 10.1080/21645515.2015.1050571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Kawasaki disease (KD) after rotavirus and hepatitis A vaccination has not previously been reported in a baby in China. Herein, we describe a 20-month-old child who developed Kawasaki disease after receiving her second dose of Lanzhou lamb rotavirus vaccine (LLR) and her first dose of freeze-dried live attenuated hepatitis A vaccine. The case report was conducted by collecting and analyzing the hospital in-patient medical records and reviewing both the domestic and foreign pertinent literature. These findings will be important to note this possible side effect and to further investigate the association between the above 2 vaccines and Kawasaki disease.
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Affiliation(s)
- Shi Yin
- a Department of Pharmacy ; The Second Xiangya Hospital of Central South University ; Changsha , PR China.,b School of Pharmaceutical Sciences; Central South University ; Changsha , PR China
| | - Peng Liubao
- a Department of Pharmacy ; The Second Xiangya Hospital of Central South University ; Changsha , PR China
| | - Tan Chongqing
- a Department of Pharmacy ; The Second Xiangya Hospital of Central South University ; Changsha , PR China
| | - Wan Xiaomin
- a Department of Pharmacy ; The Second Xiangya Hospital of Central South University ; Changsha , PR China
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Lee SB, Choi HS, Son S, Hong YM. Cardiac Function in Kawasaki Disease Patients with Respiratory Symptoms. Korean Circ J 2015; 45:317-24. [PMID: 26240586 PMCID: PMC4521110 DOI: 10.4070/kcj.2015.45.4.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/03/2015] [Accepted: 04/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives Respiratory symptoms are often observed in children with Kawasaki disease (KD) during the acute phase. The association of respiratory viruses in children with KD was investigated using multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) and tissue Doppler echocardiography. Subjects and Methods 138 KD patients were included from January 2010 to June 2013. We compared 3 groups (group 1: n=94, KD without respiratory symptoms; group 2: n=44, KD with respiratory symptoms; and group 3: n=50, febrile patients with respiratory symptoms). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide (NT-proBNP). Echocardiographic measurements were compared between group 1 and group 2. RT-PCR was performed using nasopharyngeal secretion to screen for the presence of 14 viruses in groups 2 and 3. Results The incidence of KD with respiratory symptoms was 31.8%. The duration of fever was significantly longer, and coronary artery diameter was larger in group 2 than in group 1. Tei index was significantly higher and coronary artery diameter larger in group 2 than group 1. Coronary artery diameter, C-reactive protein levels, platelet count, alanine aminotransferase levels, and NT-pro BNP levels were significantly higher and albumin levels lower in group 2 compared with group 3. Conclusion NT-pro BNP was a valuable diagnostic tool in differentiating KD from other febrile viral respiratory infections. Some viruses were more frequently observed in KD patients than in febrile controls. Tei index using tissue Doppler imaging was increased in KD patients with respiratory symptoms.
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Affiliation(s)
- Seul Bee Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Han Seul Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Son
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Bae HK, Lee DK, Kwon JH, Kim HS, Sohn S, Hong YM. Clinical characteristics and serum N-terminal pro-brain natriuretic peptide as a diagnostic marker of Kawasaki disease in infants younger than 3 months of age. KOREAN JOURNAL OF PEDIATRICS 2014; 57:357-62. [PMID: 25210523 PMCID: PMC4155180 DOI: 10.3345/kjp.2014.57.8.357] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/10/2014] [Accepted: 03/05/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The incidence of Kawasaki disease (KD) is rare in young infants (less than 3 months of age), who present with only a few symptoms that fulfill the clinical diagnostic criteria. The diagnosis for KD can therefore be delayed, leading to a high risk of cardiac complications. We examined the clinical characteristics and measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of these patients for assessing its value in the early detection of KD. METHODS We retrospectively reviewed the data of young infants diagnosed with KD from 2004 to 2012. The control group included 20 hospitalized febrile patients. Laboratory data, including NT-proBNP were obtained for each patient in both groups. RESULTS Incomplete KD was observed in 21/24 patients (87.5%). The mean fever duration on admission was 1.36±1.0 days in the KD group. Common symptoms included erythema at the site of Bacille Calmette-Guerin inoculation (70.8%), skin rash (50.0%), changes of oropharyngeal mucosa (29.1%), and cervical lymphadenopathy (20.8%). The mean number of major diagnostic criteria fulfilled was 2.8±1.4. Five KD patients (20.8%) had only one symptom matching these criteria. The incidence of coronary artery complications was 12.5%. The mean serum NT-proBNP level in the acute phase, in the KD and control groups, were 4,159±3,714 pg/mL and 957±902 pg/mL, respectively, which decreased significantly in the convalescent phase. CONCLUSION Incomplete KD was observed in 87.5% patients. Serum NT-proBNP might be a valuable biomarker for the early detection of KD in febrile infants aged <3 months.
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Affiliation(s)
- Hyun Kyung Bae
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Do Kyung Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea. ; Ewha Womans University Global Top 5 Research Program, Seoul, Korea
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Yeom JS, Woo HO, Park JS, Park ES, Seo JH, Youn HS. Kawasaki disease in infants. KOREAN JOURNAL OF PEDIATRICS 2013; 56:377-82. [PMID: 24223598 PMCID: PMC3819680 DOI: 10.3345/kjp.2013.56.9.377] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/12/2013] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is an acute febrile illness that is the predominant cause of pediatric acquired heart disease in infants and young children. Because the diagnosis of KD depends on clinical manifestations, incomplete cases are difficult to diagnose, especially in infants younger than 1 year. Incomplete clinical manifestations in infants are related with the development of KD-associated coronary artery abnormalities. Because the diagnosis of infantile KD is difficult and complications are numerous, early suspicion and evaluation are necessary.
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Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyang Ok Woo
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji Sook Park
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eun Sil Park
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Lou J, Xu S, Zou L, Zhong R, Zhang T, Sun Y, Lu X, Liu L, Li C, Wang L, Xiong G, Wang W, Gong F, Wu J. A functional polymorphism, rs28493229, in ITPKC and risk of Kawasaki disease: an integrated meta-analysis. Mol Biol Rep 2012; 39:11137-44. [PMID: 23065250 DOI: 10.1007/s11033-012-2022-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 10/01/2012] [Indexed: 01/07/2023]
Abstract
Kawasaki disease (KD) is a multi-systemic vasculitis which preferentially affects infants and children. A single nucleotide polymorphism (rs28493229) in the inositol 1,4,5-trisphosphate 3-kinase C (ITPKC) was identified to be associated with the increased risk of KD; however, in more recent studies associations have been controversial. Thus, we performed a meta-analysis, integrating case-control and transmission/disequilibrium test (TDT) studies, to investigate the relationship between this polymorphism and risk of KD. A total of ten case-control and two TDT studies, comprising 3,821 cases, 12,802 controls and 949 families, were included in this meta-analysis. There was a significant association between the C allele of rs28493229 and the increased risk of KD (OR = 1.53, 95 % CI = 1.34-1.74, P < 0.001), by the random-effects model because of heterogeneity (Q = 27.67, P (heterogeneity) = 0.004). Nevertheless, it was screened out by meta-regression analysis that the coronary artery lesions (CALs) status of KD could partly explain the heterogeneity, with consistently significant associations in both subgroups after stratification by CALs status. Moreover, estimates before and after the deletion of each study were similar in sensitivity analysis, indicating robust stability of the meta-analysis. This meta-analysis reveals that the functional polymorphism rs28493229 in ITPKC significantly contributes to the risk of KD.
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Affiliation(s)
- Jiao Lou
- Department of Epidemiology and Biostatistics and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Mandal S, Pande A, Mandal D, Sarkar A, Kahali D, Panja M. Various coronary artery complications of Kawasaki disease: Series of 5 cases and review of literature. J Cardiovasc Dis Res 2012; 3:231-5. [PMID: 22923943 PMCID: PMC3425032 DOI: 10.4103/0975-3583.98900] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Kawasaki disease is a generalized systemic vasculitis of unknown etiology involving medium and small size blood vessels throughout the body, virtually always involving the coronaries. In many part of this world, it is more common than rheumatic fever and viral myocarditis. Here, we are reporting 5 cases with history suggestive of Kawasaki disease in the early life, presenting with different coronary artery abnormalities. One of the patients had left main coronary artery cut-off, and the remaining 4 had some form of coronary artery aneurysms. 3 patients were given medical management, 1 patient had coronary bypass grafting, and the remaining 1 was planned for surgical correction. All the patients were stable on subsequent follow-ups.
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Affiliation(s)
- Saroj Mandal
- Department of Cardiology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Arindam Pande
- Department of Cardiology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Debosmita Mandal
- Department of Gynecology and Obstetrics, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Achyut Sarkar
- Department of Cardiology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
- BM Birla Heart Research Institute, Kolkata, West Bengal, India
| | - Dhiman Kahali
- BM Birla Heart Research Institute, Kolkata, West Bengal, India
| | - Manotosh Panja
- BM Birla Heart Research Institute, Kolkata, West Bengal, India
- Institute of Cardiovascular Science, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Lee EJ, Park YW, Hong YM, Lee JS, Han JW. Epidemiology of Kawasaki disease in infants 3 months of age and younger. KOREAN JOURNAL OF PEDIATRICS 2012; 55:202-5. [PMID: 22745644 PMCID: PMC3382700 DOI: 10.3345/kjp.2012.55.6.202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/15/2011] [Accepted: 12/27/2011] [Indexed: 11/27/2022]
Abstract
Purpose This study investigated the epidemiology of Kawasaki disease (KD) in infants ≤3-month-old. Methods To study the epidemiology of KD in Korea, data for 27,851 KD patients were collected on a 3-year basis between 2000 and 2008 in a retrospective survey. From this, data for 609 KD patients ≤3-month-old were analyzed and compared with the data for KD patients >3-month-old. Results The 609 KD patients ≤3-month-old (385 males and 224 females) constituted 2.2% of the KD patients. They included 25 infants <1-month-old, 198 infants ≤1- to 2-month-old, and 386 infants >2- and 3-months-old. The ratio of males to females was 1.72:1. The incidence of coronary artery (CA) dilatation (19.9% vs. 18.7%) and CA aneurysms (3.4% vs. 2.6%) detected by echocardiography did not differ significantly between patients with KD younger and older than 3-month-old. Conclusion Compared with the data for the KD patients >3-month-old, the data for the 609 patients ≤3-month-old did not show a significantly higher incidence of CA dilatation or CA aneurysms.
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Affiliation(s)
- Eun Jung Lee
- Department of Pediatrics, The Catholic University of Korea School of Medicine, Seoul, Korea
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Gupta A, Singh S. Kawasaki disease—A preventable cause of cardiac morbidity. INDIAN JOURNAL OF RHEUMATOLOGY 2012. [DOI: 10.1016/s0973-3698(12)60033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Gerding R. Kawasaki disease: a review. J Pediatr Health Care 2011; 25:379-87. [PMID: 22018429 DOI: 10.1016/j.pedhc.2011.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 07/13/2011] [Accepted: 07/17/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Robin Gerding
- PGY2 Pharmacy Resident Internal Medicine, Grady Health System, Atlanta, GA, USA.
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Yoon KL, Ko JH, Shim KS, Han MY, Cha SH, Kim SK, Jung JH. Polymorphisms of methylenetetrahydrofolate reductase are not a risk factor for Kawasaki disease in the Korean population. KOREAN JOURNAL OF PEDIATRICS 2011; 54:335-9. [PMID: 22087200 PMCID: PMC3212703 DOI: 10.3345/kjp.2011.54.8.335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 05/22/2011] [Accepted: 07/21/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Hyperhomocysteinemia is known as a risk factor for atherosclerosis. Preclinical arteriosclerosis is noted and premature atherosclerosis is known to be accelerated in Kawasaki disease (KD) patients. Genetic polymorphisms in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene result in elevated plasma homocysteine concentrations and are known to be associated with the development of coronary artery disease. Our hypothesis is that single nucleotide polymorphisms (SNPs) of the MTHFR gene are related to the development of KD and coronary artery lesions (CALs). METHODS For this study, we selected 3 candidate single nucleotide polymorphisms (SNPs) (rs2274976, rs1801131, and rs1801133) of MTHFR. These SNPs are located on chromosome 1p36.3. We included 101 KD patients and 306 healthy adults as controls in this study. CALs were seen in 38 patients. Genotypes of the selected SNPs were determined by direct sequencing and analyzed with SNPAlyze. RESULTS The genetic distribution and allelic frequency of the 3 MTHFR SNPs (rs2274976, rs1801131, and rs1801133) were not significantly different in patients with KD compared to the control group (P=0.71, 0.17, and 0.96, respectively). There was no difference in the genetic distribution of the MTHFR SNPs between the normal control group and the CAL group (P=0.43, 0.39, 0.52 respectively). CONCLUSION The genetic distribution of the MTHFR SNPs (rs2274976, rs1801131, and rs1801133) was not different in the KD group compared to the control group. In addition, the genetic distribution of these SNPs was not different in the CAL group compared to the control group in the Korean population.
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Affiliation(s)
- Kyung Lim Yoon
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Hee Ko
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kye Shik Shim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Mi Young Han
- Department of Pediatrics, Kyung-Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Ho Cha
- Department of Pediatrics, Kyung-Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Su Kang Kim
- Department of Clinical Pharmacology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joo Ho Jung
- Department of Clinical Pharmacology, Kyung Hee University School of Medicine, Seoul, Korea
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Cho MA, Choi YJ, Jung JW. Affects of "age at diagnosis" on coronary artery lesions in patients with incomplete kawasaki disease. Korean Circ J 2010; 40:283-7. [PMID: 20589201 PMCID: PMC2893369 DOI: 10.4070/kcj.2010.40.6.283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 10/26/2009] [Accepted: 10/29/2009] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Diagnosis of Kawasaki disease (KD) is based on 5 clinical features. Incomplete KD (IKD), which has fewer features, is more common in infants and older children, in whom the rate of coronary artery aneurysms is paradoxically higher. We conducted this study to evaluate risk factors associated with age-at-diagnosis on coronary arterial lesions (CAL) in patients with IKD. Subjects and Methods Retrospective data from 396 patients with KD in a single center were collected from January 2003 to July 2007. Patients were grouped according to their age at diagnosis; Group A (<1 year of age), Group B (1≤age<5 years of age), and Group C (≥5 years of age). Results Among a total of 396 patients with KD, 87 (22.0%) were in Group A, 246 (62.1%) in Group B, and 63 (15.9%) in Group C. In groups A and C, lag times for starting intravenous immunoglobulin (IVIG) were longer than in Group B. There were no differences in the incidence of IKD, late CAL, or rates of IVIG retreatment among the three groups. Among 174 patients with IKD, there were no age-related differences in late CAL incidence or IVIG retreatment. Compared with typical KD, duration of fever and lag times to start IVIG were longer, and the rate of IVIG retreatment was higher in IKD, but there was no difference in the risk of CAL between typical KD and IKD. Conclusion In the management of KD, especially the incomplete type, age-associated factors appear not to be significant for predicting the development of CAL.
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Affiliation(s)
- Min A Cho
- Division of Pediatric Cardiology, Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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Chi H, Huang FY, Chen MR, Chiu NC, Lee HC, Lin SP, Chen WF, Lin CL, Chan HW, Liu HF, Huang LM, Lee YJ. ITPKC gene SNP rs28493229 and Kawasaki disease in Taiwanese children. Hum Mol Genet 2010; 19:1147-51. [DOI: 10.1093/hmg/ddp586] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee DW, Kim YH, Hyun MC, Kwon TC, Lee SB. NT-proBNP as a useful tool in diagnosing incomplete Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.4.519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dong Won Lee
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yeo Hyang Kim
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae Chan Kwon
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Bum Lee
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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Kawasaki disease after vaccination: reports to the vaccine adverse event reporting system 1990-2007. Pediatr Infect Dis J 2009; 28:943-7. [PMID: 19755926 DOI: 10.1097/inf.0b013e3181a66471] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is a multisystemic vasculitis primarily affecting children<5 years. A review of RotaTeq (rotavirus vaccine live) clinical trial data revealed higher, though not statistically significantly, KD rates among RotaTeq vaccines than placebo recipients. In June 2007, the RotaTeq label was revised accordingly. OBJECTIVES To describe and assess KD reported to Vaccine Adverse Event Reporting System (VAERS) for all US licensed vaccines. METHODS We reviewed all KD reports received by VAERS from 1990 through mid-October 2007. Cases were characterized by age, gender, onset interval, and vaccine type. Proportional reporting ratio (PRR) was used to evaluate KD reporting for each vaccine compared with all others. Reporting rates were calculated using number of doses distributed as denominator. RESULTS Through October 14, 2007, 107 KD reports were received by VAERS: 26 were categorized as classic cases, 19 atypical, 52 possible, and 10 were noncases. Of the 97 cases, 91% were children<5 years. There was no clustering of onset intervals after day 1 postvaccination. Before the RotaTeq label revision, the KD PRR was elevated only for Pediarix (DTaP, hepB, and IPV combined) but the KD reporting rate for Pediarix (0.59/100,000 person-years) was much lower than the background incidence rate (9-19/100,000 person-years) for children<5 years in the United States. After the revision, reporting of KD for RotaTeq was stimulated but the reporting rate for RotaTeq (1.47/100,000 person-years) was still much lower than the background rate. CONCLUSIONS Our review does not suggest an elevated KD risk for RotaTeq or other vaccines. Continued postmarketing monitoring for KD is ongoing.
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Cunha BA, Pherez FM, Alexiadis V, Gagos M, Strollo S. Adult Kawasaki's disease with myocarditis, splenomegaly, and highly elevated serum ferritin levels. Heart Lung 2009; 39:164-72. [PMID: 20207278 PMCID: PMC7132363 DOI: 10.1016/j.hrtlng.2009.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 06/06/2009] [Indexed: 11/29/2022]
Abstract
Kawasaki's disease is a disease of unknown cause. The characteristic clinical features of Kawasaki's disease are fever ≥ 102°F for ≥ 5 days accompanied by a bilateral bulbar conjunctivitis/conjunctival suffusion, erythematous rash, cervical adenopathy, pharyngeal erythema, and swelling of the dorsum of the hands/feet. Kawasaki's disease primarily affects children and is rare in adults. In children, Kawasaki's disease is more likely to be associated with aseptic meningitis, coronary artery aneurysms, and thrombocytosis. In adult Kawasaki's disease, unilateral cervical adenopathy, arthritis, conjunctival suffusion/conjunctivitis, and elevated serum transaminases (serum glutamic oxaloacetic transaminase [SGOT]/serum glutamate pyruvate transaminase [SGPT]) are more likely. Kawasaki's disease in adults may be mimicked by other acute infections with fever and rash, that is, group A streptococcal scarlet fever, toxic shock syndrome (TSS), and Rocky Mountain Spotted Fever (RMSF). Because there are no specific tests for Kawasaki's disease, diagnosis is based on clinical criteria and the syndromic approach. In addition to rash and fever, scarlet fever is characterized by circumoral pallor, oropharyngeal edema, Pastia's lines, and peripheral eosinophilia, but not conjunctival suffusion, splenomegaly, swelling of the dorsum of the hands/feet, thrombocytosis, or an elevated SGOT/SGPT. In TSS, in addition to rash and fever, there is conjunctival suffusion, oropharyngeal erythema, and edema of the dorsum of the hands/feet, an elevated SGOT/SGPT, and thrombocytopenia. Patients with TSS do not have cervical adenopathy or splenomegaly. RMSF presents with fever and a maculopapular rash that becomes petechial, first appearing on the wrists/ankles after 3 to 5 days. RMSF is accompanied by a prominent headache, periorbital edema, conjunctival suffusion, splenomegaly, thrombocytopenia, an elevated SGOT/SGPT, swelling of the dorsum of the hands/feet, but not oropharyngeal erythema. We present a case of adult Kawasaki's disease with myocarditis and splenomegaly. The patient's myocarditis rapidly resolved, and he did not develop coronary artery aneurysms. In addition to splenomegaly, this case of adult Kawasaki's disease is remarkable because the patient had highly elevated serum ferritin levels of 944-1303 ng/mL; (normal < 189 ng/mL). To the best of our knowledge, this is the first report of adult Kawasaki's disease with highly elevated serum ferritin levels. This is also the first report of splenomegaly in adult Kawasaki's disease. We conclude that Kawasaki's disease should be considered in the differential diagnosis in adult patients with rash/fever for ≥ 5 days with conjunctival suffusion, cervical adenopathy, swelling of the dorsum of the hands/feet, thrombocytosis and otherwise unexplained highly elevated ferritin levels.
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Affiliation(s)
- Burke A Cunha
- Divisions of Infectious Disease, General Internal Medicine, and Cardiology, Winthrop-University Hospital, Mineola, New York 11501, USA
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Kim SH, Yun JW, Lee YH, Cheon EJ. Polymorphisms of tumor necrosis factor-alpha promotor gene in Kawasaki disease and relation to the risk of coronary artery lesion. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.4.476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Se-hwa Kim
- Department of Pediatrics, College of Medicine, Konyang University, Daejeon, Korea
| | - Jang-won Yun
- Department of Pediatrics, College of Medicine, Konyang University, Daejeon, Korea
| | - Young-hyuk Lee
- Department of Pediatrics, College of Medicine, Konyang University, Daejeon, Korea
| | - Eun-jung Cheon
- Department of Pediatrics, College of Medicine, Konyang University, Daejeon, Korea
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Cheung YF, Huang GY, Chen SB, Liu XQ, Xi L, Liang XC, Huang MR, Chen S, Huang LS, Liu XQ, Chan KW, Lau YL. Inflammatory gene polymorphisms and susceptibility to kawasaki disease and its arterial sequelae. Pediatrics 2008; 122:e608-14. [PMID: 18710885 DOI: 10.1542/peds.2008-0646] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that single-nucleotide polymorphisms of inflammatory genes C-reactive protein (CRP) and tumor necrosis factor alpha (TNF-alpha) may exert influence on susceptibility to Kawasaki disease and its arterial sequelae. METHODS We analyzed the CRP +1444 C-->T and TNF-alpha -308 G-->A polymorphisms in 167 patients aged 8.9 +/- 4.1 years with a history of Kawasaki disease (73 with and 94 without coronary aneurysms) and 124 healthy control subjects. For patients with Kawasaki disease, we further determined whether these single-nucleotide polymorphisms were associated with coronary aneurysms, carotid arterial stiffening, and intima-media thickness. RESULTS Genotypic and allelic frequencies of CRP +1444 for T carrier and TNF-alpha -308 for A carrier were significantly higher in patients than in control subjects. The genotypic and allelic distributions did not differ between patients with and those without coronary aneurysms; however, patients with CRP +1444 CT/TT genotype compared with those with a CC genotype and patients with TNF-alpha -308 GA/AA genotype compared with those with a GG genotype had significantly greater carotid arterial stiffness and intima-media thickness. Carriers of both CRP +1444 T allele and TNF-alpha -308 A allele had the highest susceptibility to Kawasaki disease and a significant trend of increased arterial stiffness and intima-media thickness compared with those who carried either 1 or none of the rare alleles. Multiple linear regression analysis identified CRP +1444 allele carrier as a significant determinant of both carotid stiffness and carotid intima-media thickness and TNF-alpha -308 A allele carrier as a determinant of only intima-media thickness. CONCLUSIONS Our findings suggest that CRP +1444 C-->T and TNF-alpha -308 G-->A polymorphisms are associated with predisposition to Kawasaki disease and, in patients with Kawasaki disease, increased carotid arterial stiffness and intima-media thickness in the long-term.
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Affiliation(s)
- Yiu-Fai Cheung
- Grantham Hospital, University of Hong Kong, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, 125 Wong Chuk Hang Rd, Hong Kong, China.
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Crowell CS, Melin-Aldana H, Tan TQ. Fever, rash, and hepatic dysfunction in a 3-year-old child: a case report. Clin Pediatr (Phila) 2008; 47:517-20. [PMID: 18509155 DOI: 10.1177/0009922807312084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claudia S Crowell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614, USA.
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Gurtu R, Uemura H, Tsuda E, Dubrey SW. Giant coronary artery aneurysms and myocardial infarction: aetiology and management. Br J Hosp Med (Lond) 2008; 68:618-9. [PMID: 18087857 DOI: 10.12968/hmed.2007.68.11.27687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rokesh Gurtu
- Department of Cardiology, Hillingdon Hospital, Uxbridge
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Hsueh KC, Lin YJ, Chang JS, Wan L, Tsai YH, Tsai CH, Chen CP, Tsai FJ. Association of vascular endothelial growth factor C-634 g polymorphism in taiwanese children with Kawasaki disease. Pediatr Cardiol 2008; 29:292-6. [PMID: 17874221 DOI: 10.1007/s00246-007-9049-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 07/28/2007] [Accepted: 08/09/2007] [Indexed: 10/22/2022]
Abstract
High expression of circulating vascular endothelial growth factor (VEGF) has been reported in patients with Kawasaki disease (KD). In the pathophysiology of KD, VEGF is considered to be involved, especially in the development of coronary artery lesions. This study aimed to examine whether the VEGF-634 promoter polymorphism is a marker of KD susceptibility or severity in Chinese patients in Taiwan. The study included 93 KD patients and 96 normal control subjects. Genotype and allelic frequencies for the VEGF gene polymorphism in the two groups were compared. The number of individuals with the VEGF-634 G/G genotype was significantly greater among the patients with KD than among the healthy control subjects (p = 0.011). The odds ratio for the development of KD in individuals with the VEGF-634 G/G genotype was found to be 2.03 (95% confidence interval [CI], 1.14-3.63) compared with the VEGF-634 G/C and VEGF-634 C/C genotypes. No significant difference was observed in the genotype or allelic frequencies of VEGF C-634 G polymorphism between the patients with and those without coronary artery lesions. In conclusion, the results suggest that VEGF-634 G/G genotype may be involved in the development of KD in Taiwanese children.
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Affiliation(s)
- K-C Hsueh
- Department of Pediatrics, China Medical University Hospital, No. 2 Yuh Der Road, Taichung, Taiwan
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Marquez J, Gedalia O, Candia L, Ranjit K, Hescock GC, Espinoza LR, Stopa AR, Gedalia A. Kawasaki Disease: Clinical Spectrum of 88 Patients in a High-Prevalence African- American Population. J Natl Med Assoc 2008; 100:28-32. [DOI: 10.1016/s0027-9684(15)31171-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Park YW, Han JW, Park IS, Kim CH, Cha SH, Ma JS, Lee JS, Kwon TC, Lee SB, Kim CH, Lee HJ, Yun YS. Kawasaki disease in Korea, 2003-2005. Pediatr Infect Dis J 2007; 26:821-3. [PMID: 17721378 DOI: 10.1097/inf.0b013e318124aa1a] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to investigate the incidence rate and epidemiologic patterns of Kawasaki disease in Korea for the 3-year-period, 2003-2005. METHODS The questionnaire for an epidemiologic survey on Kawasaki disease was distributed to all 102 Korean hospitals that conduct pediatric residency programs, and obtained data were analyzed upon receipt. RESULTS The 9662 patients of Kawasaki disease from 85 hospitals that responded (response rate, 83.3%) consisted of 5877 males and 3785 females (male:female ratio, 1.55:1). The incidence rate per 100,000 children <5-year-old was 104.2 in 2003, 106.4 in 2004, and 104.6 in 2005 (average rate, 105.0). Their mean age of onset was 33.3 months, and the proportions of sibling cases and recurrent cases were 0.29% and 2.0%, respectively. Coronary arterial abnormalities were detected at follow-up by echocardiogram in 18.8% of all such cases including dilatations of 18.0% and aneurysms of 2.5%. CONCLUSION The average annual rate of incidence, 105.0/100,000 in children <5-year-old is the second highest reported rate in the world.
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Affiliation(s)
- Yong-Won Park
- Department of Pediatrics, Inje University, Seoul, Republic of Korea.
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Abstract
We describe an 11-year-old boy who presented with meningoencephalitis and was found later to have Kawasaki disease. The neurologic outcome of this patient was excellent, with full recovery without any neurologic deficit. The case report is followed by a review of the neurologic associations and complications of Kawasaki disease.
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Monedero Picazo MD, Gómez Fernández-Montes J, Molina Fábrega R, Vallcanera Calatayud A, Alabau Vázquez G, Revert Ros MA. [Radiologic findings in the lungs of patients with Kawasaki disease]. RADIOLOGIA 2006; 48:14-8. [PMID: 17059204 DOI: 10.1016/s0033-8338(06)73124-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To review the cases of Kawasaki disease (KD) in a pediatric reference hospital, analyzing the associated radiologic findings in the lungs. MATERIAL AND METHODS Retrospective study of the cases of KD diagnosed at our hospital in the last ten years. We reviewed the clinical histories and imaging studies (plain-film chest radiographs and chest CT scans) of 24 patients and analyzed the radiologic findings in the lungs during the acute phase of the disease. RESULTS Of the total of 24 cases reviewed, 5 (20.8%) showed alterations on plain-film chest radiographs. The mean age of onset of KD in these five patients was 2 years 5 months. Findings were interstitial pattern (n=3), alveolar infiltrates (n=3), subsegmental atelectasis (n=2), pleural effusion (n=1) and cardiomegaly (n=1). In one case, chest CT showed multiple pulmonary nodules. All findings appeared in the acute febrile phase and evolved favorably to complete resolution on radiologic studies. CONCLUSIONS Radiologic findings in the lungs of patients with KD are uncommon. In our series, they were seen in 20.8% of the patients, in the acute febrile phase, due to inflammation of the lower respiratory tract or cardiac insufficiency. It is important to note that the pulmonary nodules observed in one patient are extremely rare. It is conceivable that more cases of KD presenting with small pulmonary nodules undetected at plain-film radiography might be seen as more children undergo CT.
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Ling JC, Freeman AF, Gharib AM, Arai AE, Lederman RJ, Rosing DR, Holland SM. Coronary artery aneurysms in patients with hyper IgE recurrent infection syndrome. Clin Immunol 2006; 122:255-8. [PMID: 17098478 PMCID: PMC6588833 DOI: 10.1016/j.clim.2006.10.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 09/22/2006] [Accepted: 10/08/2006] [Indexed: 01/28/2023]
Abstract
Hyper IgE recurrent infection syndrome (HIES, or Job's syndrome) is a primary immunodeficiency characterized by recurrent skin and lung infections, eczema, elevated serum immunoglobulin E (IgE) levels, and various connective tissue and skeletal system abnormalities including characteristic facies, scoliosis, joint hyperextensibility, retained primary dentition, craniosynostosis, osteopenia, and pathologic fractures. We have identified two patients with aneurysmal coronary artery disease. One was a forty-three-year-old man with HIES and coronary artery aneurysms and ectasia identified on cardiac catheterization following myocardial infarction. The other was a 48-year-old man with coronary artery ectasia-aneurysm identified after cardiac catheterization for evaluation of chest pain. Although connective tissue abnormalities are common in HIES, this is the first report of coronary artery aneurysms in HIES. Further studies are necessary to determine the incidence, pathogenesis, and optimal therapy of these arterial abnormalities in HIES.
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Affiliation(s)
- Jennifer C Ling
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Vogel-Claussen J, Rochitte CE, Wu KC, Kamel IR, Foo TK, Lima JAC, Bluemke DA. Delayed enhancement MR imaging: utility in myocardial assessment. Radiographics 2006; 26:795-810. [PMID: 16702455 DOI: 10.1148/rg.263055047] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of magnetic resonance (MR) imaging for diagnosis of cardiac diseases and treatment monitoring is expanding. Delayed myocardial enhancement MR imaging is performed after administration of paramagnetic contrast agents and is used for a growing number of clinical applications. This technique was developed primarily for characterization of myocardial scarring after myocardial infarction. On delayed enhancement MR images, scarring or fibrosis appears as an area of high signal intensity that is typically subendocardial or transmural in a coronary artery distribution. However, delayed myocardial enhancement is not specific for myocardial infarction and can occur in a variety of other disorders, such as inflammatory or infectious diseases of the myocardium, cardiomyopathy, cardiac neoplasms, and congenital or genetic cardiac conditions, as well as after cardiac interventions. In nonischemic myocardial disease, the delayed enhancement usually does not occur in a coronary artery distribution and is often midwall rather than subendocardial or transmural. Therefore, the patient's clinical history is critical in the evaluation of delayed myocardial enhancement MR images.
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Affiliation(s)
- Jens Vogel-Claussen
- Department of Radiology, Johns Hopkins Hospital, MRI, Room 143, 600 N Wolfe St, Baltimore, MD 21287, USA
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Pyrc K, Bosch BJ, Berkhout B, Jebbink MF, Dijkman R, Rottier P, van der Hoek L. Inhibition of human coronavirus NL63 infection at early stages of the replication cycle. Antimicrob Agents Chemother 2006; 50:2000-8. [PMID: 16723558 PMCID: PMC1479111 DOI: 10.1128/aac.01598-05] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human coronavirus NL63 (HCoV-NL63), a recently discovered member of the Coronaviridae family, has spread worldwide and is associated with acute respiratory illness in young children and elderly and immunocompromised persons. Further analysis of HCoV-NL63 pathogenicity seems warranted, in particular because the virus uses the same cellular receptor as severe acute respiratory syndrome-associated coronavirus. As there is currently no HCoV-NL63-specific and effective vaccine or drug therapy available, we evaluated several existing antiviral drugs and new synthetic compounds as inhibitors of HCoV-NL63, targeting multiple stages of the replication cycle. Of the 28 compounds that we tested, 6 potently inhibited HCoV-NL63 at early steps of the replication cycle. Intravenous immunoglobulins, heptad repeat 2 peptide, small interfering RNA1 (siRNA1), siRNA2, beta-D-N(4)-hydroxycytidine, and 6-azauridine showed 50% inhibitory concentrations of 125 microg/ml, 2 microM, 5 nM, 3 nM, 400 nM, and 32 nM, respectively, and low 50% cytotoxicity concentrations (>10 mg/ml, >40 microM, >200 nM, >200 nM, >100 microM, and 80 microM, respectively). These agents may be investigated further for the treatment of coronavirus infections.
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Affiliation(s)
- Krzysztof Pyrc
- Department of Human Retrovirology, University of Amsterdam, The Netherlands.
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Abstract
Polymorphism of angiotensin converting enzyme (ACE) gene is reported to be associated with ischemic heart disease, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy. In this study, we investigated the relationship between Kawasaki disease and insertion/deletion polymorphism of ACE gene. Fifty five Kawasaki disease patients and 43 healthy children were enrolled. ACE genotype was evaluated from each of the subjects' DNA fragments through polymerase chain reaction (PCR). Frequencies of ACE genotypes (DD, ID, II) were 12.7%, 60.0%, 27.3% in Kawasaki group, and 41.9%, 30.2%, 27.9% in control group respectively, indicating low rate of DD and high rate of ID genotype among Kawasaki patients (p<0.01). Comparing allelic (I, D) frequencies, I allele was more prevalent in Kawasaki group than in control group (57.3% vs. 43.0%, p<0.05). In Kawasaki group, both genotype and allelic frequencies were not statistically different between those with coronary dilatations and those without. ACE gene I/D polymorphism is thought to be associated with Kawasaki disease but not with the development of coronary dilatations.
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Affiliation(s)
- Yoon Hee Shim
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hae Soon Kim
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
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Huang GY, Ma XJ, Huang M, Chen SB, Huang MR, Gui YH, Ning SB, Zhang TH, Du ZD, Yanagawa H, Kawasaki T. Epidemiologic pictures of Kawasaki disease in Shanghai from 1998 through 2002. J Epidemiol 2006; 16:9-14. [PMID: 16369103 PMCID: PMC7560545 DOI: 10.2188/jea.16.9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epidemiologic features of Kawasaki disease in China is still not clear. METHODS A questionnaire form and diagnostic guidelines for Kawasaki disease were sent to hospitals in Shanghai, which provided with pediatric medical care. All patients with Kawasaki disease diagnosed during January 1998 through December 2002 were recruited in this study. RESULTS A total of 768 patients with Kawasaki disease were reported. The incidence rates of Kawasaki disease for each year were 16.79 (1998), 25.65 (1999), 28.16 (2000), 28.05 (2001), and 36.76 (2002) per 100,000 children under 5 years of age. The male/female ratio was 1.83:1. The age at onset ranged from 1 month to 18.8 years (median: 1.8 years). The disease occurred more frequently in spring and summer. Fever was the most common clinical symptom, followed by oral changes, extremities desquamate, rash, conjunctive congestion, lymphadenopathy, extremities swelling, and crissum desquamate. Cardiac abnormalities were found in 24.3% of patients. The most common cardiac abnormality was coronary artery lesions including dilatation (68%) and aneurysm (10%). The case-fatality rate at acute stage of the disease was 0.26%. A second onset of the disease occurred in 1.82% of patients. CONCLUSIONS The incidence rate of Kawasaki disease in Shanghai is lower than that reported in Japan, but higher than those in western countries. The increasing trend in incidence, sex distribution and cardiac abnormalities are similar to those in previous reports. The seasonal distribution is similar to the report from Beijing and different from other reports.
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Affiliation(s)
- Guo-Ying Huang
- Children's Hospital of Fudan University, Department of Pediatrics of Shanghai Medical College, People's Republic of China.
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Cha JH, Hong YM. Serum homocysteine and tumor necrosis factor-alpha levels after intravenous gammaglobulin treatment in patients with Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.10.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jung Hwa Cha
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
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Diana MC, Villa G, Gattorno M, Ottonello G, Costabel S, Savioli C, DiPietro P. Sudden death in an infant revealing atypical Kawasaki disease. Pediatr Emerg Care 2006; 22:35-7. [PMID: 16418610 DOI: 10.1097/01.pec.0000195757.74328.68] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of a 4-month-old girl referred to the emergency department with a provisional diagnosis of acute life-threatening event with a recent episode of heart block and a history of long-lasting fever. Soon after admission, the child suddenly deteriorated rapidly; she became pulseless with complete heart block and died despite intensive resuscitation efforts. Postmortem examination showed coronary arteritis with aneurysmal dilatation and coronary thrombosis, revealing atypical Kawasaki disease. With this case presentation, we discuss the importance of early recognition and treatment of atypical and/or incomplete forms of Kawasaki disease, which are most common in young infants and may lead, if untreated, to coronary artery abnormalities with a potential for myocardial infarctions, aneurysm formation, and sudden death. In addition, the relevance of postmortem examination in a case of sudden and undiagnosed infant death is underlined.
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Affiliation(s)
- Maria Cristina Diana
- Emergency Department of Paediatrics, G. Gaslini Children's Hospital, Genoa, Italy.
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Abuhammour WM, Hasan RA, Eljamal A, Asmar B. Kawasaki disease hospitalizations in a predominantly African-American population. Clin Pediatr (Phila) 2005; 44:721-5. [PMID: 16211198 DOI: 10.1177/000992280504400812] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a descriptive study of the occurrence of Kawasaki disease (KD) in an urban population that was a majority of African Americans. Records of 189 children (mean age, 2.9 +/- 2.2 years [range: 2 months to 11.1 years]) hospitalized for KD over 8 years (January 1, 1992 to December 31, 1999) were reviewed and data analyzed. One hundred thirty-six (72%) were African American (AA), 43 (23%) were white, and 9 (5%) children were "others.'' The annual frequency was 15 for AA and 7.7 for white per 100,000 5-year-old children. Coronary artery abnormalities (CAA) were reported in 21 (11%) children (18 [13.2%] of 136 AA, and 3 [4.7%] of 43 whites [p=0.095]). AA children with CAA were older than their white counterparts (26 to 24 vs. 5 to 2.8 months, p=0.03). There was a higher occurrence in winter and spring (110 cases [58%] vs. 79 cases [42%]) compared to summer and fall. KD occurrence was positively associated with average monthly snowfall (r=0.35, p=0.004) and inversely associated with average monthly temperature (r = - 0.2, p=0.048). African-American children were more likely to be hospitalized for KD compared to white children. The association of KD with temperature and precipitation suggest that it is influenced by environmental factors.
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Affiliation(s)
- Walid M Abuhammour
- Pediatric Infectious Disease, Hurley Medical Center--Michigan State University, Flint 48503, USA
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Miura M, Garcia FL, Crawford SE, Rowley AH. Detection of Kawasaki disease-associated antigen in inflamed gastrointestinal tract in acute Kawasaki disease. Pediatr Infect Dis J 2005; 24:927-9. [PMID: 16220096 DOI: 10.1097/01.inf.0000180973.98862.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We performed immunohistochemistry experiments using synthetic antibodies on the gastrointestinal tract and kidney from acute Kawasaki disease patients. Significant gastrointestinal tract inflammation was present in only 2/7 patients, who had antigen detected at the site of inflammation. Antigen was not detected in kidney from 6 patients. The presence of antigen may be related to gastrointestinal pathology in acute Kawasaki disease.
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Affiliation(s)
- Masaru Miura
- Department of Pediatrics, Northwestern University, The Feinberg School of Medicine, Chicago, IL, USA
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45
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Freeman AF, Crawford SE, Cornwall ML, Garcia FL, Shulman ST, Rowley AH. Angiogenesis in fatal acute Kawasaki disease coronary artery and myocardium. Pediatr Cardiol 2005; 26:578-84. [PMID: 16132289 DOI: 10.1007/s00246-005-0801-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Angiogenesis has been shown to be dysregulated in coronary artery (CA) aneurysms in the chronic phase of Kawasaki disease (KD). Neovascularization may occur in inflammatory-related vascular diseases because many angiogenesis mediators are secreted by inflammatory cells. We hypothesized that inflammation of the acute KD CA aneurysm could lead to dysregulation of angiogenesis mediators and subsequent neovascularization. To investigate this hypothesis, acute fatal KD cardiac tissues were immunostained for angiogenic inducers and inhibitors. Microvessel density was determined and the degree of inflammation assessed. Marked inflammation and angiogenesis were found in acute KD CA aneurysms and myocardium, with the highest microvessel density seen in patients who died 2-3 weeks after onset of the disease. Expression of proangiogenic proteins was higher than expression of inhibitors in KD CA aneurysms and myocardium. Angiogenesis mediators were localized to inflammatory cells in the myointima, adventitia, and myocardium. We conclude that significant neovascularization occurs in acute KD CA aneurysms and myocardium much sooner after onset of the disease than has been previously reported, that multiple angiogenesis factors are involved, and that dysregulation of angiogenesis likely contributes to KD vasculopathy.
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Affiliation(s)
- A F Freeman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, W140, Ward 12-204, 303 E. Chicago Avenue, Chicago, IL 60611, USA.
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Park YW, Han JW, Park IS, Kim CH, Yun YS, Cha SH, Ma JS, Lee SB, Kim CH, Lee HJ, Tockgo YC. Epidemiologic picture of Kawasaki disease in Korea, 2000-2002. Pediatr Int 2005; 47:382-7. [PMID: 16091073 DOI: 10.1111/j.1442-200x.2005.02079.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to investigate the incidence rate and epidemiologic patterns of Kawasaki disease in Korea for a 3 year period during 2000 to 2002. METHODS An epidemiologic survey on Kawasaki disease was retrospectively performed. The questionnaire was sent to all 112 hospitals having pediatric residency programs, and obtained data were analyzed. RESULTS The 9150 cases of Kawasaki disease from 92 hospitals which responded (response rate, 82.1%) included 5515 males and 3635 females (male : female ratio, 1.52:1). The incidence rate per 100,000 children <5 years old was 73.7 in 2000, and increased to 90.8 in 2001, and 95.5 in 2002 (average rate, 86.4). The monthly number of patients was slightly higher in May, June and July. Their mean age of onset, the proportion of sibling cases, and a rate of recurrent cases were 30.5 months, 0.17%, and 2.9%, respectively. Coronary arterial abnormalities occurred in 18.6% of cases including dilatations of 17.3% and aneurysms of 3.1%. CONCLUSION The average annual incidence, 86.4/100 000 in children <5 years old is the second highest rate in the world.
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Affiliation(s)
- Yong Won Park
- Department of Pediatrics, Inje University, Seoul, Korea.
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Biezeveld MH, van Mierlo G, Lutter R, Kuipers IM, Dekker T, Hack CE, Newburger JW, Kuijpers TW. Sustained activation of neutrophils in the course of Kawasaki disease: an association with matrix metalloproteinases. Clin Exp Immunol 2005; 141:183-8. [PMID: 15958085 PMCID: PMC1809423 DOI: 10.1111/j.1365-2249.2005.02829.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Kawasaki disease (KD) is an acute febrile syndrome of childhood, characterized by vasculitis of the medium-sized arteries. White blood cell counts and the inflammatory parameter C-reactive protein (CRP) are known to be elevated in the acute phase of the disease. In this study we investigated the course of inflammatory cell type-specific parameters in KD over a longer period of time. Plasma levels of human neutrophil elastase (HNE), matrix metalloproteinases-2 and -9 (MMP2, MMP9), and neutrophil gelatinase-associated lipocalin (NGAL), macrophage neopterin and CRP were measured. Plasma samples were collected in the acute, subacute and early convalescent stage, and three months after the onset of disease. Median CRP and neopterin normalized within two weeks. In contrast, six weeks and three months after onset of disease, levels of HNE were still elevated, with median values of 163 ng/ml and 156 ng/ml, respectively (control children median < 50 ng/ml; for all time-points P < 0.0001). Values of NGAL correlated with the levels of HNE (r = 0.39, P = 0.013). These results demonstrate a longer state of neutrophil activation in KD than was previously assumed. The potential relationship between this prolonged neutrophil activation, coronary artery lesion formation and their persistence, as well as the risk of premature atherosclerosis warrants further evaluation.
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Affiliation(s)
- M H Biezeveld
- Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
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McCulloch MA, Gutgesell HP, Saulsbury FT, Hellems M, Hammill WW, Lim DS. Limitations of Echocardiographic Periarterial Brightness in the Diagnosis of Kawasaki Disease. J Am Soc Echocardiogr 2005; 18:768-70. [PMID: 16003276 DOI: 10.1016/j.echo.2004.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michael A McCulloch
- Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22901, USA
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Zhao C, Shuke N, Yamamoto W, Okizaki A, Sato J, Kajino H, Fujieda K, Aburano T. Impaired cardiac sympathetic nerve function in patients with Kawasaki disease: comparison with myocardial perfusion. Pediatr Res 2005; 57:744-8. [PMID: 15718355 DOI: 10.1203/01.pdr.0000156511.03924.9f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Kawasaki disease (KD) is a leading cause of CAD in children. The impairment of cardiac sympathetic nerve function (CSNF) in the adult patients with coronary artery disease (CAD) could often be seen. However, little is known concerning the impairment of CSNF in KD patients. We investigated CSNF and its relationship with myocardial perfusion in KD patients. Eleven children with KD and 4 controls were studied with 123I-metaiodobenzylguanidine (MIBG) and stressed 201Tl single photon emission computed tomography. By the findings on coronary artery angiography (CAG), the patients were divided into 2 groups: A, without stenosis; B, with significant stenosis and/or old myocardial infarction. CSNF was evaluated from the uptake of 123I-MIBG. While myocardial perfusion was evaluated from 201Tl uptake. The numbers of patients in the groups A and B were 7 and 4. Perfusion defect was found in 0, and 2 patients in group A (0%), and B (50%). 123I-MIBG defects were found in 1 and 4 patients in the group A (14%) and B (100%). There were excellent concordances between the finding of 201Tl and 123I-MIBG in group A. While in group B, the coronary territories with 123I-MIBG defects were significantly more than those with perfusion defects (p < 0.05). In KD patients, the impairment of CSNF might be subsequent to coronary artery stenosis and was more severe than the injury of myocardial perfusion.
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Affiliation(s)
- Chunlei Zhao
- Department of Radiology, Asahikawa Medical College, 078-8510, Japan.
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Guzman-Cottrill JA, Garcia FL, Shulman ST, Rowley AH. CD8 T lymphocytes do not express cytotoxic proteins in coronary artery aneurysms in acute Kawasaki disease. Pediatr Infect Dis J 2005; 24:382-4. [PMID: 15818305 DOI: 10.1097/01.inf.0000157224.25722.76] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronary arterial inflammation in acute Kawasaki disease (KD) is characterized by transmural infiltration of CD8 T lymphocytes, suggesting that CD8 T lymphocyte cytotoxic activity may be important in the pathogenesis of coronary arterial damage in acute KD. We performed immunohistochemistry for the cytotoxic proteins perforin and granzyme B on paraffin-embedded, formalin-fixed coronary artery aneurysm tissue from 6 children who died in the acute stage of KD. Neither perforin nor granzyme B was detected in the KD coronary aneurysm wall. We speculate that the etiologic agent of KD interferes with expression of these cytotoxic proteins by CD8 T lymphocytes, prolonging inflammation in the arterial wall and leading to coronary artery aneurysm formation.
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Affiliation(s)
- Judith A Guzman-Cottrill
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL, USA
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