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Gottlieb M, Rice M, Gore SR. What Is the Role of Corticosteroids for the Treatment of Kawasaki Disease in Children? Ann Emerg Med 2023; 81:140-142. [PMID: 36210244 DOI: 10.1016/j.annemergmed.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Melissa Rice
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Stephen R Gore
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
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2
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Liu Y, Xiao S, Yin X, Gao P, Wu J, Xiong S, Hockham C, Hone T, Wu JHY, Pearson SA, Neal B, Tian M. Nation-Wide Routinely Collected Health Datasets in China: A Scoping Review. Public Health Rev 2022; 43:1605025. [PMID: 36211230 PMCID: PMC9532513 DOI: 10.3389/phrs.2022.1605025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives: The potential for using routinely collected data for medical research in China remains unclear. We sought to conduct a scoping review to systematically characterise nation-wide routinely collected datasets in China that may be of value for clinical research. Methods: We searched public databases and the websites of government agencies, and non-government organizations. We included nation-wide routinely collected databases related to communicable diseases, non-communicable diseases, injuries, and maternal and child health. Database characteristics, including disease area, data custodianship, data volume, frequency of update and accessibility were extracted and summarised. Results: There were 70 databases identified, of which 46 related to communicable diseases, 20 to non-communicable diseases, 1 to injury and 3 to maternal and child health. The data volume varied from below 1000 to over 100,000 records. Over half (64%) of the databases were accessible for medical research mostly comprising communicable diseases. Conclusion: There are large quantities of routinely collected data in China. Challenges to using such data in medical research remain with various accessibility. The potential of routinely collected data may also be applicable to other low- and middle-income countries.
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Affiliation(s)
- Yishu Liu
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Shaoming Xiao
- The George Institute for Global Health, Health Science Centre, Peking University, Beijing, China
| | - Xuejun Yin
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Pei Gao
- School of Public Health, Health Science Center, Peking University, Beijing, China
| | - Jing Wu
- National Center for Chronic and Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shangzhi Xiong
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UK, London, United Kingdom
| | - Thomas Hone
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jason H. Y. Wu
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Sallie Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Maoyi Tian
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Maoyi Tian,
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3
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Abstract
BACKGROUND Kawasaki disease (KD), or mucocutaneous syndrome, is the leading cause of childhood-acquired heart disease in high-income countries. There is much controversy on how best to treat children with KD and in particular who may benefit from additional treatment beyond the standard intravenous immunoglobulin (IVIG) and aspirin, such as the addition of corticosteroids. This is an update of the review first published in 2017. OBJECTIVES To assess the impact of corticosteroid use on the incidence of coronary artery abnormalities in KD as either first-line or second-line treatment. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and two trials registers to 8 February 2021. We searched the reference lists of relevant articles for additional studies. SELECTION CRITERIA We selected randomised controlled trials involving children with all severities of KD who were treated with corticosteroids, including different types of corticosteroids, different durations of treatment, and where corticosteroids were used alone or in conjunction with other accepted KD treatments. We included trials using corticosteroids for both first- and second-line treatment. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed study quality and extracted data using standard Cochrane methods. We performed fixed-effect model meta-analyses with odds ratios (ORs) or mean difference (MD) with 95% confidence intervals (CIs). We used a random-effects model when there was heterogeneity. We assessed the certainty of the evidence using GRADE. The outcomes of interest were incidence of coronary artery abnormalities, serious adverse events, mortality, duration of acute symptoms (such as fever), time for laboratory parameters to normalise, length of hospital stay and longer-term coronary morbidity. MAIN RESULTS This update identified one new study, therefore the analysis included eight trials consisting of 1877 participants. Seven trials investigated the use of corticosteroids in first-line treatment and one investigated second-line treatment. The trials were all of good methodological quality. On pooled analysis, corticosteroid treatment reduced the subsequent occurrence of coronary artery abnormalities (OR 0.32, 95% CI 0.14 to 0.75; 8 studies, 986 participants; moderate-certainty evidence), without resultant serious adverse events (0 events; 6 studies, 737 participants; moderate-certainty) and mortality (0 events; 8 studies, 1075 participants; moderate-certainty evidence). In addition, corticosteroids reduced the duration of fever (MD -1.34 days, 95% CI -2.24 to -0.45; 3 studies, 290 participants; low-certainty evidence), time for laboratory parameters (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) to normalise (MD -2.80 days, 95% CI -4.38 to -1.22; 1 study, 178 participants; moderate-certainty evidence), and length of hospital stay (MD -1.01 days, 95% CI -1.72 to -0.30; 2 studies, 119 participants; moderate-certainty evidence). None of the included studies reported long-term (greater than one year after disease onset) coronary morbidity. AUTHORS' CONCLUSIONS Moderate-certainty evidence shows that use of steroids in the acute phase of KD can be associated with reduced coronary artery abnormalities, reduced inflammatory markers and shorter duration of hospital stay when compared to no corticosteroids. There were no serious adverse events or deaths reported with or without corticosteroid use. Low-certainty evidence shows use of corticosteroids can reduce duration of clinical symptoms (fever and rash). None of the included studies reported on long-term (greater than one year after disease onset) coronary morbidity. Evidence presented in this systematic review agrees with current clinical guidelines on the use of corticosteroids in the first-line treatment in KD.
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Affiliation(s)
- Jessica Green
- Children's & Adolescent Services, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - Andrew J Wardle
- Cardiology, Hammersmith Hospital, Imperial College London, London, UK
| | - Robert Mr Tulloh
- Congenital Heart Disease, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol, UK
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4
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Buda P, Friedman-Gruszczyńska J, Książyk J. Anti-inflammatory Treatment of Kawasaki Disease: Comparison of Current Guidelines and Perspectives. Front Med (Lausanne) 2021; 8:738850. [PMID: 34917629 PMCID: PMC8669475 DOI: 10.3389/fmed.2021.738850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/04/2021] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD), an acute, generalized vasculitis, is associated with an increased risk of coronary heart disease and is the most common cause of acquired heart disease in childhood. The incidence of KD is increasing worldwide. There are numerous international treatment guidelines. Our study aims to perform the first one so far comparison of them. While the gold standard therapy remains still the same (intravenous immunoglobulins and aspirin), there is currently a lack of evidence for choosing optimal treatment for high-risk patients and refractory KD. In this review, we also discuss the treatment of complications of KD and Kawasaki-like phenotypes, present an anti-inflammatory treatment in the light of new scientific data, and present novel potential therapeutic targets for KD.
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Affiliation(s)
- Piotr Buda
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Janusz Książyk
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
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5
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Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat Rev Rheumatol 2021; 17:731-748. [PMID: 34716418 PMCID: PMC8554518 DOI: 10.1038/s41584-021-00709-9] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
Children and adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are predominantly asymptomatic or have mild symptoms compared with the more severe coronavirus disease 2019 (COVID-19) described in adults. However, SARS-CoV-2 is also associated with a widely reported but poorly understood paediatric systemic vasculitis. This multisystem inflammatory syndrome in children (MIS-C) has features that overlap with myocarditis, toxic-shock syndrome and Kawasaki disease. Current evidence indicates that MIS-C is the result of an exaggerated innate and adaptive immune response, characterized by a cytokine storm, and that it is triggered by prior SARS-CoV-2 exposure. Epidemiological, clinical and immunological differences classify MIS-C as being distinct from Kawasaki disease. Differences include the age range, and the geographical and ethnic distribution of patients. MIS-C is associated with prominent gastrointestinal and cardiovascular system involvement, admission to intensive care unit, neutrophilia, lymphopenia, high levels of IFNγ and low counts of naive CD4+ T cells, with a high proportion of activated memory T cells. Further investigation of MIS-C will continue to enhance our understanding of similar conditions associated with a cytokine storm.
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6
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Sabatino J, Borrelli N, Fraisse A, Herberg J, Karagadova E, Avesani M, Bucciarelli V, Josen M, Paredes J, Piccinelli E, Spada M, Krupickova S, Indolfi C, Di Salvo G. Abnormal myocardial work in children with Kawasaki disease. Sci Rep 2021; 11:7974. [PMID: 33846402 PMCID: PMC8042008 DOI: 10.1038/s41598-021-86933-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Kawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7 ± 5 years) were included: 45 children with KD and CADL (KD/CADL) (Z-score > 2.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD/CADL patients had lower MWI (1433.2 ± 375.8 mmHg% vs 1752.2 ± 265.7 mmHg%, p < 0.001), MCW (1885.5 ± 384.2 mmHg% vs 2175.9 ± 292.4 mmHg%, p = 0.001) and MWE (994.0 ± 4.8% vs 95.9 ± 2.0%, p = 0.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3 ± 361.7 mmHg%; KD vs CTRL p = 0.028) and was comparable between KD/CADL and KD groups (KD/CADL vs KD p = 0.896). Moreover, KD/CADL patients with normal GLS (n = 38) preserved significant differences in MWI and MCW in comparison with CTRL. MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.
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Affiliation(s)
- Jolanda Sabatino
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK. .,National Heart and Lung Institute, Imperial College, London, UK.
| | - Nunzia Borrelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Jethro Herberg
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Elena Karagadova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Martina Avesani
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Valentina Bucciarelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Manjit Josen
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Josefa Paredes
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Enrico Piccinelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Maraisa Spada
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, URT-CNR, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK. .,National Heart and Lung Institute, Imperial College, London, UK.
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7
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Tulloh RMR, Mayon-White R, Harnden A, Ramanan AV, Tizard EJ, Shingadia D, Michie CA, Lynn RM, Levin M, Franklin OD, Craggs P, Davidson S, Stirzaker R, Danson M, Brogan PA. Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015. Arch Dis Child 2019; 104:640-646. [PMID: 30104394 DOI: 10.1136/archdischild-2018-315087] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/24/2018] [Accepted: 07/23/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Kawasaki disease (KD) is an increasingly common vasculitis with risk of coronary artery aneurysms (CAAs). The last UK survey was in 1990, whereas current epidemiology, treatment patterns and complication rates are unknown. The aim of this study was to address this knowledge gap. METHODS A British Paediatric Surveillance Unit survey in the UK and Ireland from 1 January 2013 to 28 February 2015 ascertained demographics, ethnicity, seasonal incidence, treatment and complication rates. RESULTS 553 cases were notified: 389 had complete KD, 46 had atypical KD and 116 had incomplete KD; 2 were diagnosed at postmortem with an incidence of 4.55/100 000 children under 5 years, with a male to female ratio of 1.5:1 and a median age of 2.7 years (2.5 months-15 years). Presentation was highest in January and in rural areas. Most were white (64%), and Chinese and Japanese Asians were over-represented as were black African or African mixed-race children. 94% received intravenous immunoglobulin (IVIG). The overall CAA rate was 19%, and all-cardiac complications affected 28%. Those with CAA received IVIG later than in those without (median 10 days vs 7 days). Those under 1 year had fewer symptoms, but the highest CAA rate (39%). Overall 8 of 512 cases (1.6%) had giant CAA, and 4 of 86 cases (5%) under 1 year of age developed giant CAA. Mortality from KD was 0.36%. CONCLUSIONS The UK and Ireland incidence of KD has increased and is more frequently seen in winter and rural areas. Delayed IVIG treatment is associated with CAA, suggesting earlier and adjunctive primary treatment might reduce complications to prevent CAA, particularly in the very young.
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Affiliation(s)
- Robert M R Tulloh
- Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Athimalaipet V Ramanan
- Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - E Jane Tizard
- Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Delane Shingadia
- Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Richard M Lynn
- British Paediatric Surveillance Unit, Royal College of Paediatrics, London, UK
| | | | - Orla D Franklin
- Paediatric Cardiology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Pippa Craggs
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Mike Danson
- Social Sciences, Heriot-Watt University, Edinburgh, UK
| | - Paul A Brogan
- Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
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8
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9
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Pascall B, Thakker A, Foo Y, Thakker P. Immunoglobulin for Kawasaki disease: a 3-year retrospective audit. BMJ Paediatr Open 2019; 3:e000451. [PMID: 31548996 PMCID: PMC6733330 DOI: 10.1136/bmjpo-2019-000451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/27/2019] [Accepted: 06/01/2019] [Indexed: 12/25/2022] Open
Abstract
AIM To evaluate whether intravenous immunoglobulin (IVIG) use in children with suspected Kawasaki disease (KD) was given according to local trust and the newly revised American Heart Association (AHA) guidelines. METHODS In our tertiary hospital, any child with suspected KD given IVIG, over the past 3 years, was identified. Their electronic notes were then reviewed. RESULTS Ten patients were identified. Nine patients had a fever lasting 5 days or more. Four patients had either 5/5 or 4/5 of the diagnostic criteria for KD and were diagnosed with complete KD. The remaining six patients were suspected to have incomplete KD. 7/10 patients received IVIG within 10 days of onset of illness. Patients suspected to have incomplete KD experienced a mean delay in administration of IVIG of 5.3 days compared with those with complete KD. In four patients, an alternative diagnosis was established. Three patients had coronary artery abnormalities on first echocardiogram. From these patients, only one had a follow-up echocardiogram recorded in their notes. No patient had more than one follow-up echocardiogram (at both 2 and 6 weeks). CONCLUSION Identifying patients with incomplete KD is more difficult than identifying those with complete KD and any delay in giving IVIG could be due to this reason. This audit suggests that increasing awareness of incomplete KD and a clear guideline will aid prompter diagnosis and administration of IVIG. This audit also suggests that all patients with KD should receive more than one follow-up echocardiogram.
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Affiliation(s)
- Beth Pascall
- Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arjuna Thakker
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Ying Foo
- Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pradip Thakker
- Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
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10
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Ribatti D, Tamma R, Ruggieri S, Annese T, Marzullo A, Crivellato E. Mast cells and primary systemic vasculitides. Microcirculation 2018; 25:e12498. [DOI: 10.1111/micc.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/09/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Roberto Tamma
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Simona Ruggieri
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Tiziana Annese
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Andrea Marzullo
- Department of Emergency and Organ Transplantation; University of Bari Medical School; Bari Italy
| | - Enrico Crivellato
- Department of Medicine, Human Anatomy Section; University of Udine Medical School; Udine Italy
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11
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Marchesi A, Tarissi de Jacobis I, Rigante D, Rimini A, Malorni W, Corsello G, Bossi G, Buonuomo S, Cardinale F, Cortis E, De Benedetti F, De Zorzi A, Duse M, Del Principe D, Dellepiane RM, D'Isanto L, El Hachem M, Esposito S, Falcini F, Giordano U, Maggio MC, Mannarino S, Marseglia G, Martino S, Marucci G, Massaro R, Pescosolido C, Pietraforte D, Pietrogrande MC, Salice P, Secinaro A, Straface E, Villani A. Kawasaki disease: guidelines of the Italian Society of Pediatrics, part I - definition, epidemiology, etiopathogenesis, clinical expression and management of the acute phase. Ital J Pediatr 2018; 44:102. [PMID: 30157897 PMCID: PMC6116535 DOI: 10.1186/s13052-018-0536-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/03/2018] [Indexed: 12/18/2022] Open
Abstract
The primary purpose of these practical guidelines related to Kawasaki disease (KD) is to contribute to prompt diagnosis and appropriate treatment on the basis of different specialists’ contributions in the field. A set of 40 recommendations is provided, divided in two parts: the first describes the definition of KD, its epidemiology, etiopathogenetic hints, presentation, clinical course and general management, including treatment of the acute phase, through specific 23 recommendations. Their application is aimed at improving the rate of treatment with intravenous immunoglobulin and the overall potential development of coronary artery abnormalities in KD. Guidelines, however, should not be considered a norm that limits treatment options of pediatricians and practitioners, as treatment modalities other than those recommended may be required as a result of peculiar medical circumstances, patient’s condition, and disease severity or complications.
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Affiliation(s)
- Alessandra Marchesi
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy.
| | | | - Donato Rigante
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | | | | | | | | | - Sabrina Buonuomo
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | - Fabrizio De Benedetti
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | - Andrea De Zorzi
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | - Marzia Duse
- , Università degli Studi Sapienza, Rome, Italy
| | | | | | | | - Maya El Hachem
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | - Ugo Giordano
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | | | | | - Giulia Marucci
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | | | | | | | - Aurelio Secinaro
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | - Alberto Villani
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
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12
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Increased Kawasaki Disease Incidence Associated With Higher Precipitation and Lower Temperatures, Japan, 1991-2004. Pediatr Infect Dis J 2018; 37:526-530. [PMID: 29140936 DOI: 10.1097/inf.0000000000001838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile vasculitis, which primarily affects children. The etiology of KD is unknown; while certain characteristics of the disease suggest an infectious origin, genetic or environmental factors may also be important. Seasonal patterns of KD incidence are well documented, but it is unclear whether these patterns are caused by changes in climate or by other unknown seasonal effects. METHODS The relationship between KD incidence and deviations from expected temperature and precipitation were analyzed using KD incidence data from Japanese nationwide epidemiologic surveys (1991-2004) and climate data from 136 weather stations of the Japan Meteorological Agency. Seven separate Poisson-distributed generalized linear regression models were run to examine the effects of temperature and precipitation on KD incidence in the same month as KD onset and the previous 1, 2, 3, 4, 5 and 6 months, controlling for geography as well as seasonal and long-term trends in KD incidence. RESULTS KD incidence was negatively associated with temperature in the previous 2, 3, 4 and 5 months and positively associated with precipitation in the previous 1 and 2 months. The model that best predicted variations in KD incidence used climate data from the previous 2 months. An increase in total monthly precipitation by 100 mm was associated with increased KD incidence (rate ratio [RR] 1.012, 95% confidence interval [CI]: 1.005-1.019), and an increase of monthly mean temperature by 1°C was associated with decreased KD incidence (RR 0.984, 95% CI: 0.978-0.990). CONCLUSIONS KD incidence was significantly affected by temperature and precipitation in previous months independent of other unknown seasonal factors. Climate data from the previous 2 months best predicted the variations in KD incidence. Although fairly minor, the effect of temperature and precipitation independent of season may provide additional clues to the etiology of KD.
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13
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Kuo HC, Wong HSC, Chang WP, Chen BK, Wu MS, Yang KD, Hsieh KS, Hsu YW, Liu SF, Liu X, Chang WC. Prediction for Intravenous Immunoglobulin Resistance by Using Weighted Genetic Risk Score Identified From Genome-Wide Association Study in Kawasaki Disease. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.116.001625. [PMID: 29025760 PMCID: PMC5647111 DOI: 10.1161/circgenetics.116.001625] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/27/2017] [Indexed: 12/30/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Intravenous immunoglobulin (IVIG) is the treatment of choice in Kawasaki disease (KD). IVIG is used to prevent cardiovascular complications related to KD. However, a proportion of KD patients have persistent fever after IVIG treatment and are defined as IVIG resistant. Methods and Results— To develop a risk scoring system based on genetic markers to predict IVIG responsiveness in KD patients, a total of 150 KD patients (126 IVIG responders and 24 IVIG nonresponders) were recruited for this study. A genome-wide association analysis was performed to compare the 2 groups and identified risk alleles for IVIG resistance. A weighted genetic risk score was calculated by the natural log of the odds ratio multiplied by the number of risk alleles. Eleven single-nucleotide polymorphisms were identified by genome-wide association study. The KD patients were categorized into 3 groups based on their calculated weighted genetic risk score. Results indicated a significant association between weighted genetic risk score (groups 3 and 4 versus group 1) and the response to IVIG (Fisher’s exact P value 4.518×10−03 and 8.224×10−10, respectively). Conclusions— This is the first weighted genetic risk score study based on a genome-wide association study in KD. The predictive model integrated the additive effects of all 11 single-nucleotide polymorphisms to provide a prediction of the responsiveness to IVIG.
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Affiliation(s)
- Ho-Chang Kuo
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Henry Sung-Ching Wong
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Wei-Pin Chang
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Ben-Kuen Chen
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Mei-Shin Wu
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Kuender D Yang
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Kai-Sheng Hsieh
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Yu-Wen Hsu
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Shih-Feng Liu
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Xiao Liu
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.)
| | - Wei-Chiao Chang
- From the Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy (H.-C.K., W.-C.C.), Department of Clinical Pharmacy, School of Pharmacy (H.S.-C.W., M.-S.W., W.-C.C.), School of Health Care Administration, College of Management (W.-P.C.), and PhD Program in Biotechnology Research and Development, College of Pharmacy (W.-C.C.), Taipei Medical University, Taiwan; Department of Pediatrics and Kawasaki Disease Center (H.-C.K., K.-S.H.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (S.-F.L.), and Department of Respiratory Therapy (S.-F.L.), Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan (B.-K.C.); Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan (K.D.Y.); Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (K.D.Y.); The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan (Y.-W.H.); Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL (X.L.); Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taiwan (W.-C.C.); and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Taiwan (W.-C.C.).
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14
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Bryan P, Seabroke S, Wong J, Donegan K, Webb E, Goldsmith C, Vipond C, Feavers I. Safety of multicomponent meningococcal group B vaccine (4CMenB) in routine infant immunisation in the UK: a prospective surveillance study. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:395-403. [DOI: 10.1016/s2352-4642(18)30103-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
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15
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Guile L, Parke S, Kelly A, Tulloh R. Giant coronary artery aneurysms in a 12-week-old infant with incomplete Kawasaki disease. BMJ Case Rep 2018; 2018:bcr-2018-224479. [PMID: 29593004 PMCID: PMC5878266 DOI: 10.1136/bcr-2018-224479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Kawasaki disease (KD) is an acute inflammatory vasculitis that occurs worldwide and disproportionately affects male children, most commonly between the ages of 6 months and 5 years. KD can present with only a few features and thus be difficult to diagnose, particularly in the youngest and oldest patients. We describe a 12-week-old Caucasian female infant who presented with rash and fever but no other features of KD, who developed giant coronary artery aneurysms. Considering how common is the presentation of a febrile infant with a rash, this case highlights the importance of considering KD early in the differential diagnosis for any infant with unexplained fever. Furthermore, it emphasises how echocardiography can help in the investigation of a febrile child with no clear source of infection.
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Affiliation(s)
- Lucy Guile
- School of Clinical Sciences, University of Bristol, Bristol, UK.,Department of Paediatric Surgery, Bristol Royal Hospital For Children, Bristol, UK
| | - Simon Parke
- Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Alison Kelly
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
| | - Robert Tulloh
- School of Clinical Sciences, University of Bristol, Bristol, UK.,Department of Paediatric Cardiology, Bristol Royal Hospital For Children, Bristol, UK
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16
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Stemberger Maric L, Papic N, Sestan M, Knezovic I, Tesovic G. Challenges in early diagnosis of Kawasaki disease in the pediatric emergency department: differentiation from adenoviral and invasive pneumococcal disease. Wien Klin Wochenschr 2018; 130:264-272. [PMID: 29476365 DOI: 10.1007/s00508-018-1324-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/30/2018] [Indexed: 12/19/2022]
Abstract
Early recognition and distinction of Kawasaki disease (KD) from other febrile infectious diseases is one of the biggest challenges in pediatric emergency departments (PED). The aim of this study was to assess the utility of clinical findings and routinely used laboratory parameters for early discrimination between KD, invasive pneumococcal disease (IPD) and adenovirosis (AdV). A retrospective, cross-sectional study of children aged 3-36 months consecutively admitted to the PED and diagnosed with either KD (n = 110), AdV (n = 440) or IPD (n = 122) was conducted. At first presentation to the PED, 56.3% of KD patients had none or only one clinical criterion, 31% of patients with AdV and 11% with IPD had > 2 criteria. The levels of platelets (Plt), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were higher and white blood cells (WBC) significantly lower in KD than in IPD and AdV group. The WBC < 20 ×109/l showed a sensitivity of 80.9% and specificity of 79.7% in comparison to AdV. The ROC curve showed a significant, but low sensitivity for AST, ALT and Plt. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) did not show any significant diagnostic accuracy. Significant association between incomplete KD and rash, WBC < 20 ×109 and Plt > 400 ×109/L compared to AdV and conjuctivitis, rash and Plt > 400 × 109/L, was found. Due to the time delay and nonspecific early presentation, differentiating KD from IPD and AdV is challenging. Tools used for identification of patients at risk for severe bacterial infections in PED lack sensitivity for identification of KD cases. New biomarkers are warranted for distinction of KD from IPD or AdV.
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Affiliation(s)
- Lorna Stemberger Maric
- Clinical Department for Pediatric Infectious Diseases, University Hospital for Infectious Diseases, Mirogojska 8, 10000, Zagreb, Croatia. .,School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
| | - Neven Papic
- Department for Viral Hepatitis, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Mario Sestan
- Clinical Department for Pediatric Infectious Diseases, University Hospital for Infectious Diseases, Mirogojska 8, 10000, Zagreb, Croatia
| | - Ivica Knezovic
- Clinical Department for Pediatric Infectious Diseases, University Hospital for Infectious Diseases, Mirogojska 8, 10000, Zagreb, Croatia
| | - Goran Tesovic
- Clinical Department for Pediatric Infectious Diseases, University Hospital for Infectious Diseases, Mirogojska 8, 10000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Abstract
BACKGROUND Kawasaki disease (KD) is the leading cause of acquired heart disease in developed countries. Reported incidences vary worldwide but incidence of KD has not been established in Portugal. AIM The aims of the study were to describe the epidemiologic characteristics and estimate incidence rates of KD among hospitalized children in Portugal. METHODS This study was a descriptive, population-based study, which used hospital discharge records of patients <20 years of age diagnosed with KD from the Hospital Register database for 2000-2011. Incidence rates were calculated using the number of KD patients and corresponding National census data. RESULTS There were 533 hospitalizations of 470 patients with KD as the primary diagnosis in Portugal, 63 hospitalizations were transfers of patients between hospitals and there were no relapses. The mean age at admission was 2.8 years, with male predominance (male-to-female ratio: 1.6:1). Children <5 years and infants <1 year represented 83% and 23% of all the patients admitted, respectively. Mean annual incidence was 6.5 per 100,000 children <5 years, 4.5 per 100,000 infants <1 year and 7.8 per 100,000 infants 1-4 years. We found considerable differences between national territorial regions, with majority of cases in most dense regions. The mean length of hospital stay was 9 days, and the incidence peaked in spring (35%) and spring/winter (63%). Coronary aneurysms were reported in 8.5% of patients with a higher male-to-female ratio (3.4:1) and a lower mean age (1.93 years). Reported mortality was 0.4%. CONCLUSIONS This is the first large-scale epidemiologic study of KD in Portugal. The highest incidences occurred among male children 1-4 years of age and in spring/winter.
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18
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Wardle AJ, Connolly GM, Seager MJ, Tulloh RMR. Corticosteroids for the treatment of Kawasaki disease in children. Cochrane Database Syst Rev 2017; 1:CD011188. [PMID: 28129459 PMCID: PMC6464937 DOI: 10.1002/14651858.cd011188.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Kawasaki disease (KD), or mucocutaneous syndrome, is the leading cause of childhood-acquired heart disease in the developed world. There is much controversy on how best to treat children with KD and in particular who may benefit from additional treatment beyond the standard intravenous immunoglobulin (IVIG) and aspirin, such as the addition of corticosteroids. OBJECTIVES To assess the impact of corticosteroid use on the incidence of coronary artery abnormalities in KD as either first-line or second-line treatment. Corticosteroids may be given alone or in conjunction with other accepted KD treatments. Secondary objectives include the effect of steroids on mortality, the time taken for laboratory parameters to normalise, the duration of acute symptoms (such as fever), the long-term impact of steroid use and evaluating their safety in KD and their efficacy in relevant population subgroups. SEARCH METHODS The Cochrane Vascular Information Specialist searched Cochrane Vascular's Specialised Register (25 November 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10) in the Cochrane Library (searched 25 November 2016). Trial registries were also searched for details of ongoing or unpublished studies. SELECTION CRITERIA We selected randomised trials involving children with all severities of KD who were treated with corticosteroids, including different types of corticosteroid and different durations of treatment. DATA COLLECTION AND ANALYSIS MJS and GMC independently selected studies, assessed evidence quality and extracted data. This process was overseen by AJW. MAIN RESULTS Seven trials consisting of 922 participants were included in this analysis. Trials ranged from 32 to 242 participants. On pooled analysis, corticosteroids reduced the subsequent occurrence of coronary artery abnormalities (odds ratio (OR) 0.29, 95% confidence interval (CI) 0.18 to 0.46; 907 participants; 7 studies; I² = 55%) without resultant serious adverse events (no events, 737 participants) and mortality (no events, 915 participants). In addition, corticosteroids reduced the duration of fever (mean difference (MD) -1.65 days, 95% CI -3.31 to 0.00; 210 participants; 2 studies; I² = 88%), time for laboratory parameters (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) to normalise (MD -2.80 days, 95% CI -4.38 to -1.22; 178 participants; 1 study) and length of hospital stay (MD -1.41 days, 95% CI -2.36 to -0.46; 39 participants; 1 study). No studies detailed outcomes beyond 24 weeks. Subgroup analysis showed some potential groups that may benefit more than others; however, further randomised controlled trials are required before this can be the basis for clinical action.Evidence quality was graded according to the GRADE system. Evidence was considered high quality for the incidence of serious adverse events, mortality and time for laboratory parameters to normalise. Evidence was considered moderate for the incidence of coronary artery abnormalities due to potential inconsistencies in data geography and patient benefits according to grouping. Evidence was moderate for duration of clinical symptoms (fever, rash) due to potential subjectivity in measurement. Evidence was moderate for length of hospital stay as only one study recorded this outcome. This means that we are reasonably confident that the true effect is close to that estimated in this work. AUTHORS' CONCLUSIONS Moderate-quality evidence shows that use of steroids in the acute phase of KD can be associated with improved coronary artery abnormalities, shorter duration of hospital stay and a decreased duration of clinical symptoms. High-quality evidence shows reduced inflammatory marker levels. There were insufficient data available regarding incidence of adverse effects attributable to steroids, mortality and long-term (> 1 year) coronary morbidity. Certain groups, including those based in Asia, those with higher risk scores, and those receiving longer steroid treatment may have greater benefit from steroid use, especially with decreasing rates of heart problems, but more tests are needed to answer these questions. Evidence presented in this study suggests that treatment with a long course of steroids should be considered for all children diagnosed with KD until further studies are performed.
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Affiliation(s)
- Andrew J Wardle
- Imperial College LondonCardiology, Hammersmith HospitalNorfolk PlaceLondonUKW2 1PG
| | - Georgia M Connolly
- University of Bristol, Medical Sciences BuildingUniversity WalkBristolUKBS8 1TD
| | - Matthew J Seager
- Imperial College LondonAcademic Section of Vascular SurgeryCharing Cross HospitalFulham Palace RoadLondonUKW6 8RF
| | - Robert MR Tulloh
- Bristol Royal Hospital for Children and Bristol Heart InstituteCongenital Heart DiseaseUpper Maudlin StreetBristolUKBS2 8BJ
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Hamburger J. Orofacial manifestations in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:826-850. [PMID: 27964791 DOI: 10.1016/j.berh.2016.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Abstract
The main orofacial manifestation of the inflammatory rheumatic diseases is that of Sjögren's syndrome. In addition, there is a constellation of orofacial manifestations of the inflammatory rheumatic diseases, many of which are extra-articular with some constituting presenting signs of the underlying rheumatic disease. This review will discuss the orofacial manifestations in a variety of connective tissue diseases and will also allude to the oral adverse drug reactions that may occur as a consequence of therapy.
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Affiliation(s)
- John Hamburger
- Birmingham Behçet's Syndrome Centre of Excellence, Sheldon Block, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, UK.
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Ha S, Seo GH, Kim KY, Kim DS. Epidemiologic Study on Kawasaki Disease in Korea, 2007-2014: Based on Health Insurance Review & Assessment Service Claims. J Korean Med Sci 2016; 31:1445-9. [PMID: 27510389 PMCID: PMC4974187 DOI: 10.3346/jkms.2016.31.9.1445] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/19/2016] [Indexed: 01/26/2023] Open
Abstract
The aim of this study is to assess the actual epidemiologic features of Kawasaki disease (KD) in Korea using the data from Health Insurance Review & Assessment Service (HIRA) claims from 2007 to 2014. We investigated HIRA claims of patients who had KD (International Classification of Diseases-10, M30.3) as a major diagnosis and were given intravenous immunoglobulin (IVIG) from 2007 to 2014. A total of 39,082 patients were reported during the period. The male-to-female ratio was 1.42 and the median age was 28 months. The incidence rates were 168.3 per 100,000 population aged 0 to 4 years in 2007, 159.1 in 2008, 167.3 in 2009, 190.4 in 2010, 188.2 in 2011, 190.2 in 2012, 210.4 in 2013 and 217.2 in 2014. These rates were much higher than those in the previous studies in Korea. KD occurred more often in early summer (May, June and July) and winter (December and January). The annual incidence rate of KD had been increasing every year, reaching 217.2 per 100,000 population aged 0 to 4 years in 2014. It is the second highest incidence rate of KD in the world after Japan.
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Affiliation(s)
- Sangmi Ha
- Healthcare Review and Assessment Committee, Health Insurance Review & Assessment Service, Seoul, Korea. ,
| | - Gi Hyeon Seo
- Healthcare Review and Assessment Committee, Health Insurance Review & Assessment Service, Seoul, Korea
| | - Kyu Yeun Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University, Seoul, Korea
| | - Dong Soo Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University, Seoul, Korea
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Álvarez EP, Rey F, Peña SC, Rubio A, Calvo C, Collado P. Has joint involvement lessened in Kawasaki disease? ACTA ACUST UNITED AC 2016; 13:145-149. [PMID: 27263965 DOI: 10.1016/j.reuma.2016.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is an acute systemic vasculitis affecting medium-sized arteries, particularly the coronary arteries. Classic diagnosis is based in prolonged fever and different clinical features, including acute arthritis. Our objective is to determine the prevalence of arthritis at the moment of the diagnosis, the response to intravenous immunoglobulin infusion and the relation with cardiac findings. MATERIAL AND METHODS Retrospective study through review of medical records of 42 patients with KD from 1988 to 2013. Demographic, clinical, laboratory variables and treatment were reviewed. RESULTS Male sex was predominant (57%). Fever (100%), exanthema (92,9%), conjunctivitis (78,6%), oropharingeal changes (76,2%), cervical lymphadenopathy (71,4%), edema (52,4%) and peripheral desquamation (46,3%) were reported. Eight patients presented ecocardiography alterations (ectasia and aneurism). Acute articular involvement was reported in 7 (16%) patients, including oligoarticular (57%), monoarticular (29%) and polyarticular (14%) patterns. All patients had elevation of acute phase reactants with neutrophilia (57%) and hypoalbuminemia (71,5%), but showed a good therapeutic response to intravenous immunoglobulin, without sequelaes. Sixteen patients had incomplete KD nine males, with 100% of fever exanthema (75%), conjunctivitis (56%) and 50% of cervical lymphadenopathy. Whereas oropharingeal changes and edemas was described in 44% and 25% of them. Four patients with incomplete KD had coronary artery abnormalities. CONCLUSIONS Acute arthritis was an uncommon finding (16%) and resulted in no sequelae. Maybe the treatment with intravenous immunoglobulin and aspirin prevents the development of articular abnormalities and then leading to a decrease in its follow-up requierement by reumathologist. The cardiovascular sequelae, mainly incomplete KD, remains determining its prognosis. The presence of articular involvement seems not to have influence over cardiac involvement.
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Affiliation(s)
- Eva Pilar Álvarez
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - Francis Rey
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Sara Carolina Peña
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Aranzazu Rubio
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Cristina Calvo
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Paz Collado
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
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Peng Q, Deng Y, Yang X, Leng X, Yang Y, Liu H. Genetic variants of ADAM17 are implicated in the pathological process of Kawasaki disease and secondary coronary artery lesions via the TGF-β/SMAD3 signaling pathway. Eur J Pediatr 2016; 175:705-13. [PMID: 26833052 DOI: 10.1007/s00431-016-2696-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023]
Abstract
UNLABELLED Kawasaki disease (KD) is a systemic vasculitis childhood disease frequently complicating coronary artery lesions (CALs). Recently, the gene encoding a disintegrin and metalloprotease 17 (ADAM17) was found to modify vascular pathology in humans by differentially regulating the transforming growth factor-β (TGF-β) signaling pathway, which affects KD/CAL susceptibility. To explore the potential role of ADAM17 in KD occurrence and outcomes, we investigated the association of 28 single nucleotide polymorphisms (SNPs) in ADAM17 and three pathway genes of TGF-β signaling with KD phenotypes in a Han Chinese population, including 392 KD patients and 421 non-KD controls. Three ADAM17 SNPs showed an association with KD risk, which was further confirmed by haplotype analysis. The effect of ADAM17 on KD was also shown by multi-variable logistic regression analysis. In two-locus model analyses with SNPs in ADAM17 and TGF-β signaling pathway genes, stronger compound effects on the risk of KD and secondary CAL formation were observed relative to comparable single SNPs. CONCLUSION Our results suggest that ADAM17 contributes to the KD risk and is involved in secondary CAL formation via the TGF-β/SMAD3 signaling pathway. This further enriches our understanding of the importance of the signaling pathway in KD occurrence and outcomes. WHAT IS KNOWN • The transforming growth factor (TGF)-β/SMAD3 signaling pathway greatly influences susceptibility to Kawasaki disease (KD) and secondary coronary artery lesions (CALs) and/or the treatment response of intravenous immunoglobulin. • A disintegrin and metalloprotease 17 (ADAM17) effectively reduces TGF-β signaling by cleaving TGF-β receptor type-1, while ADAM17 genetic variants modify human vascular pathology by differentially regulating this signaling although it is unknown whether ADAM17 contributes to KD phenotypes. What is New: • ADAM17 genetic variants were shown to be associated with KD risk, even when excluding the influence of TGF-β signaling pathway genes, suggesting that ADAM17 is an important KD susceptibility-related genetic locus. • The more significant compound effects of two-locus models, combining single nucleotide polymorphisms (SNPs) in ADAM17 and other TGF-β signaling pathway genes including TGFB2 and SMAD3, on KD phenotypes relative to single SNPs suggest that ADAM17 is also involved in secondary CAL formation and confers the risk of KD/CALs via the TGF-β/SMAD3 signaling pathway.
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Affiliation(s)
- Qian Peng
- Department of Pediatric Cardiology, West China Second University Hospital/West China Women's and Children's Hospital, West China School of Medicine, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Xiling Yang
- Department of Medical Genetics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Xiangyou Leng
- Department of Medical Genetics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Yuan Yang
- Department of Medical Genetics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Hanmin Liu
- Department of Pediatric Cardiology, West China Second University Hospital/West China Women's and Children's Hospital, West China School of Medicine, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
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Kawasaki disease incidence in children and adolescents: an observational study in primary care. Br J Gen Pract 2016; 66:e271-6. [PMID: 26906631 DOI: 10.3399/bjgp16x684325] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/11/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Kawasaki disease is reported to be increasing in incidence and is the commonest childhood cause of acquired heart disease in the Western world. AIM To determine the current UK incidence of Kawasaki disease across childhood and adolescence; and investigate trends over time and season. DESIGN AND SETTING An observational, descriptive study in the UK. METHOD The Health Improvement Network (THIN) database of primary healthcare records was searched for codes or text indicating Kawasaki disease. Identified records were compared with a study case definition and a date of onset was assigned to cases. The incidence, age/sex distribution, and trend in seasonal and temporal distribution were estimated (2008-2012). RESULTS A total of 110 episodes of Kawasaki disease in 109 children were identified from 3.9 million person-years observation. The incidence of Kawasaki disease was 2.8 per 100 000 person-years (95% confidence interval [CI] = 2.3 to 3.4) when aged <20 years; 9.1 (95% CI = 7.3 to 11.2) aged <5 years, and 3.0 per 100 000 (95% CI = 2.0 to 4.3) across the age groups when possible cases were included. More cases were identified in males (55%) with one-fifth of cases diagnosed after 5 years of age. There was no statistically significant trend in incidence over the study years (P = 0.10 adjusted for sex and month), or between seasons (P = 0.65 adjusted for year and sex). CONCLUSION Although the incidence of Kawasaki disease remains low and has stabilised in the UK, GPs should recognise that the condition occurs throughout childhood and across the seasons.
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Abstract
BACKGROUND National estimates of Kawasaki disease (KD) incidence often do not include incomplete cases (diagnosed based on only laboratory or echocardiographic criteria), and/or they rely on retrospective case reports and data registries where underreporting is known to be a problem. METHODS We conducted a prospective nationwide KD surveillance study in children younger than 5 years through the hospital-based German Pediatric Surveillance Unit (ESPED). We accounted for underreporting through applying capture-recapture methodology in 2 federal states using hospital discharge records with KD International Statistical Classification of Diseases and Related Health Problems 10th revision code (ie, M30.3). KD diagnosis (complete and incomplete) was established according to the American Heart Association criteria, 2004. RESULTS Incidence of KD, corrected for underreporting, was 7.2 of 100,000 in children younger than 5 years in Germany. Underreporting to ESPED was estimated at 37%-44%. Overall, 315 validated KD cases were reported. Of the 64 (20%) incomplete cases, 58% (37/64) were detected through echocardiographic findings and 42% (27/64) through laboratory criteria alone. Incomplete cases were younger than complete cases (1.2 vs. 2.0 years, P = 0.0001) and had more coronary aneurysms (43% vs. 11%, P = 0.0001). CONCLUSIONS A substantial number of incomplete KD cases were diagnosed based on the laboratory and echocardiographic criteria only. This was particularly the case in relation to infants younger than 1 year-an age group known to have an increased risk of developing coronary aneurysms. In addition, we found a high rate of underreporting to national Pediatric Surveillance Units. We suggest that improved surveillance and development of better diagnostic tests remain a high priority.
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García Rodríguez F, Flores Pineda ÁDJ, Villarreal Treviño AV, Salinas Encinas DR, Lara Herrera PB, Maldonado Velázquez MDR, Moreno Espinosa S, Faugier Fuentes E. [Kawasaki disease at a pediatric hospital in Mexico]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:166-173. [PMID: 29421203 DOI: 10.1016/j.bmhimx.2016.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is one of the most common systemic vasculitis in children under 5 years of age. The epidemiology of the disease is not well established in Mexico. The objective of this study was to describe the epidemiology, clinical features and treatment of patients with KD at the Hospital Infantil de Mexico Federico Gomez (HIMFG). METHODS We conducted a retrospective, descriptive and analytical study of patients diagnosed from January 2004 to December 2014 with KD in the HIMFG. RESULTS We analyzed 204 cases from which 55% were male, with a median age of 32.5 months (6-120) and a rate of hospitalization of 96%. Twenty percent of patients presented incomplete KD. No differences in the somatometric measurements or vitals were reported. The most frequent symptoms were fever, conjunctivitis (89%), oral changes (84%), pharyngitis (88%) and strawberry tongue (83%). We found higher acute phase reactants in the classic presentation. Echocardiographic alterations in 60 patients (29%), of which 12% were ectasia and 11% reported coronary aneurysms. On the other hand, 169 (83%) patients received intravenous immunoglobulin (IVIG), 18 (9%) presented resistance to IVIG, 6 (3%) required corticosteroids, and 2 (1%) infliximab; all received acetylsalicylic acid. CONCLUSIONS There were no important differences between classic and incomplete presentations. The incidence of cardiac alterations is less than previously reported in Mexico, but similar to that of other countries.
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Affiliation(s)
| | | | | | | | | | | | - Sarbelio Moreno Espinosa
- Departamento de Infectología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Enrique Faugier Fuentes
- Servico de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
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FCGR2A Promoter Methylation and Risks for Intravenous Immunoglobulin Treatment Responses in Kawasaki Disease. Mediators Inflamm 2015; 2015:564625. [PMID: 26089602 PMCID: PMC4451985 DOI: 10.1155/2015/564625] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/07/2014] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease (KD) is characterized by pediatric systemic vasculitis of an unknown cause. The low affinity immunoglobulin gamma Fc region receptor II-a (FCGR2A) gene was reported to be involved in the susceptibility of KD. DNA methylation is one of the epigenetic mechanisms that control gene expression; thus, we hypothesized that methylation status of CpG islands in FCGR2A promoter associates with the susceptibility and therapeutic outcomes of Kawasaki disease. In this study, 36 KD patients and 24 healthy subjects from out-patient clinic were recruited. Eleven potential methylation sites within the targeted promoter region of FCGR2A were selected for investigation. We marked the eleven methylation sites from A to K. Our results indicated that methylation at the CpG sites G, H, and J associated with the risk of KD. CpG sites B, C, E, F, H, J, and K were found to associate with the outcomes of IVIG treatment. In addition, CpG sites G, J, and K were predicted as transcription factors binding sites for NF-kB, Myc-Max, and SP2, respectively. Our study reported a significant association among the promoter methylation of FCGR2A, susceptibility of KD, and the therapeutic outcomes of IVIG treatment. The methylation levels of CpG sites of FCGR2A gene promoter should be an important marker for optimizing IVIG therapy.
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Binder E, Griesmaier E, Giner T, Sailer-Höck M, Brunner J. Kawasaki disease in children and adolescents: clinical data of Kawasaki patients in a western region (Tyrol) of Austria from 2003-2012. Pediatr Rheumatol Online J 2014; 12:37. [PMID: 27643389 PMCID: PMC5350606 DOI: 10.1186/1546-0096-12-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/08/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a rare vasculitis seen predominantly in children. In developing countries, it is the leading cause of childhood-acquired heart disease. Besides a case report from 1981 there have been no data published dealing with the epidemiology and clinical aspects of KD in Austria. METHODS The purpose of the present study was to investigate the clinical spectrum of KD in a geographically determined cohort of infants, children, and adolescents that were diagnosed and treated at the University Hospital of Innsbruck from 2003-2012. RESULTS Thirty-two patients were included in the study with a median age of 32.96 months (2-192). 59.4% of the patients were aged between six months and four years. The male-to-female ratio was 1:1.13. Clinical examination revealed non-purulent conjunctivitis and exanthema as the most common symptoms (84.4%). 75% showed oropharyngeal changes, 21.9% had gastrointestinal complaints such as diarrhoe, stomachache or vomiting prior to diagnosis. One third of the patients were admitted with a preliminary diagnosis, whereas 78.1% were pre-treated with antibiotics. The median fever duration at the time of presentation was estimated with 4.96 days (1-14), at time of diagnosis 6.76 days (3-15).75% were diagnosed with complete KD, and 25% with an incomplete form of the disease. There was no significant difference in the duration of fever neither between complete and incomplete KD, nor between the different age groups. Typical laboratory findings included increased C-reactive protein (CRP) (80.6%) and erythrocyte sedimentation rate (ESR) (96%),leukocytosis (48.4%) and thrombocytosis (40.6%) without any significant quantitative difference between complete and incomplete KD. Coronary complications could be observed in six patients: one with a coronary aneurysm and five with tubular dilatation of the coronary arteries. Our patient cohort represents the age distribution as described in literature and emphasizes that KD could affect persons of any age. The frequency of occurrence of the clinical symptoms differs from previous reports - in our study, we predominantly observed non-purulent conjunctivitis and exanthema. CONCLUSION KD should always be considered as a differential diagnosis in a child with fever of unknown origin, as treatment can significantly decrease the frequency of coronary complications.
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Affiliation(s)
- Elisabeth Binder
- Clinic of Pediatrics I, Department of Pediatrics, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Elke Griesmaier
- grid.5361.10000000088532677Clinic of Pediatrics II, Department of Pediatrics, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Thomas Giner
- grid.5361.10000000088532677Clinic of Pediatrics I, Department of Pediatrics, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michaela Sailer-Höck
- grid.5361.10000000088532677Clinic of Pediatrics I, Department of Pediatrics, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Juergen Brunner
- grid.5361.10000000088532677Clinic of Pediatrics I, Department of Pediatrics, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Abstract
Kawasaki disease (KD) is an acute self-limiting inflammatory disorder, associated with vasculitis, affecting predominantly medium-sized arteries, particularly the coronary arteries. In developed countries KD is the commonest cause of acquired heart disease in childhood. The aetiology of KD remains unknown, and it is currently believed that one or more as yet unidentified infectious agents induce an intense inflammatory host response in genetically susceptible individuals. Genetic studies have identified several susceptibility genes for KD and its sequelae in different ethnic populations, including FCGR2A, CD40, ITPKC, FAM167A-BLK and CASP3, as well as genes influencing response to intravenous immunoglobulin (IVIG) and aneurysm formation such as FCGR3B, and transforming growth factor (TGF) β pathway genes. IVIG and aspirin are effective therapeutically, but recent clinical trials and meta-analyses have demonstrated that the addition of corticosteroids to IVIG is beneficial for the prevention of coronary artery aneurysms (CAA) in severe cases with highest risk of IVIG resistance. Outside of Japan, however, clinical scores to predict IVIG resistance perform suboptimally. Furthermore, the evidence base does not provide clear guidance on which corticosteroid regimen is most effective. Other therapies, including anti-TNFα, could also have a role for IVIG-resistant KD. Irrespective of these caveats, it is clear that therapy that reduces inflammation in acute KD, improves outcome. This paper summarises recent advances in the understanding of KD pathogenesis and therapeutics, and provides an approach for managing KD patients in the UK in the light of these advances.
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Affiliation(s)
- D Eleftheriou
- Paediatric Rheumatology/Infectious Diseases and Microbiology Unit, Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, , London, UK
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Yim D, Curtis N, Cheung M, Burgner D. Update on Kawasaki disease: epidemiology, aetiology and pathogenesis. J Paediatr Child Health 2013; 49:704-8. [PMID: 23560706 DOI: 10.1111/jpc.12172] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 12/21/2022]
Abstract
Kawasaki disease is an acute systemic vasculitis predominantly affecting young children. It is due to an abnormal host response to as yet unidentified infectious trigger(s). Kawasaki disease may cause coronary artery damage, long-term cardiovascular morbidity and occasionally mortality, especially if the diagnosis is missed or timely treatment is not given. This is the first of two updates on Kawasaki disease. Here we review recent advances in epidemiology, possible aetiologies, host susceptibility and pathogenesis of this fascinating condition.
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Affiliation(s)
- Deane Yim
- Department of Cardiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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Données épidémiologiques de la maladie de Kawasaki en France : le registre KAWANET. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Principi N, Rigante D, Esposito S. The role of infection in Kawasaki syndrome. J Infect 2013; 67:1-10. [PMID: 23603251 PMCID: PMC7132405 DOI: 10.1016/j.jinf.2013.04.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 01/12/2023]
Abstract
Objectives To analyse the evidence suggesting a possible infectious origin of Kawasaki syndrome (KS). Methods PubMed was searched for all of the studies published over the last 15 years using the key words “Kawasaki syndrome” or “mucocutaneous lymph node syndrome” and “infectious disease” or “genetics” or “vasculitis” or “pathogenesis”. Results Various levels of evidence support the hypothesis that KS is a complex disease triggered by an infection due to one or more pathogens. Viruses or bacteria may be the primum movens, although no specific infectious agent can be considered definitely etiological. A number of genetic polymorphisms have been identified in subjects with KS, but none of them can currently be considered a real marker of susceptibility. Conclusions Various data suggest that KS is intimately related to infectious diseases and that its clinical expression is influenced by predisposing genetic backgrounds, but our knowledge of the infectious agent(s) involved and the genetic characteristics of susceptible children remains only partial. Further studies are needed to address the many still open questions concerning the disease.
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Affiliation(s)
- Nicola Principi
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, Milan, Italy
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Salo E, Griffiths EP, Farstad T, Schiller B, Nakamura Y, Yashiro M, Uehara R, Best BM, Burns JC. Incidence of Kawasaki disease in northern European countries. Pediatr Int 2012; 54:770-2. [PMID: 22726311 PMCID: PMC3467350 DOI: 10.1111/j.1442-200x.2012.03692.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study was to compare the epidemiologic features of Kawasaki disease (KD) in three northern European countries and Japan. METHODS Data were obtained from discharge databases for hospitals in Finland, Norway, and Sweden for 1999-2009 and from nationwide epidemiologic surveys in Japan for 1998-2008. Annual incidence for each country was calculated using regional census data. RESULTS During the 11 year period, 1390 KD patients were recorded in the registries of the three northern European countries. Average annual incidence rates per 100,000 children aged <5 years were: Finland, 11.4; Norway, 5.4; and Sweden, 7.4. Overall, 86.4% of Japanese KD patients were aged <5 years compared to only 67.8% in the four northern European countries (P < 0.001). CONCLUSIONS The incidence of KD in northern Europe was constant over the study period and much lower than in Japan. There was a significant age difference between northern European and Japanese KD patients that remains unexplained.
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Affiliation(s)
- Eeva Salo
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
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Ghelani SJ, Sable C, Wiedermann BL, Spurney CF. Increased incidence of incomplete Kawasaki disease at a pediatric hospital after publication of the 2004 American Heart Association guidelines. Pediatr Cardiol 2012; 33:1097-103. [PMID: 22349679 DOI: 10.1007/s00246-012-0232-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/04/2012] [Indexed: 02/03/2023]
Abstract
We sought to study the impact of the 2004 American Heart Association guidelines on diagnosis and treatment of patients with Kawasaki disease (KD). We reviewed patient records from July 2000 to June 2002 (group 1) and July 2007 to June 2009 (group 2) at a tertiary children's hospital. The proportion of patients with incomplete KD in group 2 (56 of 118 [47%]) was significantly higher than that in group 1 (20 of 85 [24%], p = 0.001). Median age (months) and interquartile ranges for group 1 was 26 (range 12.5-52) and for group 2 was 38.5 (range 18-63; p = 0.072). The number of patients diagnosed with KD having just 2 symptoms other than fever was significantly higher in group 2 (2.4 vs. 16.9%, p < 0.001). Erythrocyte sedimentation rate, albumin, and alanine aminotransferase levels were obtained in a significantly greater number of patients with KD after the guidelines were published. Thirty-two of the 203 patients studied had coronary artery (CA) involvement (15.8%), 4 of whom had CA aneurysms (2%) and 28 had CA ectasia only (13.8%). CA involvement was seen in 13 of 85 (15.3%) patients in group 1 and 19 of 118 (16.1%; p = 1) patients in group 2. After publication of the 2004 AHA guidelines, diagnoses of incomplete KD and laboratory use increased at our center; however, the rate of CA involvement remained stable. There also was a trend towards older age in children diagnosed with KD. Laboratory parameters and CA involvement between incomplete KD and classic KD were comparable.
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Affiliation(s)
- Sunil J Ghelani
- Division of Cardiology, Children's National Medical Center, Washington, DC 20010, USA
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Okura N, Okuda T, Shiotani S, Kohno M, Hayakawa H, Suzuki A, Kawasaki T. Sudden death as a late sequel of Kawasaki disease: postmortem CT demonstration of coronary artery aneurysm. Forensic Sci Int 2012; 225:85-8. [PMID: 22673706 DOI: 10.1016/j.forsciint.2012.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 04/16/2012] [Accepted: 04/30/2012] [Indexed: 12/14/2022]
Abstract
Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that primarily affects the coronary artery (CA) and presents during childhood. The characteristic coronary arterial lesion of KD is an aneurysm. Ischemic heart disease derived from a CA aneurysm is experienced approximately two decades after the onset of acute KD. In recent years, the primary issue of concern has been asymptomatic adults with a CA aneurysm caused by undiagnosed KD. We present a case of sudden death as a late KD sequel in a young adult. A postmortem CT scan revealed a coarse calcification of a left anterior descending CA aneurysm, which was confirmed at the time of autopsy. A postmortem CT scan is useful in cases of sudden death where the detection of a calcified CA aneurysm would suggest to the forensic pathologist that the deceased suffered from a late sequel of KD. The use of screening postmortem CT scans for young people may detect cases of unsuspected CA aneurysms, raising the possibility of untreated KD.
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Affiliation(s)
- Naoki Okura
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Abstract
Kawasaki disease (KD) is a systemic vasculitis of unknown etiology. The diagnostic criteria are fulfilled with fever of unknown origin and 4 of the following 5 criteria: bilateral conjunctival injection, cervical lymphadenopathy, polymorphous rash, oral mucous membrane changes (injected lips, strawberry tongue) and peripheral extremity changes (erythema, edema, desquamation). If less than 4 criteria are found incomplete KD can be diagnosed. The therapy is 2 g/kg body weight single dose intravenous immunoglobulin and acetylsalicylic acid (ASS). In the long-term follow-up the main focus is on the coronary arteries because coronary changes play a key role in the intensity of long-term management. There is some evidence that KD is a risk factor for cardiovascular diseases in adults.
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Affiliation(s)
- U Neudorf
- Klinik für Kinderheilkunde III - Bereiche Kardiologie und Rheumatologie, Zentrum für Kinder- und Jugendmedizin, Essen, Deutschland.
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Abstract
Kawasaki disease is a systemic vasculitis and the leading cause of acquired heart disease in North American and Japanese children. The epidemiology, cause, and clinical characteristics of this disease are reviewed. The diagnostic challenge of Kawasaki disease and its implications for coronary artery outcomes are discussed, as are the recommended treatment, ongoing treatment controversies, concerns associated with treatment resistance, and the importance of ongoing follow up.
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Affiliation(s)
- Rosie Scuccimarri
- Division of Pediatric Rheumatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, 2300 Tupper, Room C-505, Montreal, Quebec H3H 1P3, Canada.
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Ghelani SJ, Pastor W, Parikh K. Demographic and treatment variability of refractory kawasaki disease: a multicenter analysis from 2005 to 2009. Hosp Pediatr 2012; 2:71-6. [PMID: 24510952 DOI: 10.1542/hpeds.2011-00112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Approximately 10% to 15% of Kawasaki disease (KD) is refractory to treatment with initial intravenous immunoglobulin (IVIG). However, there is no consensus on pharmacologic treatment of refractory KD (rKD). Demographic characteristics of patients with rKD and regional variability in their treatment in the United States have not been reported on a large scale. The goal of this study was to describe the demographic and treatment variability in rKD by using a large multi-institutional database. METHODS Data were obtained for patients with KD from January 2005 to June 2009 by using the Pediatric Health Information System. Patients who received a single dose of IVIG were labeled as having standard KD (sKD) and those who required additional medications were labeled as having rKD. RESULTS Of the 5633 patients studied, 4818 (85.5%) received 1 dose of IVIG (sKD) and 815 (14.5%) received >1 medication (rKD). Median age was 30 months (interquartile range: 14-53) and 30 months (interquartile range: 15-54) for rKD and sKD patients, respectively (P= .438). No significant change was noted in the gender or ethnic distribution of patients between rKD and sKD groups. Seasonal distribution of rKD was comparable to sKD. IVIG was the most common (64.5%) initial medication chosen to treat rKD, followed by methylprednisolone (27.1%) and infliximab (8.3%); however, there was significant regional variability. Of patients with rKD, 81% required only 1 additional medication (after the initial IVIG) for treatment. CONCLUSIONS Patients with rKD have similar age, gender, ethnic, and seasonal distribution as sKD patients. IVIG is the most common initial medication chosen to treat rKD; however, there is regional variation.
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Affiliation(s)
- Sunil J Ghelani
- Pediatric Residency Program, Children's National Medical Center, Washington, District of Columbia
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Homeister JW, Willis MS. The Molecular Biology and Treatment of Systemic Vasculitis in Children. MOLECULAR AND TRANSLATIONAL VASCULAR MEDICINE 2012. [PMCID: PMC7121654 DOI: 10.1007/978-1-61779-906-8_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary systemic vasculitides are rare in childhood but are associated with significant morbidity and mortality. The cause of the majority of vasculitides is unknown, although it is likely that a complex interaction between environmental factors, such as infections and inherited host responses, triggers the disease and determines the vasculitis phenotype. Several genetic polymorphisms in vasculitides have now been described, which may be relevant in terms of disease predisposition or development of disease complications. Treatment regimens continue to improve with the use of different immunosuppressive medications and newer therapeutic approaches such as biologic agents. This chapter reviews recent studies shedding light on the pathogenesis of vasculitis with emphasis on molecular biology where known, and summarizes current treatment strategies. We discuss new emerging challenges particularly with respect to the long-term cardiovascular morbidity for children with systemic vasculitis and emphasize the importance of future international multicenter collaborative studies to further increase and standardize the scientific base investigating and treating childhood vasculitis.
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Affiliation(s)
- Jonathon W. Homeister
- grid.410711.20000 0001 1034 1720, The University of North Carolina, McAllister Heart Institute, 101 Manning Drive, Chapel Hill, 27599-7525 USA
| | - Monte S. Willis
- grid.410711.20000 0001 1034 1720, The University of North Carolina, McAllister Heart Institute, 103 Mason Farm Road, Chapel Hill, 27599-7525 USA
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Abstract
Kawasaki disease (KD) is a systemic vasculitis that mainly affects children younger than 5 years. Although Dr. Tomisaku Kawasaki first reported KD over 40 years ago, the cause of the disease remains unknown. Currently, KD has been diagnosed in more than 60 countries, including those in Asia, the Middle East, Latin America, and Africa, as well as in North America and Europe. The purpose of this review is to describe the epidemiologic features of KD—particularly its incidence, seasonality, and the occurrence of coronary artery abnormalities—primarily in Japan and the United States, but also in Europe and other Asian countries.
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Affiliation(s)
- Ritei Uehara
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan.
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Abstract
OBJECTIVE To characterize the epidemiology and estimate the incidence of Kawasaki disease (KD) among children in Israel. METHODS Using the Israel National Hospital Discharge Register, we investigated the epidemiologic features of KD among children <18 years of age between 1996 to 2009 in Israel. Incidence rates were calculated using the corresponding census data. RESULTS During 1996 through 2009, 685 children <18 years of age were hospitalized for KD in Israel. Of these children, 88% were aged <5 years; the male/female ratio was 1.7:1; and most cases occurred in late winter-early spring. The overall incidence of KD was 6.4 per 100,000 children <5 years of age. Since 2000, there was a gradual increase in KD incidence as well as in the ratio of KD-associated hospitalizations to all-cause pediatric hospitalizations. For male infants <1 year of age, KD rates almost doubled: from 5.8 per 100,000 cases in 1996-1998 to an average of 11.9 cases per 100,000 in the following years (P = 0.002). The overall proportion of patients with coronary artery aneurysm was 2.9%, higher rates of coronary artery aneurysm were observed in patients <1 or >5 years of age and in male patients. CONCLUSIONS Major epidemiologic features of KD among Israeli children are similar to those reported for the white population in Europe and the United States. KD incidence increased during the study period, especially among male infants <1 year of age.
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Arulkumaran N, Jawad S, Smith SW, Harper L, Brogan P, Pusey CD, Salama AD. Long- term outcome of paediatric patients with ANCA vasculitis. Pediatr Rheumatol Online J 2011; 9:12. [PMID: 21682926 PMCID: PMC3150312 DOI: 10.1186/1546-0096-9-12] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/19/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary systemic vasculitis presenting in childhood is an uncommon but serious condition. As these patients transfer to adult clinics for continuing care, defining long term outcomes with emphasis on disease and treatment- related morbidity and mortality is important. The aim of this study is to describe the long- term clinical course of paediatric patients with ANCA vasculitis. METHODS The adult patients in our vasculitis clinics who had presented in childhood, with a follow up time of greater than 10 years were included. We also reviewed the literature for articles describing the clinical outcome of paediatric patients with ANCA vasculitis. RESULTS We describe the clinical course of 8 adults who presented in childhood with ANCA vasculitis. 7 patients had Wegener's granulomatosis and 1 had microscopic polyangiitis. The median age at presentation was 11.5 years, and follow up time ranged form 11 to 30 years. Induction therapy for all patients was steroids and/or cyclophosphamide. Maintenance therapy was with azathioprine or mycophenolate mofetil. Biological agents were used in 3 patients for relapsed disease in adulthood only.Seven patients achieved complete remission. All patients experienced disease relapse, with a median of 4 episodes. Kidney function was generally well preserved, with median eGFR 76 ml/min. Only one patient developed end-stage renal failure and one patient died after 25 years of disease. Treatment-related morbidity rates were high; 7 suffered from infections, 4 were infertile, 2 had skeletal complications, and 1 developed malignancy. CONCLUSION Close long- term follow up of paediatric patients with ANCA vasculitis is imperative, as this patient cohort is likely to live long enough to develop significant treatment and disease- related morbidities. Prospective cohort studies with novel therapies including paediatric patients are crucial to help us determine the best approach to managing this complex group of patients. In addition, although not yet observed in our series, late cardiovascular morbidity remains a major longer-term potential concern for adult survivors of paediatric vasculitis.
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Affiliation(s)
- Nishkantha Arulkumaran
- Renal Section, Division of Medicine, Imperial College London, Hammersmith Hospital, Ducane Road, London W12 0NN, UK.
| | - Susan Jawad
- Renal Section, Division of Medicine, Imperial College London, Hammersmith Hospital, Ducane Road, London W12 0NN, UK
| | - Stuart W Smith
- Division of Renal Immunobiology, Medical School, West Extension, 1st Floor, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lorraine Harper
- Division of Renal Immunobiology, Medical School, West Extension, 1st Floor, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Paul Brogan
- Department of Rheumatology, Institute of Child Health, Great Ormond Street Hospital, 30 Guilford St, London WC1N 1EH, UK
| | - Charles D Pusey
- Renal Section, Division of Medicine, Imperial College London, Hammersmith Hospital, Ducane Road, London W12 0NN, UK
| | - Alan D Salama
- Renal Section, Division of Medicine, Imperial College London, Hammersmith Hospital, Ducane Road, London W12 0NN, UK,Centre for Nephrology, University College London, Royal Free Hospital, London NW3 2PF, UK
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Caballero-Mora F, Alonso-Martín B, Tamariz-Martel-Moreno A, Cano-Fernández J, Sánchez-Bayle M. Enfermedad de Kawasaki en 76 pacientes. Factores de riesgo de aparición de aneurismas coronarios. An Pediatr (Barc) 2011; 74:232-8. [DOI: 10.1016/j.anpedi.2010.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/03/2010] [Accepted: 11/30/2010] [Indexed: 12/01/2022] Open
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Oberle D, Pönisch C, Weißer K, Keller-Stanislawski B, Mentzer D. Schutzimpfung gegen Rotavirusgastroenteritis. Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-010-2309-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sudo D, Monobe Y, Yashiro M, Sadakane A, Uehara R, Nakamura Y. Case-control study of giant coronary aneurysms due to Kawasaki disease: the 19th nationwide survey. Pediatr Int 2010; 52:790-4. [PMID: 20487371 DOI: 10.1111/j.1442-200x.2010.03161.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk factors for recently reported cases of giant coronary aneurysms due to Kawasaki disease have not been elaborated. METHODS Fifty-three patients with giant coronary aneurysms, diagnosed as Kawasaki disease in 2005 and 2006, were selected from the 19th nationwide survey of the disease in Japan. With all the other patients recorded at the same hospitals as a control group, OR and their 95%CI were calculated to delineate the risk factors. RESULTS In multivariate analyses, patients aged younger than 1 year (OR compared with 1-2-year-olds = 6.57) and those older than 5 years (OR compared with 1-2-year-olds = 4.24), those who received additional intravenous immunoglobulin (IVIG) without the use of steroid (OR = 8.38) and those who received steroid administration with or without the additional use of IVIG (OR = 220.51 and 83.83, respectively), showed significantly higher OR for giant coronary aneurysms. As for IVIG therapy, the additional use of IVIG (OR = 14.84), total dosage of IVIG exceeding 2500 mg/kg (OR compared with 1500-2499 mg/kg = 12.26) and the duration of IVIG administration for more than 3 days (OR = 30.12), were found to significantly increase the risk of developing giant aneurysms in univariate analyses that were adjusted for sex and age. CONCLUSIONS The observation of 53 patients with giant coronary aneurysms due to Kawasaki disease among those included in the nationwide survey presented some risk factors, together with considerations about the associated aneurysms.
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Affiliation(s)
- Daisuke Sudo
- Department of Public Health, Jichi Medical University, Tochigi, Japan
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Lin YT, Manlhiot C, Ching JCY, Han RK, Nield LE, Dillenburg R, Pepelassis D, Lai LS, Smythe JF, Chahal N, Yeung RSM, McCrindle BW. Repeated systematic surveillance of Kawasaki disease in Ontario from 1995 to 2006. Pediatr Int 2010; 52:699-706. [PMID: 20113416 DOI: 10.1111/j.1442-200x.2010.03092.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rising incidences of Kawasaki disease (KD) have been reported worldwide. Reported herein are the results of 4 triennial KD surveillances conducted in Ontario. METHODS Between 1995 and 2006 all hospitals in Ontario were asked on 4 occasions to identify all patients with discharge diagnoses of KD and report incident cases. RESULTS The latest surveillance identified 697 new KD patients (100% response rate) for a total of 2378 KD patients through all 4 surveillances. Yearly incidence was 26.2/100,000 for <5 years old, 6.7/100,000 for 5-9 years old and 0.9/100,000 for 10-14 years old. KD incidence significantly increased from 1995 to 2006, although the increase seemed to plateau between the 3rd and 4th surveillance. There was an increase in the proportion of patients diagnosed with incomplete KD and a significant reduction in the rate of coronary artery abnormalities, possibly due to better disease recognition and treatment. Hospitals reporting <20 cases per surveillance were found to be more likely to report cases with incomplete KD. These patients were also less likely to be treated with i.v. immunoglobulin and aspirin but were more likely to be treated with antibiotics, suggesting uncertainties regarding diagnosis and management of KD patients in those centers. CONCLUSIONS The incidence of KD in Ontario is possibly one of the highest outside of Asia and has been rising since 1995. Although the most recent surveillance demonstrated improved cardiac outcomes, treatment delays or absence thereof continue to be a problem. Effective diagnosis and prompt treatment remain critical aspects of KD management.
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Affiliation(s)
- Yahui T Lin
- Labatt Family Heart Centre, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
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Dillon MJ, Eleftheriou D, Brogan PA. Medium-size-vessel vasculitis. Pediatr Nephrol 2010; 25:1641-52. [PMID: 19946711 PMCID: PMC2908435 DOI: 10.1007/s00467-009-1336-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/10/2009] [Accepted: 09/11/2009] [Indexed: 01/20/2023]
Abstract
Medium-size-artery vasculitides do occur in childhood and manifest, in the main, as polyarteritis nodosa (PAN), cutaneous PAN and Kawasaki disease. Of these, PAN is the most serious, with high morbidity and not inconsequential mortality rates. New classification criteria for PAN have been validated that will have value in epidemiological studies and clinical trials. Renal involvement is common and recent therapeutic advances may result in improved treatment options. Cutaneous PAN is a milder disease characterised by periodic exacerbations and often associated with streptococcal infection. There is controversy as to whether this is a separate entity or part of the systemic PAN spectrum. Kawasaki disease is an acute self-limiting systemic vasculitis, the second commonest vasculitis in childhood and the commonest cause of childhood-acquired heart disease. Renal manifestations occur and include tubulointerstitial nephritis and renal failure. An infectious trigger and a genetic predisposition seem likely. Intravenous immunoglobulin (IV-Ig) and aspirin are effective therapeutically, but in resistant cases, either steroid or infliximab have a role. Greater understanding of the pathogenetic mechanisms involved in these three types of vasculitis and better long-term follow-up data will lead to improved therapy and prediction of prognosis.
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Affiliation(s)
- Michael J Dillon
- Nephrourology Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Ozdemir H, Ciftçi E, Tapisiz A, Ince E, Tutar E, Atalay S, Dogru U. Clinical and epidemiological characteristics of children with Kawasaki disease in Turkey. J Trop Pediatr 2010; 56:260-2. [PMID: 20007257 DOI: 10.1093/tropej/fmp110] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is the leading cause of acquired heart disease in childhood in the developed countries. The objective of this study is to describe the clinical and epidemiological characteristics of children with KD in Turkey. METHODS The medical records of 24 patients treated for KD between January 1994 and June 2009 at Ankara University Medical School, Turkey were reviewed. RESULTS The male-to-female ratio was 1.4 : 1. The median age at diagnosis was 2 years (range: 6.5 months to 11 years). Conjunctivitis and changes in the lips and oral cavity were seen in 21/24 (87.5%), cervical lymphadenopathy 17/24 (70.8%), polymorphous rash 16/24 (66.7%) and peripheral changes in 12/24 (50%). Coronary artery abnormality (CAA) was observed in 8/24 (33.3%) cases. CAA was seen in both the complete and incomplete groups with similar frequency (31.3% vs. 37.5%, respectively). CONCLUSIONS KD must be kept in mind in the differential diagnosis of infants with prolonged fever.
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Affiliation(s)
- Halil Ozdemir
- Department of Pediatrics, Ankara University Medical School, Dikimevi, Ankara, Turkey.
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Heuclin T, Dubos F, Hue V, Godart F, Francart C, Vincent P, Martinot A. Increased detection rate of Kawasaki disease using new diagnostic algorithm, including early use of echocardiography. J Pediatr 2009; 155:695-9.e1. [PMID: 19595368 DOI: 10.1016/j.jpeds.2009.04.058] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 02/19/2009] [Accepted: 04/24/2009] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the incidence of Kawasaki disease (KD) in Northern France by using new American Heart Association (AHA) criteria. STUDY DESIGN A 1-year prospective multicenter cohort study was performed in all pediatric departments. Patients <18 years old, who were admitted for prolonged but initially unexplained fever or suspected KD were included. All patients received the standard treatment considered appropriate by their physicians. A descriptive analysis and comparison of patients with complete and incomplete forms of KD were performed. The incidence of confirmed cases of KD (complete and incomplete forms) was calculated. RESULTS Seventy-seven children were included (39 in whom KD was diagnosed). Of the patients with KD, 26 (67%) met the classic AHA case definition, and 7 (18%) had incomplete KD. Cardiac ultrasound scanning was helpful in the diagnosis of 6 of 7 patients with incomplete KD (86%). The final incidence of confirmed KD was 9 of 100,000 children <5 years of age. In 6 children (15%) the diagnosis of KD was uncertain, but they were successfully treated for it. Coronary disease was identified in 48% of patients with confirmed KD. CONCLUSION The incidence of KD is higher than previously reported, in part because earlier reports did not include incomplete forms. New AHA criteria (laboratory tests and early echocardiography) were helpful for the diagnosis of incomplete forms of KD.
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Affiliation(s)
- Thérèse Heuclin
- Lille University Hospital, Faculté de Médecine Henri Warembourg, Lille-2 University, Lille, France
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