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Jiao F, Pan Y, Du Z, Deng F, Yang X, Wang H, Shen J, Xiang W, Mu Z, Gao C, Bai J. Guideline for the diagnosis and treatment of incomplete Kawasaki disease in children in China. BMC Pediatr 2024; 24:477. [PMID: 39060924 PMCID: PMC11282762 DOI: 10.1186/s12887-024-04961-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a pyretic ailment predominantly observed in children aged below 5 years. There is currently a dearth of precise markers for timely identification of incomplete Kawasaki disease (IKD). It is imperative to develop updated, comprehensive, and evidence-based guidelines to effectively direct clinical practice. METHODS The guideline development group comprised individuals with diverse expertise in both content and methodology and carried out an extensive exploration of the following digital repositories: CNKI, VIP, Wanfang Data, UpToDate, BMJ, Clinical Evidence, National Guideline Clearinghouse, Joanna Briggs Institute Library, Cochrane Library, and PubMed. The entire period from the establishment of these databases until January 1, 2024 was covered. To evaluate IKD, systematic reviews and randomised controlled trials were assessed using the risk of prejudice instrument specified in the Cochrane Handbook, along with the evidence robustness framework established by the GRADE group. The recommendations were formulated based on the findings, considering the evidence strength. After several iterations of expert consensus, the relevant professional committees in China endorsed the ultimate guideline. RESULTS These guidelines address clinical questions regarding the classification and definition of KD, diagnosis of IKD, treatment during the acute phase of IKD, and follow-up of IKD. CONCLUSIONS To provide healthcare professionals with guidance and decision-making bases for the diagnosis and treatment of IKD in China, 13 recommendations were formulated based on expert consensus and evidence of best practices.
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Affiliation(s)
- Fuyong Jiao
- Children's Hospital, Shaanxi Provincial People's Hospital, Xian, 710000, China
| | - Yan Pan
- Department of Pediatrics, the First Affiliated Hospital of Yangtze University, Jingzhou, 434000, China.
| | - Zhongdong Du
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100000, China.
| | - Fangming Deng
- Editorial Department of Chinese Journal of Contemporary Pediatrics, Xiangya Hospital, Central South University, Changsha, 410000, China
| | - Xiaodong Yang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, 200120, China
| | - Hong Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, 200120, China
| | - Wei Xiang
- Hainan Women and Children's Medical Center, School of Pediatrics, Hainan Medical University, Haikou, 570100, China
| | - Zhilong Mu
- Children's Hospital, Shaanxi Provincial People's Hospital, Xian, 710000, China
| | - Chunyan Gao
- Department of Pediatrics, the Affiliated Hospital of Yan'an University, Yan'an, 716000, China
| | - Jinmei Bai
- Department of Pediatrics, the Affiliated Hospital of Yan'an University, Yan'an, 716000, China
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Kakimoto N, Suzuki H, Taruya A, Takeuchi T, Suenaga T, Tsuchihashi T, Suzuki T, Shibuta S, Ino Y, Tanaka A, Tokuhara D. Vasa vasorum enhancement on optical coherence tomography in Kawasaki disease. Pediatr Res 2024:10.1038/s41390-024-03431-w. [PMID: 39039326 DOI: 10.1038/s41390-024-03431-w] [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] [Received: 01/31/2024] [Revised: 06/26/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Patients with Kawasaki disease (KD) prone to develop coronary artery aneurysm (CAA) with unknown etiology. We aimed to disclose the relationship between vasa vasorum (VV) and intimal thickening using optical coherence tomography (OCT) in KD. METHODS Forty-three coronary artery branches of 21 patients with KD were examined by OCT. The coronary arteries were classified into three groups: the CAA group (n = 9) in which CAAs remained since the acute phase, the regressed group (n = 16) in which CAAs were regressed, and the no CAA group (n = 18). The number and distribution of VV, and intimal thickening in coronary arteries were evaluated on OCT. RESULTS Intimal thickening was significantly more severe in the CAA and regressed groups than in the no CAA group (median: 481, 474, and 218 μm, p = 0.001 and p < 0.001, respectively). The number of VV in the regressed group was significantly higher than that in the CAA and no CAA groups. The numbers of adventitial VV and internal VV were positively correlated with the intimal thickness (R = 0.64, p < 0.001; R = 0.62, p < 0.001, respectively). In the no CAA group, no internal VV were observed. CONCLUSIONS VV enhances according to intimal thickening, suggesting that VV may have some link to the healing process, such as CAA regression and intimal thickening. IMPACT Kawasaki disease (KD) is a vasculitis syndrome developing coronary artery aneurysm, however its etiology still remains unclear. Coronary artery imaging using optical coherence tomography (OCT) can reveal coronary arterial wall pathology, however OCT studies are limited in patients with KD. Using OCT, we disclosed the closed relationship between vasa vasorum enhancement and regressed coronary arterial lesions. Vasa vasorum enhancement is involved in the pathomechanism of the convalescent phase of KD.
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Affiliation(s)
- Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
- Department of Pediatrics, Wakayama Tsukushi Medical and Welfare Center, Iwade, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Tomohiro Suenaga
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | | | - Takayuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | | | - Yasushi Ino
- Department of Cardiovascular Medicine, Kinan Hospital, Tanabe, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan.
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Zhong X, Wang H, Jia X, Chen G, Li H, Li P, Liu W, Yang T, Xie J. Association of noncoding RNAs with Kawasaki disease: A meta-analysis based on the current evidences. Medicine (Baltimore) 2023; 102:e35736. [PMID: 37960719 PMCID: PMC10637536 DOI: 10.1097/md.0000000000035736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND In recent years, many studies have focused on the relationship between noncoding RNAs (ncRNAs) and Kawasaki disease (KD). Studies have indicated that ncRNAs are associated with the occurrence and development of KD. Thus, we performed a systematic review and meta-analysis to investigate the diagnostic value of ncRNAs in KD patients. METHODS We searched the PubMed, Web of Science, Embase and Cochrane Library, China National Knowledge Infrastructure, VIP, China Biology Medicine disc databases, and Wanfang databases until August 25, 2023 and screened all eligible studies focusing on the diagnostic performance of ncRNAs in KD patients. RESULTS In total, 535 articles were found, and 28 articles were included in this systematic review and meta-analysis. The calculated area under the curve value was 0.880 (95% confidence intervals, 0.840-0.900). The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 0.790, 0.830, 4.610, and 0.260, respectively. The pooled diagnostic odds ratio was 17.890 (95% confidence intervals, 13.110-24.420), indicating a relatively good diagnostic performance of the ncRNAs for detecting KD. In addition, the diagnostic value of micro RNAs in KD was better than that of long noncoding RNAs and circular noncoding RNAs. A subgroup analysis by specimen indicated a better diagnostic value of ncRNAs in plasma and platelet than serum. The diagnostic accuracy of ncRNAs was better in febrile controls than in healthy control groups, indicating a relatively good accuracy in distinguishing KD patients from febrile diseases. CONCLUSIONS This systematic review and meta-analysis demonstrated that ncRNAs could be used as novel biomarkers for detecting KD. More studies should be conducted in the future to verify the diagnostic values of ncRNAs in KD.
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Affiliation(s)
- Xiaoling Zhong
- Department of Pediatrics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
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Kolko N, Bhat YA, Al Mesned A, Al Qwaee A, Al Akhfash A, Alhobani M, Al Anazi I. Comparison of Demographic, Clinical, and Echocardiographic Features Between Complete and Incomplete, and Early and Late Presenters of Kawasaki Disease: A 10-Year Single-Center Experience. Cureus 2023; 15:e45819. [PMID: 37876391 PMCID: PMC10591783 DOI: 10.7759/cureus.45819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
INTRODUCTION The diagnosis of Kawasaki disease (KD) is based mainly on clinical findings and supported by laboratory tests. Complete KD fulfills the main clinical criteria, while incomplete KD includes patients with fewer main criteria and compatible laboratory or echocardiographic findings. The study compares the demographic, clinical, laboratory, and echocardiographic parameters between the complete and incomplete KD and early and late presenters. Moreover, it describes the coronary manifestations of the study population. METHODOLOGY A retrospective review of all patients admitted with a diagnosis of KD during the period from January 2010 to September 2020 was conducted. Clinical presentation, laboratory features, echocardiographic observations, and follow-up data were examined. Moreover, the patients were further classified as early presenters (presented within 10 days of fever onset) and late presenters (presented after 10 days of disease onset). A comparison between complete and incomplete KD and early and late presenters was performed for demographic, clinical, and echocardiographic features. RESULTS A total of 76 patients were admitted with a diagnosis of KD. The median age of presentation was 28 months, with a range of five to 144 months, and the median timing was seven days, with a range of one to 30 days. The median follow-up period was six weeks, with a range of one to 192 weeks. Complete KD was present in 38 patients (50%), and 38 (50%) had incomplete KD. Skin manifestations, oral mucosal changes, skin desquamation, conjunctivitis, and lymphadenopathy were present more in patients with complete KD than incomplete ones. Complete and incomplete diseases did not differ regarding coronary artery lesions. Of the patients, 53 (70%) presented 10 days or less after the onset of fever, and 23 (30%) presented after the 10th day of disease onset. Comparison between early and late presenters revealed significantly greater mucus membrane changes and lymphadenopathy manifestations among the early presenters and coronary artery lesions among the late presenters. CONCLUSION The clinical features of KD should prompt early referral for evaluation, echocardiography, and early administration of intravenous immunoglobulin to prevent coronary artery complications. The complete form of Kawasaki does not have more frequent coronary artery lesions than the incomplete form. Additionally, late presenters may be at increased risk for coronary artery abnormalities than early presenters.
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Affiliation(s)
- Naser Kolko
- Pediatric Cardiology, Prince Sultan Cardiac Center, Buraidah, SAU
| | - Yasser A Bhat
- Pediatric Cardiology, Prince Sultan Cardiac Center, Buraidah, SAU
| | | | | | - Ali Al Akhfash
- Pediatric Cardiology, Prince Sultan Cardiac Center, Buraidah, SAU
| | - Marwan Alhobani
- Cardiac Intensive Care, Prince Sultan Cardiac Center, Buraidah, SAU
| | - Ibrahim Al Anazi
- General Pediatrics, Maternity and Children Hospital, Buraidah, SAU
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Gong JN, Mao JJ, Kuang TG, Yang SQ, Li JF, Wang JF, Huang Q, Miao R, Guo XJ, Li YD, Yang YH. Analysis of clinical features between active and inactive patients of Takayasu's arteritis with pulmonary arteries involvement. Int J Cardiol 2023; 381:88-93. [PMID: 36914072 DOI: 10.1016/j.ijcard.2023.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/11/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The aim of this study was to investigate the clinical characteristics of patients between active and inactive Takayasu's arteritis with pulmonary artery involvement (PTA) and to identify better markers of disease activity in these patients. METHODS Sixty-four PTA patients in Beijing Chao-yang hospital (2011 to 2021) were included. According to National Institutes of Health criteria, 29 patients were in active stage and 35 were in inactive stage. Their medical records were collected and analyzed. RESULTS Compared with inactive group, patients in active group were younger. More patients in active stage presented fever (41.38% vs 5.71%), chest pain (55.17% vs 20%), increased C-reactive protein (2.91 vs 0.46 mg/L), erythrocyte sedimentation rate (35.0 vs 9 mm/h), and platelet count (291 vs 221 × 109/L). Pulmonary artery wall thickening was more common in active group (51.72% vs 11.43%). These parameters were restored after treatment. The incidence of pulmonary hypertension was comparable between groups (34.48% vs 51.43%), but patients in active group had lower pulmonary vascular resistance (PVR) (361.0 vs 891.0 dyn·s·cm-5) and higher cardiac index (2.76 ± 0.72 vs 2.01 ± 0.58 L/min/m2). On multivariate logistic regression analysis, chest pain [odds ratio (OR) 9.37, 95%CI (1.98-44.38), P = 0.005], increased platelet count (>242.5 × 109/L) [OR 9.03, 95%CI (2.10-38.87), P = 0.003] and pulmonary artery wall thickening [OR 7.08, 95%CI (1.44-34.89), P = 0.016] were independently associated with disease activity. CONCLUSION Chest pain, increased platelet count, and pulmonary artery wall thickening are potential new indicators of disease activity in PTA. Patients in active stage may have lower PVR and better right heart function.
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Affiliation(s)
- Juan-Ni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Jian-Jun Mao
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Tu-Guang Kuang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Su-Qiao Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Ji-Feng Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Jian-Feng Wang
- Department of Interventional Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Qiang Huang
- Department of Respiratory and Critical Care Medicine, China-Japan friendship Hospital, Beijing 100020, PR China
| | - Ran Miao
- Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China.; Department of Basic Laboratory, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Xiao-Juan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Yi-Dan Li
- Department of Ultrasonography, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China..
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Rajasekaran K, Duraiyarasan S, Adefuye M, Manjunatha N, Ganduri V. Kawasaki Disease and Coronary Artery Involvement: A Narrative Review. Cureus 2022; 14:e28358. [PMID: 36185934 PMCID: PMC9514671 DOI: 10.7759/cureus.28358] [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] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Kawasaki disease is a systemic vasculitis with a risk of developing coronary artery lesions if left untreated. Kawasaki disease can be diagnosed clinically with classical symptoms (conjunctivitis, rash, lymphadenopathy, mucositis, edema of hands and feet), but predicting the risk of developing coronary artery aneurysm remains challenging. The coronary sequelae of Kawasaki disease have significant morbidity and mortality and are the second most common cause of acquired cardiac disease in children. Several genetic and immune factors are involved in the inflammation of coronary artery lesions in Kawasaki disease. Inositol trisphosphate 3-Kinase (ITPKC), Foxp3+, circular RNAs, mannose-binding lectin 2 (MBL2), complement factor H (CFH), kininogen 1 (KNG1), serpin family C member 1 (SERPINC1) and fibronectin 1 (FN1) are the essential genes identified in the pathogenesis of coronary artery lesions in Kawasaki disease. The addition of methylprednisolone to a combination of aspirin and intravenous immunoglobulins and biological agents like anakinra, etanercept, infliximab, and immunosuppressants like cyclosporine prevents the occurrence of coronary artery aneurysms in Kawasaki disease. Since the coronary artery lesions form the second most common cause of acquired cardiac disease in children and the incidence of myocardial infarction is a late complication, the risk stratification for coronary artery aneurysms and follow-up protocols for the prevention of cardiac thrombosis were proposed by the American Heart Association in 2017.
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Longitudinal Cardiac Testing in Patients with Kawasaki Disease with No Coronary Involvement: How Much Is Too Much? J Pediatr 2022; 244:10-12. [PMID: 34958829 DOI: 10.1016/j.jpeds.2021.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
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Guo MMH, Huang YH, Wang FS, Chang LS, Chen KD, Kuo HC. CD36 is Associated With the Development of Coronary Artery Lesions in Patients With Kawasaki Disease. Front Immunol 2022; 13:790095. [PMID: 35154107 PMCID: PMC8828496 DOI: 10.3389/fimmu.2022.790095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Kawasaki disease (KD) is an autoimmune-like vasculitis of childhood involving the coronary arteries. Macrophages require scavenger receptors such as CD36 to effectively clear cellular debris and induce self-tolerance. In this study, we hypothesized that CD36 plays an important role in the immunopathogenesis of KD, by aiding in the clearance of plasma mitochondrial DNA, and by amplifying the immune response by activating the inflammasome pathway via AIM2. Fifty-two healthy controls, 52 febrile controls, and 102 KD patients were recruited for RT-PCR of target mRNA expression and plasma mitochondrial DNA. Blood samples were obtained 24 hours prior and 21 days after the administration of intravenous immunoglobulin (IVIG) therapy. Patients with acute KD had higher plasma levels of cell-free mitochondrial DNA (ND1, ND4, and COX1), and higher mRNA expressions of CD36 and AIM2 when compared to both healthy and febrile controls. A greater decrease in both CD36 and AIM2 mRNA expression after IVIG therapy was associated with the development of coronary artery lesions. Coronary artery lesions were associated with a larger decrease of CD36 expression following IVIG therapy, which may indicate that prolonged expression of the scavenger receptor may have a protective effect against the development of coronary artery lesions in KD.
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Affiliation(s)
- Mindy Ming-Huey Guo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Feng-Sheng Wang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Laboratory Animals, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Den Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedicine, Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Assessment of vascular and endothelial function in Kawasaki disease. Biomed J 2022; 46:100525. [PMID: 35358713 DOI: 10.1016/j.bj.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile vasculitis. Patients with previous KD have increased risk of coronary arterial aneurysms (CAA) and early-onset arteriosclerosis. Endothelial dysfunction is the earliest manifestation of arteriosclerosis. We aimed to explore the endothelial function and clinical characteristics of patients with previous KD. METHODS In this case-control study, we investigated childhood KD patients, with and without CAA, and a group of healthy controls. We obtained the anthropometric measurements, metabolic markers, vascular ultrasonography evaluating arterial stiffness and flow-mediated dilatation (FMD), and clinical information obtained by reviewing the patients' charts. Continuous variables were compared using non-parametric analyses and categorical variables, using the chi-square or Fisher's exact tests. RESULTS Seventy KD patients (median current age, 12.95 years; median follow-up duration, 10.88 years) and 14 healthy controls were recruited. FMD was significantly lower in the CAA group (n = 15) than the control group (FMDs: 5.59% [interquartile range, 3.99-6.86%] vs. 7.49% [5.96-9.42%], p = 0.049; diastolic FMD: 6.48% [4.14-7.32%] vs. 7.87% [6.19-9.98%], p = 0.042). The CAA group had a higher percentage of impaired FMD and the significantly largest coronary segments of the three groups. Other parameters including metabolic markers, carotid intima-media thickness, and arterial stiffness were not statistically different. CONCLUSION KD patients, especially those with CAAs, may have impaired endothelial function. FMD may be a good indicator of endothelial dysfunction for use in long-term follow-up of KD patients.
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Effect of breastfeeding for 6 months on disease outcomes in patients with Kawasaki disease. PLoS One 2021; 16:e0261156. [PMID: 34932591 PMCID: PMC8691627 DOI: 10.1371/journal.pone.0261156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/24/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a systematic vasculitis that occurs predominantly in young children, and is the leading cause of acquired heart disease in children younger than five-years-old in developed countries. Although the etiology of KD is unknown, it is believed to be an inflammatory disease resulting from abnormal immune responses to possible environmental or infectious stimuli in genetically predisposed individuals. Breast milk contains numerous anti-inflammatory factors which may protect against allergic and autoimmune diseases. In this study we tried to examine the effect of breastfeeding for 6 months or more on disease outcomes in patients with Kawasaki disease. METHODS A retrospective cohort study of 249 KD patients admitted from 1999- 2013 who were older than 6 months at time of diagnosis and had data regarding breastfeeding in the first 6 months of life. Demographic, clinical and laboratory data was collected by chart review. Continuous data was compared using Student's t-test and categorical variables were compared using Chi-square. Stepwise multivariate regression of all demographic factors was performed. RESULTS Breastfeeding for 6 months or more was associated with a shorter total duration of fever (5.980± 1.405 Vs. 6.910 ± 2.573 days, p = 0.001) and a lower risk of developing persistent coronary artery lesions (CALs) (7.8% Vs. 20.2%, p-value = 0.039) on univariate analysis. Multivariate regression of all factors associated with CALs including breastfeeding for 6 months found that only the presence of CALs at baseline (β-coefficient = 0.065, p < 0.001) and white blood count (β-coefficient = 0.065, p = 0.018) remained significant after regression analysis. CONCLUSIONS Breastfeeding for 6 months or more was associated with a shorter duration of fever and a lower risk of persistent CAL formation in patients with KD on univariate analysis, although this effect may be modest when other factors such as the presence of CALs at baseline and white blood cell count are also taken into consideration.
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Lei WT, Hsu CW, Chen PC, Tseng PT, Kuo HC, Guo MMH, Tu YK, Lin PY, Kao YH, Chang LS. Increased Risk of Asthma and Allergic Rhinitis in Patients With a Past History of Kawasaki Disease: A Systematic Review and Meta-Analyses. Front Pediatr 2021; 9:746856. [PMID: 34988034 PMCID: PMC8721123 DOI: 10.3389/fped.2021.746856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/30/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Allergic diseases are frequently observed in children with Kawasaki disease (KD). However, the evidence supporting the association between KD and allergies has been conflicting. The objective of the current study is to examine the association between KD and allergic diseases. Methods: We conducted an electronic search using PubMed, Embase, and the Cochrane through 24 July 2021. The inclusion criteria consisted of studies that examined the prevalence of allergic diseases in children with a previous diagnosis of KD and in a comparison group. We pooled studies by using a random effects model. The effects of KD on the subsequent risk of allergic diseases were expressed as odds ratio (OR) with 95% confidence intervals (CI). Results: We included a total of four studies that assessed the effect of KD on asthma, allergic rhinitis, and atopic dermatitis vs. non-KD children (KD individuals for asthma, four studies, n = 8,474; allergic rhinitis, four studies, n = 8,474; atopic dermatitis, three studies, n = 8,330). The overall prevalence of asthma, allergic rhinitis, and atopic dermatitis was 9.12, 27.63, and 6.55% among patients with previous KD. The meta-analysis showed a significantly increased risk of asthma (OR:1.437, CI: 1.067-1.937) and allergic rhinitis (OR: 1.726, CI: 1.291-2.307) in patients with KD, compared with the control groups. However, patients with KD did not have a significantly different level of risk of atopic dermatitis (OR: 1.243, 95% CI: 0.857-1.802). Conclusion: This meta-analysis supports that individuals with KD are more likely to have asthma and allergic rhinitis compared to controls.
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Affiliation(s)
- Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung City, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Mindy Ming-Huey Guo
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yu-Hsuan Kao
- Section of Immunology, Rheumatology, and Allergy, Department of Pediatrics, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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12
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Lin SY, He L, Xie LP, Wang Y, Lin YX, Cao YY, Yan WL, Liu F, Huang GY. Effects of immunoglobulin plus prednisolone in reducing coronary artery lesions in patients with Kawasaki disease: study protocol for a phase III multicenter, open-label, blinded-endpoints randomized controlled trial. Trials 2021; 22:898. [PMID: 34895290 PMCID: PMC8665612 DOI: 10.1186/s13063-021-05807-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis of unclear etiology that mainly affects infants and young children. Strategies to reduce the incidence and severity of coronary artery lesions (CALs), the determinant factor in the long-term prognosis of KD, are currently a focus of studies on KD. Corticosteroids, preferred in the treatment of the majority of vasculitides, are controversial in the treatment of acute KD. In this trial, we will evaluate whether the addition of prednisolone to standard intravenous immunoglobulin (IVIG) plus aspirin therapy can reduce the occurrence of CAL in Chinese patients with KD. Methods This is a multicenter, prospective, open-label, randomized controlled trial, which is expected to be conducted in more than 20 hospitals in China and aims to assess the efficacy and safety of IVIG + prednisolone treatment versus standard treatment. Patients with KD who fulfill the inclusion and exclusion criteria will be recruited and randomized (1:1) to receive either a large dose of IVIG (2 g/kg over 12–24 h with a maximum dose of 60 g) + aspirin 30 mg/kg/d or IVIG (2 g/kg over 12–24 h) + aspirin 30 mg/kg/d + prednisolone (2 mg/kg/d with a maximum dose of 60 mg tapered over 15 days after normalization of C-reactive protein concentration). The primary outcome will be the occurrence of CAL at 1 month of illness. The follow-up duration for each participant will be set as 1 year. Patients and treating physicians will be unmasked to group allocation. Discussion This will be the first multicenter randomized controlled trial to evaluate the efficacy of IVIG + aspirin + prednisolone in Chinese pediatric patients with KD, which may provide high-level evidence for improving the initial treatment for acute KD. Trial registration ClinicalTrials.govNCT04078568. Registered on 16 August 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05807-3.
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Affiliation(s)
- Si-Yuan Lin
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Lan He
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Li-Ping Xie
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yin Wang
- Clinical Trial Unit, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yi-Xiang Lin
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yin-Yin Cao
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Wei-Li Yan
- Clinical Trial Unit, Children's Hospital of Fudan University, Shanghai, 201102, China.
| | - Fang Liu
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China.
| | - Guo-Ying Huang
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China.
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13
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Chahal N, Rush J, Manlhiot C, Delayun C, Sananes R, Runeckles K, Collins T, O'Shea S, McCrindle BW. Understanding the Educational Support and Psychosocial Needs of Parents and Adolescents With Kawasaki's Disease and Coronary Artery Aneurysms. J Pediatr Health Care 2021; 35:e21-e31. [PMID: 34238625 DOI: 10.1016/j.pedhc.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kawasaki disease (KD) with coronary artery aneurysms (complex KD) presents relentless challenges for families. Psychosocial experiences and needs were explored. METHOD A descriptive, exploratory study of adolescents and parents using a needs survey and psychosocial instruments (anxiety, depression, and functional impairment). RESULTS Fifty-one parents and 38 adolescents participated. Predominant interests were for information sheets, newsletters, Web sites, and phone applications. Gaps in disease-specific knowledge and awareness of coronary artery aneurysms between parents and adolescents were identified. Psychosocial concerns for adolescents included symptoms of anxiety (22%), depression (13%), and functional impairment (22%). Multivariable analyses indicated higher depression scores associated with longer travel distance from specialists (p = .04). Parent-reported social concerns for their adolescent were associated with higher anxiety (p = .005) and functional impairment (p = .005). Written commentary complemented the findings. DISCUSSION Care protocols require psychosocial assessment/referral and the use of virtual platforms. The groundwork was laid for developing patient and family-centered strategies.
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14
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Theocharis P, Wong J, Pushparajah K, Mathur SK, Simpson JM, Pascall E, Cleary A, Stewart K, Adhvaryu K, Savis A, Kabir SR, Uy MP, Heard H, Peacock K, Miller O. Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 2021; 22:896-903. [PMID: 32766671 PMCID: PMC7454452 DOI: 10.1093/ehjci/jeaa212] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/26/2022] Open
Abstract
Aims Following the peak of the UK COVID-19 epidemic, a new multisystem inflammatory condition with significant cardiovascular effects emerged in young people. We utilized multimodality imaging to provide a detailed sequential description of the cardiac involvement. Methods and Results Twenty consecutive patients (mean age 10.6 ± 3.8 years) presenting to our institution underwent serial echocardiographic evaluation on admission (median day 5 of illness), the day coinciding with worst cardiac function (median day 7), and the day of discharge (median day 15). We performed cardiac computed tomography (CT) to assess coronary anatomy (median day 15) and cardiac magnetic resonance imaging (CMR) to assess dysfunction (median day 20). On admission, almost all patients displayed abnormal strain and tissue Doppler indices. Three-dimensional (3D) echocardiographic ejection fraction (EF) was <55% in half of the patients. Valvular regurgitation (75%) and small pericardial effusions (10%) were detected. Serial echocardiography demonstrated that the mean 3D EF deteriorated (54.7 ± 8.3% vs. 46.4 ± 8.6%, P = 0.017) before improving at discharge (P = 0.008). Left main coronary artery (LMCA) dimensions were significantly larger at discharge than at admission (Z score –0.11 ± 0.87 vs. 0.78 ± 1.23, P = 0.007). CT showed uniform coronary artery dilatation commonly affecting the LMCA (9/12). CMR detected abnormal strain in all patients with global dysfunction (EF <55%) in 35%, myocardial oedema in 50%, and subendocardial infarct in 5% (1/20) patients. Conclusions Pancarditis with cardiac dysfunction is common and associated with myocardial oedema. Patients require close monitoring due to coronary artery dilatation and the risk of thrombotic myocardial infarction.
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Affiliation(s)
| | - James Wong
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Sujeev K Mathur
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - John M Simpson
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Emma Pascall
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Aoife Cleary
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kirsty Stewart
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kaitav Adhvaryu
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Alex Savis
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Saleha R Kabir
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Mirasol Pernia Uy
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Hannah Heard
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kelly Peacock
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Owen Miller
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK.,Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, UK
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15
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Dallaire F. Z Score Disease or Coronary Artery Disease: The (Missing) Link between Statistics and Anatomy in Kawasaki Disease. J Am Soc Echocardiogr 2021; 34:673-675. [PMID: 33845157 DOI: 10.1016/j.echo.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
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16
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Kiss A, Ryan PM, Mondal T. Management of COVID-19-associated multisystem inflammatory syndrome in children: A comprehensive literature review. PROGRESS IN PEDIATRIC CARDIOLOGY 2021; 63:101381. [PMID: 33850412 PMCID: PMC8032479 DOI: 10.1016/j.ppedcard.2021.101381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023]
Abstract
Background The prevalence and severity of COVID-19 are greatly reduced in children, yet some pediatric patients develop a syndrome resembling Kawasaki Disease (KD), termed Multisystem Inflammatory Syndrome in Children (MIS-C). With an estimated incidence of 2/100,000 children, MIS-C is relatively rare but can be fatal. Clinical features can include fever, hyperinflammatory state, gastrointestinal symptoms, myocardial dysfunction, and shock. The pathogenesis of MIS-C, although yet to be completely elucidated, appears to be distinct from KD in terms of epidemiology, severity, and biochemical signature. Aim of Review Although efficacy of treatments for MIS-C have largely not yet been investigated, we aim to conduct a comprehensive literature search of numerous medical databases (AMED, EBM Reviews, Embase, Healthstar, MEDLINE, ERIC, and Cochrane) to highlight treatments used around the world, their rationale, and outcomes to better inform guidelines in the future. Using the findings, an approach to MIS-C management will be outlined. Key Scientific Concepts of Review MIS-C appears to be a SARS-CoV-2 related post-infection phenomenon that is distinct from Kawasaki disease. Although outcomes are largely favorable, there is significant variation in MIS-C treatment. Most management regimens reported to date mirror that of KD; however, targeted therapy based on specific MIS-C phenotypes may have the potential to improve outcomes. We recommend close monitoring by a multidisciplinary team, symptomatic treatment (e.g., intravenous immunoglobulin for KD-like symptoms, steroids/immunotherapy for multisystem inflammation), and long-term follow-up. Further research is required to evaluate the effectiveness of current MIS-C treatments and to determine more refined therapies.
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Affiliation(s)
- Andreea Kiss
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul MacDaragh Ryan
- Brookfield School of Medicine and Health Sciences, University College Cork, Cork, Ireland
| | - Tapas Mondal
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
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17
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Liu HH, Qiu Z, Fan GZ, Jiang Q, Li RX, Chen WX, Liu FF, Wu Y, Wang JJ, Wu YF, Luo HH, Zhang DD, Hu P. Assessment of coronary artery abnormalities and variability of Z-score calculation in the acute episode of Kawasaki disease-A retrospective study from China. Eur J Clin Invest 2021; 51:e13409. [PMID: 32916764 DOI: 10.1111/eci.13409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/12/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate classification of coronary artery abnormalities (CAAs) is essential for clinical decision-making and long-term management in Kawasaki disease (KD) patients. To date, there are several echocardiographic criteria of CAA assessment. MATERIALS AND METHODS The Japanese Ministry of Health (JMH) criteria and the Z-score criteria from 2004 American Heart Association guidelines were adopted and their detective efficacies for CAAs were compared in 251 Chinese patients with KD Z scores were calculated by 6 published methods. RESULTS According to the JMH criteria, 19 (7.57%) KD patients were classified as CAAs during the acute KD episode. However, the detective number of CAAs was highest and had a 0.68-fold increase by the Dallaire et al method with a Z-score cut point of ≥2.5 as compared with the JMH criteria; in contrast, more than 78.95% of patients with CAAs identified by the JMH criteria had a coronary artery Z score ≥2.5. All 6 different Z-score methods had satisfactory accuracies with a range from 93.23% to 97.61% in screening CAAs. For the 19 patients with CAAs identified by the JMH criteria, their Z scores presented the widest variation calculated by the McCrindle et al method. CONCLUSIONS The JMH criteria underestimate the prevalence of CAAs as compared with the Z-score criteria. Quantitative assessment of coronary artery luminal dimensions, normalized as Z scores adjusted for body surface, should be recommended. The larger coronary artery luminal dimensions vary, the more heterogeneous Z scores calculated by different methods have.
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Affiliation(s)
- Hui Hui Liu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Zhen Qiu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Guo Zhen Fan
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Qi Jiang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Rui Xue Li
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Wei Xia Chen
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Fei Fei Liu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Yue Wu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Jing Jing Wang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Yang Fang Wu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Huang Huang Luo
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Dong Dong Zhang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Peng Hu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
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18
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Zheng X, Li Y, Yue P, Ma F, Zhang Y, Wu G. Diagnostic significance of circulating miRNAs in Kawasaki disease in China: Current evidence based on a meta-analysis. Medicine (Baltimore) 2021; 100:e24174. [PMID: 33578520 PMCID: PMC7886432 DOI: 10.1097/md.0000000000024174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/10/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is no golden standard for the diagnosis of Kawasaki disease (KD), the most common cause of acquired heart disease in children in many countries. In recent years, many studies have focused on the relationship between microRNAs (miRNAs) and KD. Thus, we perform this meta-analysis to understand the role of circulating miRNAs as a biomarker to detect KD. METHODS We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure through March 10, 2019. Meta-disc 1.4 and STATA 15.1 (Stata Corporation, College Station, TX) were used to conduct the meta-analysis. RESULTS Six eligible articles were included in this meta-analysis. The overall performance of total mixed miRNAs detection was: pooled sensitivity, 0.7 (95% confidence interval, 0.66-0.74); pooled specificity, 0.87 (95% confidence interval, 0.83-0.90); and area under the summary receiver operating characteristic curves value (SROC), 0.8302. The meta-regression analysis indicated that the specimen types, the composition of the control group, and types of the reference miRNA were not responsible for the existing heterogeneities. The subgroup analysis showed that SROC of the plasma group (0.8890) was more significant than the serum group (0.7204), and SROC of the non-healthy control group (0.9622) was more significant than the healthy control group (0.8096). CONCLUSIONS : This is the first meta-analysis show that miRNAs may be used as novel biomarkers for detecting KD, especially for distinguishing KD from other febrile diseases. More studies are needed in the future to clarify the association between KD and miRNAs. PROSPERO REGISTRATION NUMBER CRD42019129976.
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Affiliation(s)
- Xiaolan Zheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yifei Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital
| | - Peng Yue
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Fan Ma
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital
| | - Yi Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital
| | - Gang Wu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital
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19
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Hu J, Ren W. Analysis of the Risk Factors in Prognosis of Kawasaki Disease With Coronary Artery Lesions. Front Pediatr 2021; 9:798148. [PMID: 34950620 PMCID: PMC8688820 DOI: 10.3389/fped.2021.798148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/19/2021] [Indexed: 12/19/2022] Open
Abstract
Kawasaki disease (KD) is one of the most common forms of systemic vasculitis in children. Pathological features include extensive inflammation of small and medium blood vessels throughout the body. The primary complication of KD is coronary artery lesions (CALs). A total of 640 children with KD were admitted to the Department of Pediatric Cardiology at Shengjing Hospital of China Medical University from January 2017 to December 2019. These patients comprised 52 coronary artery aneurysm (CAA) cases and 47 coronary artery dilation (CAD) cases. Echocardiography was performed during the acute KD phase and then at 1, 3, 6, 12, and 24 months after KD onset. Patients were divided into a poor prognosis group (n = 30) and a normal group (n = 69) based on CALs prognosis. Differences in laboratory data, clinical manifestations and coronary artery damage rates were compared between the two groups. Univariate analysis was performed on these data, and an ROC curve was used to analyze the efficacy of each risk factor. Univariate analysis revealed that age (months), number of coronary arteries involved (NACI), IgM, IgA and brain natriuretic peptide (ProBNP) levels were higher in the poor prognosis group compared with the normal group, procalcitonin (PCT) levels in the poor prognosis group were lower than in the normal group (P < 0.05). Conclusion: Age ≥ 18 months, IgM ≥ 1.07g/L, IgA ≥ 0.728g/L and NCAI ≥ 3 were poor prognostic factors of KD children with CALs. These parameters can be used as a reference indicator of early prediction where combined detection might improve the accuracy and sensitivity of prediction. Follow-up should be maintained to monitor changes in the coronary artery by echocardiography.
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Affiliation(s)
- Jinling Hu
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Shengjing Hospital of China Medical University, Shenyang, China
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20
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Xu YM, Chu YQ, Wang H. Correlation Analysis of Anti-Cardiolipin Antibody/D Dimer/C-Reactive Protein and Coronary Artery Lesions/Multiple-Organ Damage in Children With Kawasaki Disease. Front Pediatr 2021; 9:704929. [PMID: 34660478 PMCID: PMC8515483 DOI: 10.3389/fped.2021.704929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: Kawasaki disease (KD) is a systemic vasculitis with unknown etiology. In addition to cardiovascular system involvement, it can also have other multiple organs involved. This study is aimed at investigating the correlation between anti-cardiolipin antibody (ACA)/D dimer/C reactive protein (CRP) and coronary artery lesions (CAL)/multiple-organ lesions in children with KD. Methods: Retrospective analysis was performed in 284 KD/IKD patients from May 2015 to April 2016. Among them, 175 were males (61.6%), with average age of 2 years and 5 months old. Patients were divided into ACA+ group and ACA- group, elevated D dimer group (DDE) and normal D dimer group (DDN), and coronary artery injury (CAL) group and non-coronary artery injury (NCAL) group. Results: ACA was most likely tested positive in younger KD children (p < 0.05). ACA+ and hypoproteinemia were correlated with CAL, thrombocytosis, and granulocytopenia (p < 0.05-0.01). Levels of cTnI and CK in the CAL group were significantly higher than those in the NCAL group (p < 0.05). CAL was more frequently detected in younger patients and patients with prolonged fever, later IVIG treatment, and elevated CRP over 100 mg/l, but there was no statistically significant difference (all p > 0.05). In the KD with DDE group, the incidence of granulopenia, thrombocytosis, myocardial damage, cholestasis, hypoproteinemia, and aseptic urethritis was significantly higher than that in the KD with DDN group (p < 0.05-0.01). However, elevated D dimer was not associated with CAL. CRP elevation was highly correlated with D dimer, but not with CAL. Conclusion: Higher incidence of CAL and myocardial damage occurred in KD patients with positive ACA and hypoproteinemia. In the current study, ACA was only tested for positive and negative, which is a limitation to this study. To further elucidate the association, ACA titers would establish its significance in drawing a conclusion for the significance of ACA in CAL and myocardial damages. In addition, higher incidence of CAL occurred in younger patients. The higher D dimer was associated with increased multiple-organ damage (MOD). CRP was closely correlated with D dimer, but not correlated with ACA and CAL.
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Affiliation(s)
- Yun-Ming Xu
- Pediatric Department of Shengjing Hospital, China Medical University, Shenyang, China
| | - Yan-Qiu Chu
- Pediatric Department of Shengjing Hospital, China Medical University, Shenyang, China
| | - Hong Wang
- Pediatric Department of Shengjing Hospital, China Medical University, Shenyang, China
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21
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Teitel DF, Newburger JW, Sutton N, Tani LY, Harahsheh AS, Jone PN, Mensch DJ, Cotts T, Davidson A, Dahdah N, Johnson WH, Portman MA. Development and Utility of Quality Metrics for Ambulatory Pediatric Cardiology in Kawasaki Disease. Clin Pediatr (Phila) 2020; 59:245-251. [PMID: 31896280 DOI: 10.1177/0009922819896098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Adult Congenital and Pediatric Cardiology (ACPC) Section of the American College of Cardiology sought to develop quality indicators/metrics for ambulatory pediatric cardiology practice. The objective of this study was to report the creation of metrics for patients with Kawasaki disease. Over a period of 5 months, 12 pediatric cardiologists developed 24 quality metrics based on the most relevant statements, guidelines, and research studies pertaining to Kawasaki disease. Of the 24 metrics, the 8 metrics deemed the most important, feasible, and valid were sent on to the ACPC for consideration. Seven of the 8 metrics were approved using the RAND method by an expert panel. All 7 metrics approved by the ACPC council were accepted by ACPC membership after an "open comments" process. They have been disseminated to the pediatric cardiology community for implementation by the ACPC Quality Network.
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Affiliation(s)
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | | | - Ashraf S Harahsheh
- Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Pei-Ni Jone
- Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - Timothy Cotts
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Alex Davidson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nagib Dahdah
- CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
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22
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Abe M, Rastelli DD, Gomez AC, Cingolani E, Lee Y, Soni PR, Fishbein MC, Lehman TJA, Shimada K, Crother TR, Chen S, Noval Rivas M, Arditi M. IL-1-dependent electrophysiological changes and cardiac neural remodeling in a mouse model of Kawasaki disease vasculitis. Clin Exp Immunol 2020; 199:303-313. [PMID: 31758701 PMCID: PMC7008220 DOI: 10.1111/cei.13401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 02/06/2023] Open
Abstract
Kawasaki disease (KD) is the leading cause of acquired heart disease in children. In addition to coronary artery abnormalities, aneurysms and myocarditis, acute KD is also associated with echocardiogram (ECG) abnormalities in 40-80% of patients. Here, we show that these ECG changes are recapitulated in the Lactobacillus casei cell wall extract (LCWE)-induced KD vasculitis mouse model. LCWE-injected mice developed elevated heart rate and decreased R wave amplitude, with significant differences in prolonged ventricular repolarization. LCWE-injected mice developed cardiac ganglion inflammation, that may affect the impulse-conducting system in the myocardium. Furthermore, serum nerve growth factor (NGF) was significantly elevated in LCWE-injected mice, similar to children with KD vasculitis, associated with increased neural remodeling of the myocardium. ECG abnormalities were prevented by blocking interleukin (IL)-1 signaling with anakinra, and the increase in serum NGF and cardiac neural remodeling were similarly blocked in Il1r1-/- mice and in wild-type mice treated with anakinra. Thus, similar to clinical KD, the LCWE-induced KD vasculitis mouse model also exhibits electrophysiological abnormalities and cardiac neuronal remodeling, and these changes can be prevented by blocking IL-1 signaling. These data support the acceleration of anti-IL-1 therapy trials to benefit KD patients.
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Affiliation(s)
- M. Abe
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - D. D. Rastelli
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Division of Gastroenterology and NutritionBoston Children’s HospitalBostonMAUSA
| | - A. C. Gomez
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - E. Cingolani
- Cedars‐Sinai Medical CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCAUSA
| | - Y. Lee
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - P. R. Soni
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - M. C. Fishbein
- Department of PathologyDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - T. J. A. Lehman
- Division of RheumatologyDepartment of PediatricsWeill Cornell Medical SchoolNew YorkNYUSA
| | - K. Shimada
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - T. R. Crother
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - S. Chen
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - M. Noval Rivas
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - M. Arditi
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Cedars‐Sinai Medical CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
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Ahn JG, Bae Y, Shin D, Nam J, Kim KY, Kim DS. HMGB1 gene polymorphism is associated with coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease. Rheumatology (Oxford) 2020; 58:770-775. [PMID: 30535242 DOI: 10.1093/rheumatology/key356] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/25/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Kawasaki disease (KD) is an acute systemic vasculitis of unknown aetiology that affects infants and young children. Recent reports of elevated serum high mobility group box 1 (HMGB1) level during the acute phase of KD and its relationship to poor response to IVIG treatment suggest a possible association of HMGB1 polymorphisms with KD. We investigated the association between the polymorphisms of the HMGB1 gene, KD susceptibility, coronary artery lesions, and KD response to IVIG treatment. METHODS Whole genome sequencing of the HMGB1 gene was performed to identify causative variants. Two tagging single nucleotide polymorphisms of the HMGB1 gene were selected using linkage disequilibrium analysis. The tagging single nucleotide polymorphisms were genotyped using the TaqMan Allelic Discrimination assay in a total of 468 subjects (265 KD patients and 203 controls). RESULTS The HMGB1 single nucleotide polymorphisms were not associated with KD susceptibility. However, in KD patients, there was a significant association of rs1412125 with coronary artery lesions formation in the recessive model (GG vs AA + GA: odds ratio = 4.98, 95% CI = 1.69-14.66, P = 0.005). In addition, rs1412125 was associated with IVIG resistance in the recessive (GG vs AA + GA: odds ratio = 4.11, 95% CI = 1.38-12.23, P = 0.017) and allelic models (G vs A: odds ratio = 1.80, 95% CI = 1.06-3.06, P = 0.027). CONCLUSION The rs1412125 in HMGB1 might be a risk factor for the development of coronary artery lesions and IVIG resistance in KD patients.
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Affiliation(s)
- Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine
| | - Yoonsun Bae
- Department of Microbiology, College of Medicine, The Catholic University of Korea.,Integrated Research Center for Genome Polymorphism, College of Medicine, The Catholic University of Korea.,Research and Development Center, Medizen Humancare Incorporated, Seoul, Republic of Korea
| | - Dongjik Shin
- Research and Development Center, Medizen Humancare Incorporated, Seoul, Republic of Korea
| | - Jiho Nam
- Research and Development Center, Medizen Humancare Incorporated, Seoul, Republic of Korea
| | - Kyu Yeun Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine
| | - Dong Soo Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine
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Zhang D, Liu L, Huang X, Tian J. Insights Into Coronary Artery Lesions in Kawasaki Disease. Front Pediatr 2020; 8:493. [PMID: 32984207 PMCID: PMC7477115 DOI: 10.3389/fped.2020.00493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
This review summarizes recent advances in understanding the development of coronary arteritis in Kawasaki disease. Kawasaki disease is the most common cause of acquired heart disease among children characterized with coronary artery abnormalities, which can cause myocardial ischemia, infarction, and even death. The pathogenic factors of Kawasaki disease and the pathological process of coronary artery disease are not clear at present, which brings challenges to the prevention and treatment of the disease. The treatment of Kawasaki disease focuses mainly on timely administration of intravenous high doses of immunoglobulin and aspirin. However, there are still some patients who do not respond well to this standard treatment, and its management remains a challenge. As a result, coronary artery lesions still occur in patients and affect their quality of life. In this review, we discuss updated research data of Kawasaki disease coronary artery lesions.
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Affiliation(s)
- Danfeng Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lingjuan Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xupei Huang
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Jie Tian
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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25
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Xie LP, Yan WL, Huang M, Huang MR, Chen S, Huang GY, Liu F. Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017. J Epidemiol 2019; 30:429-435. [PMID: 31548437 PMCID: PMC7492704 DOI: 10.2188/jea.je20190065] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background We sought to investigate epidemiologic features of Kawasaki disease (KD) in Shanghai from 2013 through 2017 and identify risk factors for coronary artery lesions (CAL). Methods As in our previous three surveys, a set of questionnaires and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai. Medical records of KD patients diagnosed from January 2013 through December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for CAL. Results A total of 4,452 cases were enrolled. Male-to-female ratio was 1.7:1. The incidence of KD was 68.8 to 107.3 per 100,000 children aged <5 years from 2013 to 2017. Age at onset ranged from 15 days to 14.0 years (median: 1.8 years). KD occurred more frequently in spring and summer. Of 4,325 patients (97.0%) receiving intravenous immunoglobulin (IVIG), 362 (8.4%) were resistant to initial IVIG. CAL occurred in 406 (9.1%) patients, including 118 (2.7%) with medium aneurysms and 31 (0.7%) with giant aneurysms. Recurrent cases were 60 (1.3%). No death was found in this survey. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were independently associated with CAL. Conclusions The incidence of KD in Shanghai had substantially increased while the proportion of CAL had substantially decreased as compared with our previous surveys. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were risk factors for CAL.
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Affiliation(s)
- Li-Ping Xie
- Heart Center, Children's Hospital of Fudan University
| | - Wei-Li Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University
| | - Mei-Rong Huang
- Pediatric Heart Center, Shanghai Children's Medical Center
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine
| | | | - Fang Liu
- Heart Center, Children's Hospital of Fudan University
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26
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[Clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease complicated by small/medium-sized coronary artery aneurysms]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019. [PMID: 31416506 PMCID: PMC7389908 DOI: 10.7499/j.issn.1008-8830.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To study the clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease (KD) complicated by coronary artery aneurysm (CAA). METHODS A total of 77 KD children who were diagnosed with multiple small/medium-sized CAAs by echocardiography between January 2013 and June 2018 were enrolled. They were randomly divided into observation group with 38 children (treated with clopidogrel and aspirin) and control group with 39 children (treated with low-molecular-weight heparin and aspirin). All children were followed up regularly, and the first 3 months of the course of the disease was the observation period. The children were observed in terms of the change of the coronary artery and the incidence of complications. RESULTS At month 3 of follow-up, among the children in the observation group, 6 had normal coronary artery, 11 had coronary artery retraction, 19 had stable coronary artery, and 2 progressed to giant coronary aneurysm; among the children in the control group, 7 had normal coronary artery, 12 had coronary artery retraction, 19 had stable coronary artery, and 1 progressed to giant coronary aneurysm; there was no significant difference in the change of the coronary artery between the two groups (P>0.05). There were 2 cases of epistaxis and 6 cases of skin ecchymosis in the observation group, and 1 case of epistaxis and 7 cases of petechiae and ecchymosis at the injection site in the control group, and no other serious bleeding events were observed in either group. CONCLUSIONS Clopidogrel combined with low-dose aspirin is safe and effective in antithrombotic therapy for children with KD complicated by CAA.
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27
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Zheng X, Yue P, Liu L, Tang C, Ma F, Zhang Y, Wang C, Duan H, Zhou K, Hua Y, Wu G, Li Y. Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis. PLoS One 2019; 14:e0217274. [PMID: 31117119 PMCID: PMC6531010 DOI: 10.1371/journal.pone.0217274] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 05/09/2019] [Indexed: 01/17/2023] Open
Abstract
Background Kawasaki disease (KD) is now the leading cause of acquired heart disease in children in developed countries. Intravenous immunoglobulin (IVIG) and aspirin were considered as the standard initial treatment of KD for decades. However, the optimal dose of aspirin has remained controversial. In recent years, many studies compared the efficacy of low-dose with high-dose aspirin in the acute phase of KD, but the results have not always been consistent. Therefore, we performed this meta-analysis to evaluate the efficacy of low-dose aspirin compared with high-dose for the initial treatment of KD. Methods Studies related to aspirin therapy for KD were selected from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Google scholar through Mar 25th, 2019. Data were analyzed using STATA Version 15.1. Additionally, publication bias and sensitivity analysis were also performed by STATA version 15.1. Results Six studies were included in our analysis of the rate of coronary artery lesion (CAL), five reports for IVIG-resistant KD (rKD), and four for the duration of fever and hospitalization. However, no significant differences were found between low-dose and high-dose aspirin groups in the incidence of CAL (risk ratio (RR), 0.85; 95%CI (0.63, 1.14); P = 0.28), the risk of rKD (RR, 1.39; 95%CI (1.00, 1.93); P = 0.05), and duration of fever and hospitalization (the mean standard deviation (SMD), 0.03; 95%CI (-0.16, 0.22); P = 0.78). Conclusion Low-dose aspirin (3–5 mg·kg-1·d-1) may be as effective as the use of high-dose aspirin (≥30 mg·kg-1·d-1) for the initial treatment of KD. Further well-designed randomized clinical trials are needed to evaluate the efficacy of low-dose aspirin for the initial treatment of KD.
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Affiliation(s)
- Xiaolan Zheng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Peng Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Lei Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Changqing Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Fan Ma
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Duan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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28
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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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29
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Makino N, Nakamura Y, Yashiro M, Kosami K, Matsubara Y, Ae R, Aoyama Y, Yanagawa H. Nationwide epidemiologic survey of Kawasaki disease in Japan, 2015-2016. Pediatr Int 2019; 61:397-403. [PMID: 30786118 DOI: 10.1111/ped.13809] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/06/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately 50 years have passed since Kawasaki disease (KD) was first reported. The KD nationwide survey began in 1970. Although >360 000 cases have already been reported in Japan, the cause is still unknown. In Japan, the number of patients and incidence rate of KD has continued to increase. It is necessary to examine the trend of the occurrence in the surveillance of KD. METHODS The nationwide survey of patient incidence in 2015 and 2016 was conducted in 2017, as the 24th nationwide survey of KD. A questionnaire was sent to pediatric departments in hospitals with >100 beds and specialized pediatric hospitals, and was responded to by the attending pediatricians. RESULTS The total number of patients in 2 years was 31 595, and the sex ratio (male/female) was 1.34. The incidence rate (/100 000 children aged 0-4 years/year) was 330.2 (371.2 in boys, 287.3 in girls) in 2015, and 309.0 (343.2 in boys, 273.2 in girls) in 2016. The number of patients by month peaked in January. The age-specific incidence rate according to sex was highest in children between 9 and 11 months of age, after which the incidence rate gradually decreased with advancing age. CONCLUSIONS We summarize the most recent nationwide survey of KD and consider the change in the epidemiologic picture.
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Affiliation(s)
- Nobuko Makino
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mayumi Yashiro
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koki Kosami
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yuri Matsubara
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryusuke Ae
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yasuko Aoyama
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroshi Yanagawa
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
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30
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Yorifuji T, Tsukahara H, Doi H. Early childhood exposure to maternal smoking and Kawasaki Disease: A longitudinal survey in Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 655:141-146. [PMID: 30469059 DOI: 10.1016/j.scitotenv.2018.11.194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/11/2018] [Accepted: 11/13/2018] [Indexed: 06/09/2023]
Abstract
Kawasaki disease is the leading cause of acquired childhood heart disease in most developed countries, but the etiology of the disease is unknown. An aberrant immune response to some environmental triggers may play a role and involuntary exposure to tobacco smoke can alter immune functions. We thus prospectively examined the association between early childhood exposure to maternal smoking and the incidence of Kawasaki disease. We used a large, nationwide population-based longitudinal survey ongoing since 2010 and restricted participants to a total of 38,444 children for whom information on maternal smoking was available. Maternal smoking status was ascertained at 6months of age, and responses to questions about hospital admission for Kawasaki disease between the ages of 6 and 30months were used as outcome. We conducted binomial log-linear regression analyses adjusting for children's, parental, and residential factors with children of non-smoking mothers as our reference group. Maternal smoking increased the risk of admission, in particular for the period between 6 and 18months of age, in a dose-dependent manner. Compared with children of non-smoking mothers, the children of mothers who smoked had a risk ratio of 1.83 (95% confidence interval: 1.06, 3.35) for hospital admissions between 6 and 30months of age and a risk ratio of 2.69 (95% confidence interval: 1.56, 4.64) for hospital admissions between 6 and 18months of age. Early childhood exposure to maternal smoking may increase the risk of Kawasaki disease hospitalizations in childhood.
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Affiliation(s)
- Takashi Yorifuji
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan.
| | - Hirokazu Tsukahara
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hiroyuki Doi
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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31
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de La Harpe M, di Bernardo S, Hofer M, Sekarski N. Thirty Years of Kawasaki Disease: A Single-Center Study at the University Hospital of Lausanne. Front Pediatr 2019; 7:11. [PMID: 30761279 PMCID: PMC6363689 DOI: 10.3389/fped.2019.00011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022] Open
Abstract
Kawasaki disease is an acute vasculitis with a particular involvement of the coronary arteries. Coronary artery aneurysms develop in 20% of untreated children. It has been shown that early treatment with intravenous immunoglobulins and aspirin decreases this risk to 5%, but the medium to long term prognosis of children with Kawasaki disease is still unclear. To determine the outcome of the disease and risk factors for poor evolution, we reviewed retrospectively the medical records of all patients with a diagnosis of Kawasaki disease at our Institution between 1981 and 2014. Among the 207 patients included in the study, 96 patients had coronary diameter anomalies (46.4%) at diagnosis and children with atypical ages for Kawasaki disease (<1 year or >10 year of age) were more often affected with aneurysms or dilatations. Eighty-four of them had complete regression of coronary aneurysms during the follow-up (87.5%) Absence of immunoglobulins in the acute phase was associated with less regression rate (57.1 vs. 92.2%), and boys had greater z-scores at last echocardiography, statistically significant for the left anterior descending artery. We found rare complications after the acute phase documented in our patient charts (only 3.8%). Recurrence of the disease occurred in 5 children (2.4%) and myocardial ischemia in 3 patients (1.4%), all with initial coronary aneurysm. Conclusion: Medium to long term prognosis after Kawasaki disease is excellent. Boys, patients not treated with immunoglobulins or outside the usual age range are more at risk for an unfavorable outcome.
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Affiliation(s)
- Marion de La Harpe
- Pediatric Cardiology Unit, University of Lausanne, Lausanne, Switzerland
| | - Stefano di Bernardo
- Pediatric Cardiology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Michaël Hofer
- Pediatric Rheumatology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nicole Sekarski
- Pediatric Cardiology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Escobar HA, Meneses-Gaviria G, Ijají-Piamba JE, Triana-Murcia HM, Molina-Bolaños JA, Vidal-Martínez JF, Correa-Gallego CF, Cedeño-Burbano AA. Tratamiento farmacológico de la enfermedad de Kawasaki. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.64144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La enfermedad de Kawasaki corresponde a una vasculitis sistémica de origen desconocido y su principal complicación es la formación de aneurismas coronarios.Objetivo. Realizar una revisión actualizada de la literatura acerca del tratamiento farmacológico de la enfermedad de Kawasaki.Materiales y métodos. Se realizó una búsqueda estructurada de la literatura en las bases de datos ProQuest, EBSCO, ScienceDirect, PubMed, LILACS, Embase, Trip Database, SciELO y Cochrane Library con los términos “Kawasaki disease AND therapeutics”, “Kawasaki disease AND treatment” y “Mucocutaneous Lymph Node Syndrome AND therapeutics”, en inglés y con sus equivalentes en español.Resultados. Se encontraron 51 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. El diagnóstico y el tratamiento oportuno de la enfermedad de Kawasaki son fundamentales para la prevención de las complicaciones coronarias. El tratamiento incluye la terapia combinada de ácido acetilsalicílico más inmunoglobulina G, la cual reduce la incidencia de aneurismas coronarios. Por su parte, las terapias con corticosteroides y otros fármacos inmunosupresores son alternativas utilizadas en el tratamiento de la enfermedad de Kawasaki resistente a inmunoglobulina.
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Yoshizawa H, Nogami K, Matsumoto T, Tsujii N, Sakai T, Takase T, Tanaka I, Shima M. Dynamic evaluation of hemostasis in the acute phase of Kawasaki disease using comprehensive coagulation functional assays. Thromb Res 2018; 174:76-83. [PMID: 30579149 DOI: 10.1016/j.thromres.2018.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/17/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Kawasaki disease (KD) is a systemic vasculitis involving coronary arteries, sometimes resulting in aneurysms and myocardial infarction. Hyper-coagulability in the acute-phase of KD is indicated in some circumstances based on changes of individual clotting factors. Comprehensive coagulation assays, clot waveform analysis (CWA) and thrombin/plasmin generation assay (T/P-GA), have been developed to assess physiological hemostasis, but these techniques have not been applied in KD. METHODS We utilized both assays to analyze coagulation function in KD children (n = 42) prior to intravenous-immunoglobulin (IVIG) treatment (Pre), 1-week (1W) and 1-month (1M) post-IVIG. RESULTS In CWA, the clot time (CT) pre-treatment was prolonged, and was significantly shortened at 1W and 1M. However, the maximum coagulation velocity (|min1|) and acceleration (|min2|) were ~2-fold greater relative to controls, indicating an overall hypercoagulable tendency. These parameters were related to fibrinogen concentration, and were decreased at 1W and declined to normal at 1M. In T/P-GA, the endogenous potentials of thrombin and plasmin were greater relative to control at each of three time-points, and measurements at 1W were greater than those Pre-treatment. The ratios of TG and PG relative to control were similar, however, suggesting well-balanced dynamic coagulation and fibrinolysis. In non-responders to IVIG, the |min1| and |min2| measurements were greater than those in responders at 1W and 1M, suggesting that non-responders remained hypercoagulable after primary treatment. CONCLUSION The coagulation data observed in KD were consistent with hypercoagulability, although fibrinolytic function appeared to be well-balanced. Comprehensive assays of this nature could provide valuable information on coagulation potential in KD.
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Affiliation(s)
- Hiroyuki Yoshizawa
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.
| | - Tomoko Matsumoto
- Course of Hemophilia Treatment and Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobuyuki Tsujii
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Toshiyuki Sakai
- Pediatrics, Kokuho Central Hospital, Tawaramoto, Nara, Japan
| | - Toshio Takase
- Pediatrics, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Ichiro Tanaka
- Pediatrics, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
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Sudden Death as a Sequel of Ruptured Giant Coronary Artery Aneurysm in Kawasaki Disease. Am J Forensic Med Pathol 2018; 39:375-377. [PMID: 29939842 DOI: 10.1097/paf.0000000000000417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reports a case of Kawasaki disease (KD) and its rapid fatal course in a 5-year-old boy, who 3 days before hospitalization demonstrated fever and diffuse erythema in the face, neck, and torso, as well as swelling and pain below the right earlobe. During the admission, he was diagnosed with mumps and suspected scarlet fever. Abnormal laboratory findings included elevated values of procalcitonin, C-reactive protein, and interleukin 6. Sudden death occurred 8 days after admission. Autopsy confirmed the cause of death to be pericardial tamponade due to a ruptured, inflamed aneurysm of the left anterior descending coronary artery. We believe that any typical clinical sign of KD whenever associated with elevated indices of inflammation should set off suspicion of KD and further permit cardiovascular examination. This would contribute to distinguishing KD from other diseases with similar clinical signs in order to accelerate appropriate treatment.
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Abdolmanafi A, Duong L, Dahdah N, Adib IR, Cheriet F. Characterization of coronary artery pathological formations from OCT imaging using deep learning. BIOMEDICAL OPTICS EXPRESS 2018; 9:4936-4960. [PMID: 30319913 PMCID: PMC6179392 DOI: 10.1364/boe.9.004936] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 05/18/2023]
Abstract
Coronary artery disease is the number one health hazard leading to the pathological formations in coronary artery tissues. In severe cases, they can lead to myocardial infarction and sudden death. Optical Coherence Tomography (OCT) is an interferometric imaging modality, which has been recently used in cardiology to characterize coronary artery tissues providing high resolution ranging from 10 to 20 µm. In this study, we investigate different deep learning models for robust tissue characterization to learn the various intracoronary pathological formations caused by Kawasaki disease (KD) from OCT imaging. The experiments are performed on 33 retrospective cases comprising of pullbacks of intracoronary cross-sectional images obtained from different pediatric patients with KD. Our approach evaluates deep features computed from three different pre-trained convolutional networks. Then, a majority voting approach is applied to provide the final classification result. The results demonstrate high values of accuracy, sensitivity, and specificity for each tissue (up to 0.99 ± 0.01). Hence, deep learning models and especially, majority voting method are robust for automatic interpretation of the OCT images.
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Affiliation(s)
- Atefeh Abdolmanafi
- Dept. of Software and IT Engineering, École de technologie supérieure, Montréal,
Canada
| | - Luc Duong
- Dept. of Software and IT Engineering, École de technologie supérieure, Montréal,
Canada
| | - Nagib Dahdah
- Div. of Pediatric Cardiology and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montréal,
Canada
| | | | - Farida Cheriet
- Dept. of Computer Engineering, École Polytechnique de Montréal, Montréal,
Canada
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National consensus on the cardiological treatment and follow-up of Kawasaki disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Su Y, Feng S, Luo L, Liu R, Yi Q. Association between IL-35 and coronary arterial lesions in children with Kawasaki disease. Clin Exp Med 2018; 19:87-92. [PMID: 30054763 DOI: 10.1007/s10238-018-0513-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
Kawasaki disease (KD) arises due to the acute inflammation and immune system dysfunction. This study investigated the relationship between the serum level of IL-35 and coronary artery lesions (CALs) in patients with KD. We obtained blood samples from 90 children with KD before intravenous immunoglobulin therapy. Levels of IL-35, IL-6, IL-17A, IL-10, MCP-1 and VEGF were measured in 190 cases, including 4 groups: KD with coronary arterial lesions (n = 46), KD without coronary arteries lesions (n = 44), febrile control group (FC, n = 40) and the normal control group (NC, n = 60). White blood cell counts (WBC), red blood cell counts (RBC), hemoglobin, platelet, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and procalcitonin were tested in all subjects. Levels of IL-35, RBC and hemoglobin significantly decreased, and IL-6, IL-17A, IL-10, MCP-1 and VEGF were significantly elevated in the KD group compared with febrile and control groups. IL-35 serum level even decreased, and ESR, IL-6, MCP-1 and VEGF increased in the KD patients with CALs. Serum levels of IL-35 in KD patients were negatively associated with WBC, CRP, IL-6, IL-17A, IL-10, MCP-1 and VEGF in children with KD. IL-35 may have the effect on inhibiting inflammatory process in KD and further preventing KD patients from coronary artery lesion.
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Affiliation(s)
- Ya Su
- Key Laboratory of Pediatrics in Chongqing, Chongqing, 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China
| | - Siqi Feng
- Key Laboratory of Pediatrics in Chongqing, Chongqing, 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China
| | - Li Luo
- Key Laboratory of Pediatrics in Chongqing, Chongqing, 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China
| | - Ruixi Liu
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, 400014, China.
| | - Qijian Yi
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, 400014, China.
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Makino N, Nakamura Y, Yashiro M, Sano T, Ae R, Kosami K, Kojo T, Aoyama Y, Kotani K, Yanagawa H. Epidemiological observations of Kawasaki disease in Japan, 2013-2014. Pediatr Int 2018; 60:581-587. [PMID: 29498791 DOI: 10.1111/ped.13544] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 12/06/2017] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The etiology of Kawasaki disease (KD) is unknown. In Japan, the number of patients and incidence rate of KD has increased continuously since its discovery. The aim of this report was to analyze the latest nationwide epidemiological survey of KD in Japan. METHODS The 23rd nationwide survey of KD was conducted in 2015. To report on all patients diagnosed with KD in 2013 and 2014, a questionnaire was sent to hospitals with ≥100 beds containing pediatric departments, as well as specialized pediatric hospitals. RESULTS The number of KD patients reported was 15 696 in 2013 and 15 979 in 2014, resulting in an annual incidence rate of 302.5 and 308.0 per 100 000 population aged 0-4 years, respectively. The number of patients and incidence rate of KD in 2014 were the highest ever recorded in Japan. The number of patients diagnosed per month peaked in January, and a gradual increase in summer was also observed. Eight patients died of KD in 2013 and 2014. CONCLUSIONS The number of patients and incidence rate of KD in Japan continue to increase. Continued surveillance of epidemiological trends of KD is therefore required.
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Affiliation(s)
- Nobuko Makino
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Mayumi Yashiro
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Takashi Sano
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Ryusuke Ae
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Koki Kosami
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Takao Kojo
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Yasuko Aoyama
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Kazuhiko Kotani
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Hiroshi Yanagawa
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
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Barrios Tascón A, Centeno Malfaz F, Rojo Sombrero H, Fernández-Cooke E, Sánchez-Manubens J, Pérez-Lescure Picarzo J. [National consensus on the cardiological treatment and follow-up of Kawasaki disease]. An Pediatr (Barc) 2018; 89:188.e1-188.e22. [PMID: 29778491 DOI: 10.1016/j.anpedi.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/01/2018] [Indexed: 12/20/2022] Open
Abstract
Kawasaki disease is a self-limiting acute vasculitis that affects small and medium-sized vessels, and is the most common cause of acquired heart disease in children in our environment. Up to 25% of untreated patients develop coronary aneurysms. It is suspected that an infectious agent may be the trigger of the disease, but the causative agent is still unknown. Based on the previous evidence, recommendations are proposed for the diagnosis, treatment of acute disease, and the long-term management of these patients, in order to unify criteria. The diagnosis must be quick, based on easy-to-use algorithms and with the support of complementary tests. This document includes the indication of available imaging techniques, as well as the planning of cardiological examinations based on the initial involvement. Intravenous immunoglobulin is the basis of the initial treatment. The role of corticosteroids is still controversial, but there are studies that support its use as adjuvant treatment. A multidisciplinary working group has developed a scheme with different treatment guidelines depending on the risk factors at diagnosis, the patient's clinical situation, and response to previous treatment, including indications for thromboprophylaxis in patients with coronary involvement. The stratification of risk for long-term treatment is essential, as well as the recommendations on the procedures based on the initial cardiological involvement and its progression. Patients with coronary aneurysms require continuous and uninterrupted cardiological monitoring for life.
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Affiliation(s)
- Ana Barrios Tascón
- Cardiología infantil, Servicio de Pediatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas.
| | - Fernando Centeno Malfaz
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas; Cardiología infantil, Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, España
| | - Henar Rojo Sombrero
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas; Cardiología infantil, Servicio de Pediatría, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Elisa Fernández-Cooke
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Materno Infantil Doce de Octubre, Madrid, España; Sociedad Española de Infectología Pediátrica
| | - Judith Sánchez-Manubens
- Unidad de Reumatología Pediátrica, Servicio de Pediatría, Hospital Parc Taulí, Sabadell, Barcelona, España; Sociedad Española de Reumatología Pediátrica
| | - Javier Pérez-Lescure Picarzo
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas; Cardiología infantil, Servicio de Pediatría, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Qiu H, He Y, Rong X, Ren Y, Pan L, Chu M, Wu R, Shi H. Delayed intravenous immunoglobulin treatment increased the risk of coronary artery lesions in children with Kawasaki disease at different status. Postgrad Med 2018; 130:442-447. [PMID: 29745742 DOI: 10.1080/00325481.2018.1468712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Kawasaki disease (KD) is a systemic vasculitis with serious complications, especially the development of coronary artery lesions (CALs). The aim of this study was to identify the risk for the development of CALs with IVIG treatment of KD >10 days after illness onset in patients with different KD status, and explore potential moderators of the association between delayed treatment and CALs. METHODS We performed a retrospective review of the medical records of KD patients. All patients were divided into two groups (conventional therapy group and delayed therapy group, IVIG treatment ≤10 days vs >10 days). We compared the demographic and clinical characteristics, laboratory data, and analyzed risk factors for CALs in patients who received IVIG treatment >10 days, and determined whether different status of KD modified the effects of delayed IVIG treatment on CALs. RESULTS In the delayed IVIG treatment group, children were more likely to develop CALs and the proportion of incomplete KD was higher, compared with the conventional therapy group. The number of children younger than 12 months or older than 61 months was higher and children had higher BMI and were more likely to receive steroids before diagnosis in the delayed IVIG treatment group compared with the conventional therapy group. Delayed IVIG treatment was an independent risk factor for the development of CALs (adjusted OR = 2.90, 95%CI = 1.42, 5.91). Delayed therapy children with higher levels of C-reactive protein (>79 mg/L) and erythrocyte sedimentation rate (>34 mm/h) had the highest risk for developing CALs (OR = 5.68, 95%CI: 1.17, 27.59; OR = 4.11, 95%CI: 1.62, 10.46, respectively). CONCLUSION Delayed IVIG treatment was an independent risk factor for the development of CALs. Children in the delayed IVIG treatment group with higher levels of CRP and ESR (CRP >79 mg/L, ESR >34 mm/h) had the greatest likelihood of developing CALs.
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Affiliation(s)
- Huixian Qiu
- a Children's Heart Center, The Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine , WenZhou Medical University , Wenzhou , P.R. China
| | - Yuee He
- a Children's Heart Center, The Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine , WenZhou Medical University , Wenzhou , P.R. China
| | - Xing Rong
- a Children's Heart Center, The Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine , WenZhou Medical University , Wenzhou , P.R. China
| | - Yue Ren
- a Children's Heart Center, The Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine , WenZhou Medical University , Wenzhou , P.R. China
| | - Lulu Pan
- a Children's Heart Center, The Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine , WenZhou Medical University , Wenzhou , P.R. China
| | - Maoping Chu
- a Children's Heart Center, The Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine , WenZhou Medical University , Wenzhou , P.R. China
| | - Rongzhou Wu
- a Children's Heart Center, The Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine , WenZhou Medical University , Wenzhou , P.R. China
| | - Hongying Shi
- b Department of Preventive Medicine, School of Public Health and Management , WenZhou Medical University , Wenzhou , Zhejiang Province , P.R. China
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Nakamoto T. Sleep-Disordered Breathing―a Real Therapeutic Target for Hypertension, Pulmonary Hypertension, Ischemic Heart Disease, and Chronic Heart Failure? J NIPPON MED SCH 2018; 85:70-77. [DOI: 10.1272/jnms.2018_85-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Noto N, Komori A, Ayusawa M, Takahashi S. Recent updates on echocardiography and ultrasound for Kawasaki disease: beyond the coronary artery. Cardiovasc Diagn Ther 2018. [PMID: 29541613 DOI: 10.21037/cdt.2017.06.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Kawasaki disease (KD) is a systemic vasculitis with a predilection for damage to the coronary arteries. In the acute phase, clinical decision making for KD relies on the measurements of the coronary z-score obtained by 2-dimensional echocardiography (2DE). In the convalescent phase, KD patients with coronary artery abnormalities (CAAs) eventually show arteriosclerotic vascular remodeling characterized by marked intimal proliferation and neoangiogenesis after KD vasculitis, which often induces myocardial ischemia. To date, several well-established surrogate markers including dobutamine stress echocardiography (DSE), the carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD), have been made available for risk assessment and the prediction of cardiovascular disease (CVD) in KD patients. Additionally, the use of carotid contrast-enhanced ultrasonography (CEUS), has enabled the visualization and quantification of the adventitial vasa vasorum (VV) network, assessing active vascular remodeling at remote arterial sites in KD patients with CAAs. However, there was no evidence of major vascular structural changes in KD patients in whom CAAs had never been detected. Thus, assessment of multiple modalities using 2DE may provide direct information not only on the vascular health but also on the stratification of the risk of CVD in KD patients with CAAs.
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Affiliation(s)
- Nobutaka Noto
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Akiko Komori
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Pilania RK, Bhattarai D, Singh S. Controversies in diagnosis and management of Kawasaki disease. World J Clin Pediatr 2018; 7:27-35. [PMID: 29456929 PMCID: PMC5803562 DOI: 10.5409/wjcp.v7.i1.27] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 02/06/2023] Open
Abstract
Kawasaki disease (KD) is a common medium vessel systemic vasculitis that usually occurs in small children. It has a predilection for the coronary arteries, but other medium sized arteries can also be involved. The etiology of this disorder remains a mystery. Though typical presentation of KD is quite characteristic, it may also present as incomplete or atypical disease in which case the diagnosis can be very challenging. As both incomplete and atypical forms of KD can be associated with serious coronary artery complications, the pediatrician can ill afford to miss these diagnoses. The American Heart Association has enunciated consensus guidelines to facilitate the clinical diagnosis and treatment of this condition. However, there are still several issues that remain controversial. Intravenous immunoglobulin remains the cornerstone of management but several other treatment modalities, especially glucocorticoids, are increasingly finding favour. We review here some of the contemporary issues, and the controversies thereon, pertaining to management of KD.
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Affiliation(s)
- Rakesh Kumar Pilania
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Dharmagat Bhattarai
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Yorifuji T, Tsukahara H, Kashima S, Doi H. Intrauterine and Early Postnatal Exposure to Particulate Air Pollution and Kawasaki Disease: A Nationwide Longitudinal Survey in Japan. J Pediatr 2018; 193:147-154.e2. [PMID: 29212623 DOI: 10.1016/j.jpeds.2017.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/20/2017] [Accepted: 10/11/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To examine the effects of prenatal and postnatal exposure to particulate matter on Kawasaki disease (KD) occurrence, using data from a nationwide population-based longitudinal survey in Japan that began in 2010. STUDY DESIGN Prenatal and postnatal suspended particulate matter concentrations were obtained at municipality level and assigned to participants based on their municipality of birth. We analyzed data from 30 367 participants with data on either exposure period. We used hospital admission for KD from 6 to 30 months of age as the main outcome of interest. We conducted a multilevel logistic regression analysis, adjusting for individual and municipality-level variables. RESULTS Children who were exposed to higher levels of suspended particulate matter, in particular during pregnancy, were more likely to be hospitalized for KD. The ORs for ≥25 µg/m3 exposure compared with <20 µg/m3 exposure were 1.59 (95% CI 1.06, 2.38) for prenatal exposure and 1.41 (0.82, 2.41) for postnatal exposure. Prenatal exposure during mid-to-late gestation seemed to be more relevant for the increased risk. CONCLUSIONS Early life exposure to particulate air pollution, in particular during pregnancy, is associated with an increased risk of KD hospital admission in early childhood in a nationally representative sample in Japan.
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Affiliation(s)
- Takashi Yorifuji
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan.
| | - Hirokazu Tsukahara
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Saori Kashima
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Doi
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Abstract
Kawasaki disease (KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association (AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.
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Affiliation(s)
- Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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46
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Lin MT, Wu MH. The global epidemiology of Kawasaki disease: Review and future perspectives. Glob Cardiol Sci Pract 2017; 2017:e201720. [PMID: 29564341 PMCID: PMC5856963 DOI: 10.21542/gcsp.2017.20] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Kawasaki disease (KD) is one of the most common childhood vasculitides and may lead to coronary arterial complications. KD has been reported in more than 60 countries over five continents. Previous publications have provided a comprehensive description of the epidemiologic features of KD including incidence, age of onset, seasonal trends, and rates of cardiac lesions. However, the interactions among the KD patients, time (seasons) and place have been less well studied. We review the current global epidemiology of KD and focus on the longitudinal changes in incidence, seasonality and response to intravenous immunoglobulin (IVIG) therapy.
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Affiliation(s)
- Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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47
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El-Said G, Rizk S, Sorour K, Gharib S, Said K, Kandeel H. How a simple medical observation led to increased awareness and propagation of research in Kawasaki disease in Egypt. Glob Cardiol Sci Pract 2017; 2017:e201718. [PMID: 29564339 PMCID: PMC5856967 DOI: 10.21542/gcsp.2017.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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48
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Kuo HC. Preventing coronary artery lesions in Kawasaki disease. Biomed J 2017; 40:141-146. [PMID: 28651735 PMCID: PMC6136281 DOI: 10.1016/j.bj.2017.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 12/23/2022] Open
Abstract
A form of systemic vasculitis that affects mostly small and medium-sized vessels, Kawasaki disease (KD) is most commonly found in children under the age of 5 years old. Though its etiology is unknown, KD has been the most frequent acquired heart disease in developing countries. Its incidence has increased over recent decades in many centuries, including Japan, Korea, and China. The most severe complications of KD are coronary artery lesions (CAL), including dilation, fistula, aneurysm, arterial remodeling, stenosis, and occlusion. Aneurysm formation has been observed in 20–25% of KD patients that do not receive intravenous immunoglobulin (IVIG) treatment, and in 3–5% that do receive it. Coronary artery dilation has been found in about 30% of KD patients in the acute stage, although mostly in the transient form. Diminishing the occurrence and regression of CAL is a vital part of treating KD. In this review article, I demonstrate the clinical method to prevent CAL formation used at the Kawasaki Disease Center in Taiwan.
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Affiliation(s)
- Ho-Chang Kuo
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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49
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Bai L, Feng T, Yang L, Zhang Y, Jiang X, Liao J, Chen L, Feng X, Rong Y, Li Y, Qin Z, Qiao J. Retrospective analysis of risk factors associated with Kawasaki disease in China. Oncotarget 2017; 8:54357-54363. [PMID: 28903347 PMCID: PMC5589586 DOI: 10.18632/oncotarget.17530] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/14/2017] [Indexed: 11/25/2022] Open
Abstract
In order to provide early intervention for coronary artery lesion (CAL) caused by Kawasaki Disease (KD), we analyzed clinical characteristics of typical and incomplete KD cases from 1998 to 2008 in Northwest and Central China. A total of 383 patients included 298 cases of typical KD and 85 cases of incomplete KD. The morbidity of incomplete KD was 28.5%, a percentage significantly lower than that of typical KD. The occurrence of bulbar conjunctiva congestion, erythra, crissum red, film-like decrustation, lip red, rhagades, raspberry tongue, bilateral toe-end decrustation, limb sclerosis, cervical lymph nodes enlargement, agitation and irritability in incomplete KD group was lower than that in the group of typical KD (p < 0.05); however, the occurrence of unilateral toe-end decrustation, scar reappearance erythema, malaise, fatigue, liver incidence was significant higher in incomplete KD group (p < 0.05). Based on lab assays and inspection index comparisons, the incomplete KD cases whose C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significantly increased, had significantly higher reduction in blood platelet (PLT). Interestingly, the KD patients with CPR higher than 30 mg/L, ESR higher than 40 mm/h, hepatomegaly and IVIG ineffectiveness, had higher incidence of CAL development. Altogether, our data have indicated differential clinical characteristics between incomplete KD and typical KD, and have identified several high risk factors of KD for CAL, such as hepatomegaly.
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Affiliation(s)
- Lihua Bai
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China
| | - Tienan Feng
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China.,Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and Faculty of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Lifang Yang
- Shanxi Provincial People's Hospital, Xi'An Jiaotong University, Xi'an 710068, China
| | - Yi Zhang
- The 3rd Clinical Medical School, Three Gorges University, Yichang 443002, China
| | - Xuejuan Jiang
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China
| | - Jiayao Liao
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China
| | - Lihua Chen
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China
| | - Xiaoyan Feng
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China
| | - Yanming Rong
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China
| | - Yuehua Li
- Shanxi Provincial People's Hospital, Xi'An Jiaotong University, Xi'an 710068, China
| | - Zhiqiang Qin
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China.,Departments of Genetics, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, New Orleans, LA 70112, USA
| | - Jing Qiao
- Department of Pediatrics, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai 200123, China
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50
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Tian J, An X, Niu L. Correlation between NF-κB signal pathway-mediated caspase-4 activation and Kawasaki disease. Exp Ther Med 2017; 13:3333-3336. [PMID: 28587409 PMCID: PMC5450634 DOI: 10.3892/etm.2017.4409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/07/2017] [Indexed: 01/08/2023] Open
Abstract
The aim of the study was to investigate the role and mechanisms of action of nuclear factor-κB (NF-κB)-mediated caspase-4 activation in the induction of inflammatory cytokines during Kawasaki disease (KD) and coronary artery endothelial cell injury. Peripheral blood mononuclear cells (PBMCs) were isolated from KD patients and healthy controls and cultured. Double antibody sandwich enzyme-linked immunosorbent assay (ELISA) was applied to detect tumor necrosis factor (TNF)-α levels in activated PBMC-conditioned culture media. To establish a culture model for human coronary artery endothelial cells (HCAECs), we employed KD patient-origin PBMC culture-conditioned media to induce HCAEC transformation and detected the nuclear activation of NF-κB p65 and intracellular caspase-4 protein concentrations using western blot analysis. We also investigated the nuclear transfer of NF-κB p65 using immunofluorescence, as well as HCAEC interleukin (IL)-6 and IL-1β secretion using ELISA. Finally, we investigated HCAEC apoptosis using using Annexin V/PI double staining. After PBMCs were stimulated in vitro, TNF-α secretion was significantly higher in the KD group versus controls (P<0.01). HCAEC cells treated with supernatant conditioned by cells from KD patients showed a significant elevation of NF-κB p65 and caspase-4 protein expression versus HCAEC cells treated with supernatant conditioned by control cells (P<0.01). Similarly, IL-6 and IL-1β secretion, as well as apoptotic rate, were significantly elevated (P<0.01). SN50, an NF-κB inhibitor, significantly attenuated caspase-4 expression, secretion of IL-6, IL-1β, and TNF-α, as well as HCAEC apoptosis in cells treated with KD patient PBMC-conditioned media. NF-κB can induce the generation of various inflammatory factors including IL-6 and IL-1β, mediate the expression of caspase-4 in HCAEC cells, and affect apoptosis and injury of HCAEC cells. Therefore, the expression of caspase-4, mediated by NF-κB signal pathway, plays a critical role in KD.
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Affiliation(s)
- Jing Tian
- Department of Cardiology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Xinjiang An
- Department of Cardiology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Ling Niu
- Department of Cardiology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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