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Huang YN, Lin CY, Chi H, Chiu NC, Huang DTN, Chang L, Kung YH, Huang CY. Jaundice-predominant manifestation of Kawasaki disease in children. Front Pediatr 2024; 11:1281909. [PMID: 38264503 PMCID: PMC10803413 DOI: 10.3389/fped.2023.1281909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
Background A jaundice-predominant presentation of Kawasaki disease (KD) is atypical. Methods A total of 12 children with KD with a predominant manifestation of jaundice at MacKay Children's Hospital were reviewed, along with 42 cases reported in the literature since 1990. Results The median age of the 12 patients was 1.85 years (range: 3 months-4 years), and 66.6% were male. All of the patients had elevated liver function at presentation, 50% had hydrops of the gallbladder, and almost 60% had gastrointestinal symptoms and signs. Complete KD was evident in 11 of the 12 patients (91.7%), and two patients (16.7%) had recurrent episodes. All of the patients received intravenous immunoglobulin (IVIG); however, one-third were refractory to treatment. Corticosteroids were used in five (41.7%) of the patients. Three (25%) of the patients had shock, and seven (58.3%) had coronary artery abnormalities, of whom one (8.3%) had persistent coronary artery aneurysm and the others recovered. A review of the 42 cases in the literature showed that the children with a jaundice-predominant presentation of KD had high rates of IVIG-refractory disease (25%), coronary artery abnormalities (25%), shock (13.2%), and corticosteroid treatment (24.2%). Conclusions Children with KD presenting with a jaundice-predominant manifestation are at a higher risk of IVIG-refractory disease, coronary artery abnormalities, and more recurrent episodes. Physicians should be aware of the risk of shock in this population.
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Affiliation(s)
- Ya-Ning Huang
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
| | - Hsin Chi
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Daniel Tsung-Ning Huang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Lung Chang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Tamshui MacKay Memorial Hospital, Taipei, Taiwan
| | - Yen-Hsin Kung
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Tamshui MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
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Yang MC, Wu KL, Huang CN, Liu YC, Chien YH, Fu CM, Lim HK, Chin CY, Wu JR, Liu HM, Sun LC, Lee CY, Su YH, Wang YF, Lin MT. Kawasaki disease in children with Bacillus Calmette-Guérin scar reactivity: Focus on coronary outcomes. J Formos Med Assoc 2023; 122:1001-1007. [PMID: 37142476 DOI: 10.1016/j.jfma.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/19/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND /Purpose: Reactivity at the Bacillus Calmette-Guérin (BCG) scar is a pathognomonic feature of Kawasaki disease (KD). However, its value in predicting KD outcomes has not been emphasized. This study explored the clinical significance of BCG scar redness with respect to coronary artery outcomes. METHODS This retrospective study collected data on children with KD from 13 hospitals in Taiwan during 2019-2021. Children with KD were categorized into four groups based on the KD type and BCG scar reactivity. Risk factors of coronary artery abnormalities (CAA) were analyzed in all groups. RESULTS BCG scar redness occurred in 49% of 388 children with KD. BCG scar redness was associated with younger age, early intravenous immunoglobulin (IVIG) treatment, hypoalbuminemia, and CAA at the first echocardiogram (p < 0.01). BCG scar redness (RR 0.56) and pyuria (RR 2.61) were independent predictors of any CAA within 1 month (p < 0.05). Moreover, pyuria (RR 5.85, p < 0.05) in children with complete KD plus BCG scar redness was associated with CAA at 2-3 months; first IVIG resistance (RR 15.2) and neutrophil levels ≥80% (RR 8.37) in children with complete KD plus BCG scar non-redness were associated with CAA at 2-3 months (p < 0.05). We failed to detect any significant risk factors of CAA at 2-3 months in children with incomplete KD. CONCLUSION BCG scar reactivity contributes to diverse clinical features in KD. It can be effectively applied to determine the risk factors of any CAA within 1 month and CAA at 2-3 months.
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Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kun-Lang Wu
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Chi-Nan Huang
- Department of Pediatrics, Taipei City Hospital, Taipei, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Hing-Ka Lim
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Chia-Yi Chin
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsin-Ming Liu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Li-Chen Sun
- Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Chee-Yew Lee
- Department of Pediatrics, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Yi-Hsuan Su
- Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Fang Wang
- Department of Pediatrics, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
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3
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Osei FA, Hill S, Thomas-Messado LG. A 2-Month-Old with Kawasaki Disease with Coronary Artery Dilation in the Pre-COVID-19 Era. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933356. [PMID: 34775461 PMCID: PMC8607050 DOI: 10.12659/ajcr.933356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Patient: Male, 2-month-old
Final Diagnosis: Kawasaki disease
Symptoms: Bleeding and peeling lips • conjunctival injection • erythema of the palms and soles • erythematous (polymorphous) maculopapular rash • fever • nasal congestion
Medication: —
Clinical Procedure: Echocardiography • electrocardiogram
Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Frank A Osei
- Department of Pediatrics, Children's of Mississippi, University of Mississippi Medical Center, Tupelo, MS, USA.,North Mississippi Medical Center, Tupelo, MS, USA
| | - Sue Hill
- North Mississippi Medical Center, Tupelo, MS, USA
| | - Lisa-Gaye Thomas-Messado
- Department of Pediatrics, Children's of Mississippi, University of Mississippi Medical Center, Tupelo, MS, USA.,North Mississippi Medical Center, Tupelo, MS, USA
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Current Approach to the Evaluation and Management of Incomplete Kawasaki Disease in the Emergency Department. Pediatr Emerg Care 2020; 36:537-541. [PMID: 33122594 DOI: 10.1097/pec.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kawasaki disease (KD) is one of the most common vasculitides of childhood and frequently presents to the emergency department. Although the diagnosis of KD is based on clinical criteria, children who do not fulfill the criteria but have sufficient supportive features of KD are diagnosed as having incomplete KD and warrant the same course of therapy as children with classic KD. The diagnosis of incomplete KD is challenging and requires a high index of suspicion. The purpose of this article is to review presenting features of incomplete KD and the diagnostic approach and management of children in the emergency department.
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Abstract
RATIONALE Extremes of age is an important risk factor for the development of coronary arteries aneurysms (CAAs) associated to Kawasaki disease (KD) along with male gender, prolonged fever and a delay in diagnosis or treatment. PATIENT CONCERNS We report two cases of KD in the extremes of age, a 5-month-old male infant and a 9-year-old child in order to underline the features of this disorder outside the typical age range of 1 to 4 years. The 5-month-old male was admitted in our clinic for generalized polymorphous exanthema and fever for approximately 7 days. The laboratory test pointed out leukocytosis and increased inflammatory biomarkers. The 9-year-old male child was admitted in our clinic for fever and submandibular adenopathy. The onset was approximately 5 days before the admission with a sudden development of unilateral, painless, submandibular lymphadenopathy for which the ENT specialist recommended antibiotics and nonsteroid anti-inflammatory drugs. In the 2nd day of admission, he presented severe desquamation of hands and soles. DIAGNOSIS Both cases were diagnosed with KD. The echocardiography showed no cardiac impairment in the infant, while in the older patient it revealed mild dilation of the left coronary artery. INTERVENTIONS Both patients received intravenously immunoglobulin and pulsed methylprednisolone. OUTCOMES The evolution was favorable in both cases, but in the infant, the C-reactive protein levels persisted mildly elevated for approximately 2 months after the diagnosis. LESSONS The peculiarities of KD in the extremes of age are related to a higher frequency of incomplete features and an increased incidence of coronary artery lesions resulting in a delay of the diagnosis, and subsequent poorer outcomes.
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Affiliation(s)
| | | | - Maria Oana Mărginean
- Department of Paediatric, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Gheorghe Marinescu Street No. 38, Târgu Mures 540136, Romania
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Li W, Zhang L, Huang P, Zhang Z. Clinical features and mid-term follow-up in infants younger than 3 months with Kawasaki disease in a Chinese population. J Paediatr Child Health 2019; 55:523-527. [PMID: 30246351 DOI: 10.1111/jpc.14233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 11/30/2022]
Abstract
AIM To explore the clinical features and mid-term follow-up of Kawasaki disease (KD) in infants younger than 3 months of age in a Chinese population. METHODS We performed a retrospective analysis of clinical signs, laboratory data, echocardiography results and outcomes for patients with KD diagnosed at our hospital from January 2009 to December 2013. A total of 1150 children were diagnosed with KD, and 200 KD patients were enrolled in this study. Group 1 included 40 children younger than 3 months of age. We randomly selected a control group as Group 2 included 160 children older than 3 months of age who fulfilled diagnostic criteria for KD and maintained follow-up for more than 1 year. RESULTS There was a significant difference in clinical manifestations between the two groups, except respiratory infection. Group 1 was more likely to have incomplete presentation (P < 0.001). There were no significant differences in laboratory data except for white blood cell counts between the two groups. Coronary artery abnormalities were significantly different between the two groups (P < 0.001). At a mean follow-up of 18 months (range 12-48 months), all patients with coronary artery abnormalities, except for giant coronary aneurysms, returned to normal in terms of diameter as assessed by echocardiography. CONCLUSIONS Infants younger than 3 months of age with KD often present with incomplete criteria, and diagnosis may be delayed. In addition, there may be a higher risk of developing coronary artery abnormalities. All patients except those with giant coronary aneurysms recovered well without complications at mid-term follow-up.
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Affiliation(s)
- Wei Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Affiliated South China Hospital, Southern Medical University, Guangdong General Hospital, Guangzhou, China.,Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Li Zhang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ping Huang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhiwei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Affiliated South China Hospital, Southern Medical University, Guangdong General Hospital, Guangzhou, China
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Abstract
RATIONALE Coronary artery lesion is the most prominent cardiac manifestation in Kawasaki disease. However, few cases of life-threatening cardiac arrhythmia were reported in the acute phase of Kawasaki disease. PATIENT CONCERNS A 1-year-old girl presented in the hospital with ventricular premature beats and ventricular tachycardia after 2 days of fever. DIAGNOSIS On the fifth day of fever, the diagnosis of Kawasaki disease was achieved. INTERVENTIONS Immunoglobulin was administered. OUTCOME The temperature became normal and ventricular arrhythmia disappeared. LESSONS This case suggests that Kawasaki disease has various clinical manifestations besides typical features, and it can cause life-threatening cardiac arrhythmia in the acute phase with normal coronary artery and normal cardiac function.
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Affiliation(s)
- Fan Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Xiaoqing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
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8
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Downie ML, Manlhiot C, Collins TH, Chahal N, Yeung RS, McCrindle BW. Factors associated with development of coronary artery aneurysms after Kawasaki disease are similar for those treated promptly and those with delayed or no treatment. Int J Cardiol 2017; 236:157-161. [DOI: 10.1016/j.ijcard.2017.01.068] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/06/2017] [Indexed: 11/15/2022]
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9
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Telcharova-Mihaylovska A, Nikolova I, Marinov R, Stefanov S, Gaidarova M, Ganeva M, Temelkova K. Kawasaki disease – experience of Pediatric University Hospital, Sofia, Bulgaria, 1993–2014. Part I: clinical manifestations. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1316683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Petrarca L, Nenna R, Versacci P, Frassanito A, Cangiano G, Nicolai A, Scalercio F, Russo LL, Papoff P, Moretti C, Midulla F. Difficult diagnosis of atypical kawasaki disease in an infant younger than six months: a case report. Ital J Pediatr 2017; 43:30. [PMID: 28274249 PMCID: PMC5341178 DOI: 10.1186/s13052-017-0345-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/25/2017] [Indexed: 12/18/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute inflammatory vasculitis of unknown origin. Case presentation We report the case of a 5-month-old child with an atypical form of KD, characterized by undulating symptoms, who developed an aneurysm of the right coronary artery and an ectasia of the left anterior descending coronary artery. Conclusion This case report underlines the difficulties in recognizing incomplete forms of the illness in young infants, who are at higher risk of cardiac complications.
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Affiliation(s)
- L Petrarca
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - R Nenna
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - P Versacci
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - A Frassanito
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - G Cangiano
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - A Nicolai
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - F Scalercio
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - L Lo Russo
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - P Papoff
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - C Moretti
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - F Midulla
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy.
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Multimodality Cardiac Imaging in a Patient with Kawasaki Disease and Giant Aneurysms. Case Rep Pediatr 2016; 2016:4298098. [PMID: 27872783 PMCID: PMC5107831 DOI: 10.1155/2016/4298098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/05/2016] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease is a well-known cause of acquired cardiac disease in the pediatric and adult population, most prevalent in Japan but also seen commonly in the United States. In the era of intravenous immunoglobulin (IVIG) treatment, the morbidity associated with this disease has decreased, but it remains a serious illness. Here we present the case of an adolescent, initially diagnosed with Kawasaki disease as an infant, that progressed to giant aneurysm formation and calcification of the coronary arteries. We review his case and the literature, focusing on the integral role of multimodality imaging in managing Kawasaki disease.
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12
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Koca T, Aslan N, Akaslan Kara A, Pektas A, Ozen M, Akcam M. Kawasaki disease in a 9-year old girl presenting with febrile cholestasis: case report and review of literature. Int J Rheum Dis 2015; 21:2046-2049. [PMID: 26177575 DOI: 10.1111/1756-185x.12700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Kawasaki disease is a systemic vasculitis that develops during childhood, especially in those younger than 5 years. Gastrointestinal involvement does not belong to the classic diagnostic criteria. We reported here, a 9-year old girl who presented with febrile cholestasis, and developed a medium right coronary artery aneurysm despite intravenous immunoglobulin administration on the 9th day of fever. Hepatobiliary ultrasonographic evaluation revealed normal findings. Seroimmunologic markers of cholestasis were negative. Her clinical feature was ameliorated shortly after a second dose of intravenous immunoglobulin administration. We consider that a high index of suspicion of Kawasaki disease could prevent delayed diagnosis and complications.
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Affiliation(s)
- Tugba Koca
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, S. Demirel University School of Medicine, Isparta, Turkey
| | - Nagehan Aslan
- Department of Pediatrics, S. Demirel University School of Medicine, Isparta, Turkey
| | - Aybuke Akaslan Kara
- Division of Pediatric Infectious Diseases, S. Demirel University School of Medicine, Isparta, Turkey
| | - Ayhan Pektas
- Division of Pediatric Cardiology, Department of Pediatrics, Afyon Kocatepe University School of Medicine, Afyon, Turkey
| | - Metehan Ozen
- Division of Pediatric Infectious Diseases, S. Demirel University School of Medicine, Isparta, Turkey
| | - Mustafa Akcam
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, S. Demirel University School of Medicine, Isparta, Turkey
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Ye Q, Shao WX, Shang SQ, Zhang T, Hu J, Zhang CC. A Comprehensive Assessment of the Value of Laboratory Indices in Diagnosing Kawasaki Disease. Arthritis Rheumatol 2015; 67:1943-50. [PMID: 25778686 DOI: 10.1002/art.39112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/05/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Qing Ye
- The Children's Hospital of Zhejiang University School of Medicine and Zhejiang Key Laboratory for the Diagnosis and Treatment of Neonatal Diseases; Hangzhou China
| | - Wen-xia Shao
- Hangzhou First People's Hospital; Hangzhou China
| | - Shi-qiang Shang
- The Children's Hospital of Zhejiang University School of Medicine; Hangzhou China
| | - Ting Zhang
- Zhejiang Chinese Medical University; Hangzhou China
| | - Jian Hu
- The Children's Hospital of Zhejiang University School of Medicine; Hangzhou China
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14
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Yim D, Curtis N, Cheung M, Burgner D. An update on Kawasaki disease II: clinical features, diagnosis, treatment and outcomes. J Paediatr Child Health 2013; 49:614-23. [PMID: 23647873 DOI: 10.1111/jpc.12221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2012] [Indexed: 01/30/2023]
Abstract
This is the second of two updates on Kawasaki disease. The first review focused on epidemiology and aetio-pathogenesis. Here, we review the clinical features and diagnosis of Kawasaki disease, as well as recent evidence on treatment, follow-up and cardiovascular outcomes.
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Affiliation(s)
- Deane Yim
- Department of Cardiology, The University of Melbourne, Melbourne, Victoria, Australia
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15
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16
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Abstract
Kawasaki disease (KD) is characterized by persistent fever in addition to 4 of 5 signs of mucocutaneous inflammation. Although gastrointestinal involvement does not belong to the classic diagnostic criteria, it has been often associated with KD onset. We reviewed patients who were admitted for febrile cholestatic jaundice between 2003 and 2010 in 2 tertiary pediatric care centers. KD was the second most frequent cause (21%) after viral infections. Considering the relative high frequency of this condition, a high index of suspicion of KD should be maintained in patients presenting with febrile cholestatic jaundice.
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Falcini F, Capannini S, Rigante D. Kawasaki syndrome: an intriguing disease with numerous unsolved dilemmas. Pediatr Rheumatol Online J 2011; 9:17. [PMID: 21774801 PMCID: PMC3163180 DOI: 10.1186/1546-0096-9-17] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 07/20/2011] [Indexed: 12/13/2022] Open
Abstract
More than 40 years have passed since Kawasaki syndrome (KS) was first described. Yet KS still remains an enigmatic illness which damages the coronary arteries in a quarter of untreated patients and is the most common cause of childhood-acquired heart disease in developed countries. Many gaps exist in our knowledge of the etiology and pathogenesis of KS, making improvements in therapy difficult. In addition, many KS features and issues still demand further efforts to achieve a much better understanding of the disease. Some of these problem areas include coronary artery injuries in children not fulfilling the classic diagnostic criteria, genetic predisposition to KS, unpredictable ineffectiveness of current therapy in some cases, vascular dysfunction in patients not showing echocardiographic evidence of coronary artery abnormalities in the acute phase of KS, and risk of potential premature atherosclerosis. Also, the lack of specific laboratory tests for early identification of the atypical and incomplete cases, especially in infants, is one of the main obstacles to beginning treatment early and thereby decreasing the incidence of cardiovascular involvement. Transthoracic echocardiography remains the gold-standard for evaluation of coronary arteries in the acute phase and follow-up. In KS patients with severe vascular complications, more costly and potentially invasive investigations such as coronary CT angiography and MRI may be necessary. As children with KS with or without heart involvement become adolescents and adults, the recognition and treatment of the potential long term sequelae become crucial, requiring that rheumatologists, infectious disease specialists, and cardiologists cooperate to develop specific guidelines for a proper evaluation and management of these patients. More education is needed for physicians and other professionals about how to recognize the long-term impact of systemic problems related to KS.
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Affiliation(s)
- Fernanda Falcini
- Department of BioMedicine, Section of Rheumatology, Transition Clinic, University of Florence, Florence, Italy.
| | - Serena Capannini
- Department of BioMedicine, Section of Rheumatology, Transition Clinic, University of Florence, Florence, Italy
| | - Donato Rigante
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy
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Dodi I, Raggi V, Verna M, Tchana B, Vignali D, Bandello MA, Lacava S, Izzi GC, Agnetti A. Atipical Kawasaki disease with coronary aneurysm in infant. Ital J Pediatr 2011; 37:19. [PMID: 21496328 PMCID: PMC3102615 DOI: 10.1186/1824-7288-37-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 04/17/2011] [Indexed: 12/03/2022] Open
Abstract
Kawasaki disease is an acute febrile disease of unknown etiology, characterized by systemic vascular inflammation involving the small and medium sized arteries, with a predilection for the coronary arteries. It represents the leading cause of acquired heart diseases in children in developed countries. Diagnosis, difficult because of the clinical characteristics of the disease with typical signs and symptoms appearing sequentially and not simultaneously, may be even more complicated in case of unusual presentation, leading to delay in recognition, particularly in infant in whom a higher incidence of coronary arteries aneurysms has been reported. A high index of suspicion of Kawasaki disease must be maintained in case of prolonged fever in these patients. Timely appropriate treatment is essential to avoid severe sequels. We report the case of a 2 months old male infant with persistent febrile episode, transferred to us from another institution, who presented on echocardiography giant aneurysms on both coronary arteries.
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Affiliation(s)
- Icilio Dodi
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Parma University Hospital, Italy.
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Abstract
OBJECTIVE To investigate the epidemiological characteristics of Kawasaki disease in Jilin province of China and explore its clinical features. METHODS The medical records of children with Kawasaki disease hospitalised in the First Affiliated Hospital of Jilin University and Yanbian University between January, 2000 and December, 2008 were retrospectively analysed. RESULTS A total of 735 children with Kawasaki disease were enrolled in this study with 483 boys and 252 girls. The ratio of male to female was 1.92:1. The ages of the children at onset varied from 51 days to 12 years with a mean age of 2.8 years. The children under the age of 5 years accounted for 79.5%, but most children were 2-3 years old. Kawasaki disease occurred all the year and more frequently in both the ending of spring and the beginning of summer. Fever was the most common clinical feature and enlarged cervical lymph nodes were the smallest clinical feature. A cardiovascular lesion was found in 41.4% of these children, in whom coronary artery dilatation was the most common (26.97%). A total of 117 (18.2%) of 643 children (87.5%) receiving intravenous immunoglobulin had a non-response to gamma globulin. Of the 117 children, 66 (56.4%) had cardiovascular lesion. Kawasaki disease recurred in 19 children (2.6%). CONCLUSION The incidence of Kawasaki disease in Jilin province has shown an increasing tendency. The age at onset is slightly higher than that described in other reports. Kawasaki disease is the most common in both the ending of spring and the beginning of summer, and the second incidence peak occurs in autumn.
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Yellen ES, Gauvreau K, Takahashi M, Burns JC, Shulman S, Baker AL, Innocentini N, Zambetti C, Pancheri JM, Ostrow A, Frazer JR, Sundel RP, Fulton DR, Newburger JW. Performance of 2004 American Heart Association recommendations for treatment of Kawasaki disease. Pediatrics 2010; 125:e234-41. [PMID: 20100771 PMCID: PMC2896313 DOI: 10.1542/peds.2009-0606] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The 2004 American Heart Association (AHA) statement included a clinical case definition and an algorithm for diagnosing and treating suspected incomplete Kawasaki disease (KD). We explored the performance of these recommendations in a multicenter series of US patients with KD with coronary artery aneurysms (CAAs). METHODS We reviewed retrospectively records of patients with KD with CAAs at 4 US centers from 1981 to 2006. CAAs were defined on the basis of z scores of >3 or Japanese Ministry of Health and Welfare criteria. Our primary outcome was the proportion of patients presenting at illness day < or =21 who would have received intravenous immunoglobulin (IVIG) treatment by following the AHA guidelines at the time of their initial presentation to the clinical center. RESULTS Of 195 patients who met entry criteria, 137 (70%) met the case definition and would have received IVIG treatment at presentation. Fifty-three patients (27%) had suspected incomplete KD and were eligible for algorithm application; all would have received IVIG treatment at presentation. Of the remaining 5 patients, 3 were excluded from the algorithm because of fever for <5 days at presentation and 2 because of <2 clinical criteria at >6 months of age. Two of these 5 patients would have entered the algorithm and received IVIG treatment after follow-up monitoring. Overall, application of the AHA algorithm would have referred > or =190 patients (97%) for IVIG treatment. CONCLUSIONS Application of the 2004 AHA recommendations, compared with the classic criteria alone, improves the rate of IVIG treatment for patients with KD who develop CAAs. Future multicenter prospective studies are needed to assess the performance characteristics of the AHA algorithm in febrile children with incomplete criterion findings and to refine the algorithm further.
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Affiliation(s)
- Elizabeth S. Yellen
- Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Kimberlee Gauvreau
- Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Masato Takahashi
- Department of Cardiology, Children’s Hospital of Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jane C. Burns
- Department of Pediatrics, Rady Children’s Hospital San Diego and School of Medicine, University of California, San Diego, California
| | - Stanford Shulman
- Department of Pediatrics, Children’s Memorial Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Annette L. Baker
- Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Nancy Innocentini
- Department of Pediatrics, Children’s Memorial Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Chiara Zambetti
- Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Joan M. Pancheri
- Department of Pediatrics, Rady Children’s Hospital San Diego and School of Medicine, University of California, San Diego, California
| | - Adam Ostrow
- Department of Cardiology, Children’s Hospital of Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey R. Frazer
- Department of Pediatrics, Rady Children’s Hospital San Diego and School of Medicine, University of California, San Diego, California
| | - Robert P. Sundel
- Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - David R. Fulton
- Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jane W. Newburger
- Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Harvard University, Boston, Massachusetts
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Abstract
Kawasaki disease (KD) is the most common systemic vasculitis in childhood after Henoch-Schonlein purpura, and the most common cause of acquired heart disease among children living in Western countries. Its diagnosis relies on clinical findings; laboratory tests are useful to rule out other causes of unexplained fever but are not specific for the diagnosis of KD. Numerous efforts to produce a diagnostic algorithm have been made, but without success. Expert opinion is therefore required in doubtful cases, especially those that lack classical criteria (the so-called atypical or incomplete cases). Renal, gastrointestinal, neurologic, pulmonary and ocular involvements have all been described. Infants may be at higher risk of complications since recognising manifestations of the disease might be more difficult in this group. Approaches to treatment and follow-up of KD are changing in parallel with changes in concepts of what constitutes classical and incomplete KD. Guiding this evolution is the probability that the diagnosis is actually KD, the duration of the child's illness and the desired effects of therapy. Until a gold standard for diagnosing KD is available, these therapeutic decisions will continue to be made on an individual basis.
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Affiliation(s)
- R Cimaz
- AOU Meyer and University of Florence, 50139 Florence, Italy.
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Kawasaki disease after vaccination: reports to the vaccine adverse event reporting system 1990-2007. Pediatr Infect Dis J 2009; 28:943-7. [PMID: 19755926 DOI: 10.1097/inf.0b013e3181a66471] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is a multisystemic vasculitis primarily affecting children<5 years. A review of RotaTeq (rotavirus vaccine live) clinical trial data revealed higher, though not statistically significantly, KD rates among RotaTeq vaccines than placebo recipients. In June 2007, the RotaTeq label was revised accordingly. OBJECTIVES To describe and assess KD reported to Vaccine Adverse Event Reporting System (VAERS) for all US licensed vaccines. METHODS We reviewed all KD reports received by VAERS from 1990 through mid-October 2007. Cases were characterized by age, gender, onset interval, and vaccine type. Proportional reporting ratio (PRR) was used to evaluate KD reporting for each vaccine compared with all others. Reporting rates were calculated using number of doses distributed as denominator. RESULTS Through October 14, 2007, 107 KD reports were received by VAERS: 26 were categorized as classic cases, 19 atypical, 52 possible, and 10 were noncases. Of the 97 cases, 91% were children<5 years. There was no clustering of onset intervals after day 1 postvaccination. Before the RotaTeq label revision, the KD PRR was elevated only for Pediarix (DTaP, hepB, and IPV combined) but the KD reporting rate for Pediarix (0.59/100,000 person-years) was much lower than the background incidence rate (9-19/100,000 person-years) for children<5 years in the United States. After the revision, reporting of KD for RotaTeq was stimulated but the reporting rate for RotaTeq (1.47/100,000 person-years) was still much lower than the background rate. CONCLUSIONS Our review does not suggest an elevated KD risk for RotaTeq or other vaccines. Continued postmarketing monitoring for KD is ongoing.
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Song D, Yeo Y, Ha K, Jang G, Lee J, Lee K, Son C, Lee J. Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. Eur J Pediatr 2009; 168:1315-21. [PMID: 19159953 DOI: 10.1007/s00431-009-0925-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age. MATERIALS AND METHODS From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings. RESULTS While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1 +/- 3.3 vs 6.3 +/- 1.9 days, p = 0.002) and showed fewer diagnostic symptoms (3.0 +/- 1.2 vs 4.3 +/- 1.1, p < 0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1 +/- 10.4 vs 6.5 +/- 1.9 days, p = 0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9 +/- 9.6 vs 1.1 +/- 0.8 days, p = 0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR = 0.494, 95% confidence interval (CI) = 0.281-0.871, p = 0.015) in the younger group and the duration of post-IVGG fever (OR = 1.958, 95% CI = 1.098-3.492, p = 0.023) and the Harada score (OR = 3.455, 95% CI = 1.012-11.796, p = 0.048) in the older group. CONCLUSION Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.
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Affiliation(s)
- DooIl Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea
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Papadodima SA, Sakelliadis EI, Goutas ND, Vlachodimitropoulos DG, Spiliopoulou CA. Atypical kawasaki disease presenting with symptoms from the genitourinary system: an autopsy report. J Trop Pediatr 2009; 55:55-7. [PMID: 18669530 DOI: 10.1093/tropej/fmn065] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Symptoms from the genitourinary system are unusual in Kawasaki disease (KD). Renal involvement is even rarer and it is confirmed by biopsy when the person is alive. We describe the case of an 11-year-old boy admitted to the hospital complaining about prolonged fever (5 days) and hematuria. His urinalysis showed also pyuria, proteinuria and urinary renal tubular epithelial cells concentrations. During the next days, the patient presented limb edema. After almost 2 weeks of hospitalization the patient was transferred to the intensive care unit because of melena and intense abdominal pain. Upon admission, the patient collapsed and died. The diagnosis of KD was established during autopsy. The macroscopical and histopathological examination of the heart showed increased dimensions and weight and multiple thrombi in the coronary arteries with intramural dense polymorphonuclear inflammatory infiltration and necrosis. Histological examination of the kidneys revealed normal glomerulus, mild expansion of mesangial matrix, interstitial infiltration with lymphocytes, plasmatocytes and eosinophiles, normal vessels and normal immunofluorescence.
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Affiliation(s)
- Stavroula A Papadodima
- Department of Forensic Medicine & Toxicology, National & Kapodistrian University of Athens, Greece.
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Yeo Y, Kim T, Ha K, Jang G, Lee J, Lee K, Son C, Lee J. Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr 2009; 168:157-62. [PMID: 18478263 DOI: 10.1007/s00431-008-0722-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 03/20/2008] [Accepted: 03/24/2008] [Indexed: 11/24/2022]
Abstract
Kawasaki disease (KD) patients younger than 1 year of age are at especially high risk of developing coronary artery abnormalities (CAA). To define the clinical characteristics of this group, as well as the risk factors predisposing them to CAA, we reviewed the medical records of 136 KD patients younger than 1 year of age who were treated at the Korea University Medical Center from January 2001 to July 2006. Of these patients, 16 developed CAA (11.8%). The CAA(+) group had a longer duration of total fever than the CAA(-) group (9.1+/-3.7 days vs. 6.3+/-2.0 days, p=0.011), but did not differ in the duration of pre- and post-intravenous gamma-globulin (IVGG) fever. The CAA(+) group had fewer diagnostic symptoms than the CAA(-) group (2.7+/-1.1 vs. 4.3+/-1.2, p<0.001). Of the hematological findings, the CAA(+) group only differed from the CAA(-) group in having significantly higher total white blood cell (19.2+/-6.0 vs. 14.7+/-4.7 K/mm(3), p=0.007) and platelet (462.9+/-101.0 vs. 383.6+/-121.1 K/mm(3), p=0.014) levels. Multivariable logistic regression analysis showed that the only factors which were significantly associated with the development of CAA were the total number of symptoms (OR=0.493, 95% CI=0.293-0.829, p=0.007) and the duration of total fever (OR=1.405, 95% CI=1.092-1.808, p=0.008). Conclusively, incomplete clinical manifestations and a longer duration of total fever are significantly associated with the development of CAA in KD patients younger than 1 year of age. Therefore, these patients should be monitored for incomplete KD, especially if unexplained fever continues, and treatment to shorten the duration of total fever should be initiated.
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Affiliation(s)
- Yunku Yeo
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
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De Maddi F, Cinelli R, Rigante D, Mazzarella G, Siani P. Lung parenchymal consolidation as an uncommon presentation and cause of delayed diagnosis in atypical Kawasaki syndrome. Rheumatol Int 2008; 29:1373-6. [PMID: 19116718 DOI: 10.1007/s00296-008-0830-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
We report three patients who initially showed prolonged fever, lung parenchymal consolidation and laboratory findings of pneumonia, and secondarily presented a clinical picture ascribed to Kawasaki syndrome. Two of these children developed coronary artery dilations, which regressed upon echocardiography after 12 months. In the case of infants showing broncho-pulmonary abnormalities with slow resolution, active inflammatory parameters and high fever persistence, pediatricians should consider atypical Kawasaki syndrome as a possible alternative diagnosis.
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Affiliation(s)
- Francesco De Maddi
- Department of Pediatrics, Cardarelli National Hospital, 80131 Naples, Italy.
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Abstract
Cardiac emergencies in the first year of life can be anxiety provoking for the health care provider. An understanding of the pathophysiology involved in the most common emergency department presentations is crucial to the development of appropriate treatment plans. This article discusses the most common causes of cyanotic and acyanotic heart disease in infants.
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Juan CC, Hwang B, Lee PC, Lin YJ, Chien JC, Lee HY, Meng CCL. The clinical manifestations and risk factors of a delayed diagnosis of Kawasaki disease. J Chin Med Assoc 2007; 70:374-9. [PMID: 17908651 DOI: 10.1016/s1726-4901(08)70023-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile vasculitis and may cause coronary artery abnormalities. Due to the higher incidence in Asian countries, most pediatricians in Taiwan are familiar with KD. However, there are still some patients being diagnosed 10 days after the onset of the illness and not receiving a highly effective therapy. In this study, we analyzed the risk factors and clinical manifestations of patients with a delayed diagnosis of KD. METHODS A retrospective review was made of the medical records of the patients diagnosed with KD at our institution between January 1996 and December 2005. The patients were divided into 2 groups: early-diagnosis group (EDG: diagnosis was made within 10 days after the onset of the fever) and delayed-diagnosis group (DDG: diagnosis was made 10 days after the onset of the fever). RESULTS Fourteen of a total of 78 children (17.9%) were grouped into the DDG group, and 64 into the EDG group. There were no statistical differences between the 2 groups in terms of age, gender, number of antibiotics used, day of the first medical visit, total days of skin rash, conjunctivitis, mucosa changes, lymphadenopathy or laboratory examinations except for the higher white blood cell count and serum immunoglobulin G level in the DDG group. The patients in the EDG group had a clustered onset of symptoms as compared to the DDG group with a dispersed and late onset of symptoms. There was a higher risk of coronary artery abnormalities in the DDG group than the EDG group (42.9% vs. 14.1%; p = 0.036), and in the patients with KD who were younger than 1 year (29.0% vs. 12.7%; p = 0.043). CONCLUSION Patients with delayed diagnosis of KD were associated with higher risk of developing coronary arterial lesions. It is necessary to develop a diagnostic test for KD and provide more education to health care providers for early recognition of KD.
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Affiliation(s)
- Chien-Chang Juan
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, Yashiro M, Nakamura Y, Yanagawa H. Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 2007; 49:421-6. [PMID: 17587261 DOI: 10.1111/j.1442-200x.2007.02396.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of the present study was to determine the prevalence of coronary artery abnormality (CAA) and other clinical features in patients with incomplete Kawasaki disease (iKD) using the data from the 17th Japanese nationwide survey of KD. METHODS iKD was defined as the presence of four or fewer of the principal symptoms of the Japanese diagnostic guidelines, regardless of whether the patient had CAA. A total of 15,857 cases were analyzed. RESULTS Among 15,857 cases, 83.9% of patients had five to six principal symptoms (complete KD: cKD), and 16.1% had iKD. The prevalence of CAA in cKD was 14.2%, and 18.4% in iKD. The prevalence of CAA in patients with four principal symptoms was 18.1%, which was higher than in cKD cases (14.2%). Although the reliability of the data has some limitations, the prevalence of CAA among patients with one to three symptoms was 19.3%. Among all CAA patients, 14% had four symptoms, and 6% had only one to three symptoms. CONCLUSION Incomplete KD should not be equated with mild KD. Patients with four principal symptoms were comparable to cKD with respect to CAA occurrence. In patients with one to three symptoms also, especially in those under 1 year and older than 4 years of age, other significant symptoms and laboratory findings of the guidelines are very important in making a correct and early diagnosis of iKD so as to prevent CAA.
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Affiliation(s)
- Tomoyoshi Sonobe
- Department of Pediatrics, Japanese Red Cross Medical Center, Tokyo, Japan.
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Nigrovic LE, Nigrovic PA, Harper MB, Chiang VW. Extreme thrombocytosis predicts Kawasaki disease in infants. Clin Pediatr (Phila) 2006; 45:446-52. [PMID: 16891278 DOI: 10.1177/0009922806289621] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infants with Kawasaki disease are at high risk of developing life-threatening coronary complications, yet may elude timely diagnosis because they often lack the full complement of classic clinical features. We retrospectively studied 26,540 children 1 year of age or less who were evaluated at a tertiary care pediatric emergency department in whom a platelet count was performed. Among those infants with fever without a source identified, 8.5% with platelet counts of 800,000 cells/mm(3) or greater had Kawasaki disease compared to 0.4% with platelet counts of less than 800,000 cells/mm(3) (likelihood ratio for Kawasaki disease was 17 [95% confidence interval, 8-34]). Because many infants present atypically, Kawasaki disease should be considered in all children of 1 year or less with prolonged fever, extreme elevation of the platelet count, and no compelling alternative diagnosis.
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Affiliation(s)
- Lise E Nigrovic
- Division of Emergency Medicine, Children's Hospital Boston, Boston, MA 02115, USA
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Abstract
OBJECTIVE Most pediatric providers in Colorado are familiar with Kawasaki syndrome (KS). However, in a recent outbreak, 30% of cases were diagnosed after illness day 10. We hypothesized that these children saw providers who were not familiar with KS, were given antibiotics for other diagnoses that delayed identification, had access-to-care issues, or presented atypically. METHODS A retrospective chart review of 106 consecutive KS cases seen at the Children's Hospital in Denver during 1994-2000 was conducted. RESULTS Twenty-five of 106 children (23.6%) were diagnosed after day 10 of illness (delayed-diagnosis group [DDG]), and these 25 cases were compared with 81 cases diagnosed on or before day 10 (early-diagnosis group [EDG]). There were no differences between patients in the DDG and EDG in age, gender, number of visits, specialty of the primary care physician, time to the first medical visit, number of antibiotics received, coronary artery abnormalities, white blood cell count, or erythrocyte sedimentation rate. Patients in the DDG had significantly more days of fever, rash, red eyes, and oral changes. A platelet count of >450000/mm3 occurred more often in the DDG (56%) than the EDG (30%). After additional analysis, patients in the EDG had close clustering of symptom onset in the first few days of illness, but patients in the DDG had onset of symptoms scattered over 9 days. Patients in the DDG were 2.8 times more likely to have coronary artery aneurysms than patients in the EDG (DDG: 24%; EDG: 8.6%). CONCLUSIONS Diagnosis after the 10th day of illness was not linked to type of medical provider, number of antibiotics received, or number of physician visits. Patients in the DDG exhibited the typical features of KS, but the onset of their symptoms was dispersed over time as opposed to the close clustering of symptoms in the EDG. Because coronary artery aneurysms occurred significantly more often in the patients in the DDG, more education is needed to teach health care providers to have a high index of suspicion for KS in young children presenting with fever/rash illnesses.
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Affiliation(s)
- Marsha S Anderson
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA.
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Affiliation(s)
- Rekwan Sittiwangkul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Maya Enero S, Cols Roig M, Ros Viladoms JB, Pou Fernández J. Enfermedad de Kawasaki en un lactante de tres meses. An Pediatr (Barc) 2004; 61:271-2. [PMID: 15469814 DOI: 10.1016/s1695-4033(04)78809-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Expósito Montes JF, González García RM, Avila Casas A, Alados Arboledas F. Enfermedad de Kawasaki: importancia del diagnóstico precoz. An Pediatr (Barc) 2004; 61:78-9. [PMID: 15228941 DOI: 10.1016/s1695-4033(04)78360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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