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Barman P, Pilania RK, Cv G, Thangaraj A, Arora M, Singh S. Treatment intensification in Kawasaki disease - current perspectives. Expert Rev Clin Immunol 2024:1-13. [PMID: 38979573 DOI: 10.1080/1744666x.2024.2378900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/08/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Intravenous immunoglobulin is the standard of care in Kawasaki disease. However, a subset of patients exhibits resistance to intravenous immunoglobulin treatment, even when Kawasaki disease is promptly diagnosed and managed. While intravenous immunoglobulin reduces the occurrence of coronary artery abnormalities from 15-25% to 3-5%, it does not entirely eliminate the risk. Besides, management guidelines for non-coronary complications of Kawasaki disease, for instance, myocarditis, remain speculative. AREAS COVERED Recent literature suggests that a subset of patients with Kawasaki disease may benefit from treatment intensification with drugs, such as corticosteroids, infliximab, anakinra, and/or ciclosporin. In this manuscript, we have reviewed recent advances in the management of Kawasaki disease, especially with regard to preemptive intensification of therapy in children at high risk of cardiac complications. A comprehensive search was made using Web of Science, Scopus, and PubMed databases to gather English articles published from 1967 to 2023 on the treatment of Kawasaki disease. We incorporated the following words in the search strategy: 'Kawasaki disease,' 'intravenous immunoglobulin/IVIg,' 'intravenous immunoglobulin/IVIg-resistant Kawasaki disease,' 'treatment intensification,' or 'primary intensification of treatment/therapy.' EXPERT OPINION The 'high-risk' group in Kawasaki disease needs to be identified with early intensification of primary therapy for better coronary and myocardial outcomes.
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Affiliation(s)
- Prabal Barman
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gayathri Cv
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abarna Thangaraj
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Munish Arora
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Iio K, Hanna H, Beykou M, Gale C, Herberg JA. Role of procalcitonin in predicting complications of Kawasaki disease. Arch Dis Child 2023; 108:862-864. [PMID: 37524408 DOI: 10.1136/archdischild-2023-325787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Kazuki Iio
- Applied Paediatrics MSc course, Imperial College London, London, UK
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Heather Hanna
- Section of Paediatric Infectious Disease, Imperial College London, London, UK
| | - Melina Beykou
- Circuits and Systems Group, Centre of Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
- Dynamical Cell Systems Group, Division of Cancer Biology, Institute of Cancer Research, London, UK
- Cancer Research UK Convergence Science Centre, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Jethro Adam Herberg
- Section of Paediatric Infectious Disease, Imperial College London, London, UK
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Hosseininasab A, Pashang F, Rukerd MRZ, Mirkamali H, Nakhaie M, Sayyadi A. Kawasaki disease in children: a retrospective cross-sectional study. Reumatologia 2023; 61:152-160. [PMID: 37522144 PMCID: PMC10373172 DOI: 10.5114/reum/163170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/12/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Kawasaki disease (KD) is a systemic vasculitis, seen mostly in children. Epidemiology of KD is dependent on geographical location and seasonality. Although many years have passed since the first report of KD, multiple related factors are still unknown. Material and methods We investigated the clinical, paraclinical, and therapeutic aspects of KD in Kerman, Iran by performing a retrospective, descriptive, cross-sectional study on all children hospitalized due to KD between 2007 and 2020. Results A total of 340 patients with mean ±SD age of 29.83 ±22.55 months participated in the study. Most of our patients were two to five years old. The male : female ratio was ~ 1.4 : 1. A few of our patients had a family history of KD or vasculitis (0.3%, 1.7%). Typical KD was more common by a large margin (316 patients with typical KD). More than half of our patients had a duration of hospitalization of under ten days. All of our patients were febrile. Hand/foot and lip/mouth changes were the second and third most common clinical findings in more than 60% of our patients. Other manifestations were conjunctivitis in 40%, skin rashes in 34.8%, gastrointestinal manifestations in 33.9%, and lymphadenopathy in 25.3%. Echocardiography revealed abnormalities in 78.6% of the participants; coronary artery aneurysm (CAA) was the most frequent (22.5%) and follow-up echocardiography revealed that all of them regressed within 6 months after treatment. The two laboratory tests with the highest ratio of abnormality were erythrocyte sedimentation rate (95%) and hemoglobin (83.3%). C-reactive protein and liver function tests were also abnormal in most patients. All of our patients received intravenous immunoglobulin and acetylsalicylic acid. Conclusions Kawasaki disease must be considered in every febrile child, especially those with risk factors, because timely diagnosis and treatment are essential to prevent complications. Health policies should focus on appropriate diagnosis and treatment to prevent the occurrence of sequelae.
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Affiliation(s)
- Ali Hosseininasab
- Tropical and Infectious Diseases Research Center, Kerman University of Medical Sciences, Iran
| | - Fahime Pashang
- Tropical and Infectious Diseases Research Center, Kerman University of Medical Sciences, Iran
| | - Mohammad Rezaei Zadeh Rukerd
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Iran
| | - Hanieh Mirkamali
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Iran
| | - Mohsen Nakhaie
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Iran
| | - Amin Sayyadi
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Iran
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Galeotti C, Bajolle F, Belot A, Biscardi S, Bosdure E, Bourrat E, Cimaz R, Darbon R, Dusser P, Fain O, Hentgen V, Lambert V, Lefevre-Utile A, Marsaud C, Meinzer U, Morin L, Piram M, Richer O, Stephan JL, Urbina D, Kone-Paut I. French national diagnostic and care protocol for Kawasaki disease. Rev Med Interne 2023:S0248-8663(23)00647-1. [PMID: 37349225 DOI: 10.1016/j.revmed.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
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Affiliation(s)
- C Galeotti
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - F Bajolle
- M3C-Necker-Enfants-Malades, hôpital Necker-Enfants-Malades, université de Paris Cité, Paris, France
| | - A Belot
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - S Biscardi
- Service des urgences pédiatriques, centre hospitalier intercommunal de Créteil, Créteil, France
| | - E Bosdure
- Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 13385 Marseille cedex 5, France
| | - E Bourrat
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - R Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Department of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - R Darbon
- Association France vascularites, Blaisy-Bas, France
| | - P Dusser
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - O Fain
- Service de médecine interne, hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - V Hentgen
- Service de pédiatrie, centre de référence des maladies auto-inflammatoires et de l'amylose (CEREMAIA), centre hospitalier de Versailles, Le Chesnay, France
| | - V Lambert
- Service de radiologie pédiatrique, Institut mutualiste Montsouris, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - A Lefevre-Utile
- Service de pédiatrie générale et des urgences pédiatriques, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - C Marsaud
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - U Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Morin
- Service de réanimation pédiatrique et néonatale, DMU 3 santé de l'enfant et adolescent, hôpital Bicêtre, université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - M Piram
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, Quebec, Canada
| | - O Richer
- Service des urgences pédiatriques, hôpital universitaire de Pellegrin, Bordeaux, France
| | - J-L Stephan
- Service de pédiatrie, CHU Saint-Étienne, Saint-Étienne, France
| | - D Urbina
- Service d'accueil des urgences pédiatriques, hôpital Nord, AP-HM, 13005 Marseille, France
| | - I Kone-Paut
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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Chiang WN, Huang PY, Kuo HC, Huang YH, Chang LS. Evaluation of Formosa score and diagnostic sensitivity and specificity of four Asian risk scores for predicting intravenous immunoglobulin resistance in Kawasaki disease: a bivariate meta-analysis. Front Cardiovasc Med 2023; 10:1164530. [PMID: 37378410 PMCID: PMC10291052 DOI: 10.3389/fcvm.2023.1164530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Background In 2016, Lin et al. developed a prediction score of non-responsiveness to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD) (Lin et al., 2016). Various studies have attempted to validate the Formosa score, but inconsistent results have given us new opportunities and challenges. The aim of this meta-analysis is to explore the role of the Formosa score as a risk score in detecting IVIG-resistant KD patients and then compare the pooled sensitivity and specificity of four Asian risk scores, Egami, Formosa, Kobayashi, and Sano risk scores. Methods A comprehensive search of Cochrane, Embase, and PubMed was conducted through 20 December 2021, using key terms relevant to the research question "What are the sensitivities and specificities of the four Asian predicting scores, Egami, Formosa, Kobayashi, and Sano, in Kawasaki disease patients with IVIG resistance?" The reference lists of the included studies were manually reviewed to identify pertinent references. A random-effects bivariate model was used to estimate the summary of sensitivity and specificity of the tools. Results We found 41 relevant studies of the four Asian risk scores that were eligible to analyze for pooled accuracy. Eleven studies involving 5,169 KD patients reported the diagnostic performance of the Formosa score for the risk of IVIG resistance. The overall performance of the Formosa score was as follows: pooled sensitivity, 0.60 [95% confidence interval (CI), 0.48-0.70]; pooled specificity, 0.59 (95% CI, 0.50-0.68); and area under the hierarchical summary receiver operating characteristic curve, 0.62. The Formosa score exhibited the highest sensitivity 0.76 (95% CI, 0.70-0.82) for detecting IVIG-resistant KD patients among the 21,389 children included in the 41 studies. In terms of specificity estimates, Formosa had the lowest specificity of 0.46 (95% CI, 0.41-0.51). Conclusion Patients at high risk for IVIG resistance may receive adjunctive treatment to reduce coronary lesions and thus also cardiovascular morbidity. Among all of the included studies, we found Formosa score to have the best sensitivity (0.76) but unsatisfactory specificity (0.46) for predicting IVIG resistance in Kawasaki disease. In the future, network meta-analysis should also incorporate the accuracy of the new scores after they have undergone a certain degree of validation around the world. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD42022341410.
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Affiliation(s)
- Wan-Ni Chiang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Yu Huang
- Department of Traditional Chinese Medicine, 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, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Spezia PG, Filippini F, Nagao Y, Sano T, Ishida T, Maggi F. Identification of Torquetenovirus Species in Patients with Kawasaki Disease Using a Newly Developed Species-Specific PCR Method. Int J Mol Sci 2023; 24:8674. [PMID: 37240024 PMCID: PMC10218515 DOI: 10.3390/ijms24108674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
A next-generation sequencing (NGS) study identified a very high viral load of Torquetenovirus (TTV) in KD patients. We aimed to evaluate the feasibility of a newly developed quantitative species-specific TTV-PCR (ssTTV-PCR) method to identify the etiology of KD. We applied ssTTV-PCR to samples collected from 11 KD patients and 22 matched control subjects who participated in our previous prospective study. We used the NGS dataset from the previous study to validate ssTTV-PCR. The TTV loads in whole blood and nasopharyngeal aspirates correlated highly (Spearman's R = 0.8931, p < 0.0001, n = 33), supporting the validity of ssTTV-PCR. The ssTTV-PCR and NGS results were largely consistent. However, inconsistencies occurred when ssTTV-PCR was more sensitive than NGS, when the PCR primer sequences mismatched the viral sequences in the participants, and when the NGS quality score was low. Interpretation of NGS requires complex procedures. ssTTV-PCR is more sensitive than NGS but may fail to detect a fast-evolving TTV species. It would be prudent to update primer sets using NGS data. With this precaution, ssTTV-PCR can be used reliably in a future large-scale etiological study for KD.
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Affiliation(s)
| | - Fabio Filippini
- Department of Translational Research, University of Pisa, 56127 Pisa, Italy
| | - Yoshiro Nagao
- Department of Paediatrics, Japan Community Health Care Organisation Osaka Hospital, Osaka 5530003, Japan
- Department of Paediatrics, Fukuoka Tokushukai Hospital, Fukuoka 8160864, Japan
| | - Tetsuya Sano
- Department of Paediatrics, Japan Community Health Care Organisation Osaka Hospital, Osaka 5530003, Japan
| | - Takafumi Ishida
- Department of Biological Sciences, University of Tokyo, Tokyo 1130033, Japan
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani”—IRCCS, 00149 Rome, Italy
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Koliou MG, Aristidou A, Mazeri S, Georgiou E, Agathocleous M, Kousparou M, Elia A, Jossif A. Epidemiology and risk factors for resistance to treatment of Kawasaki disease in Cyprus. Sci Rep 2023; 13:352. [PMID: 36611091 PMCID: PMC9825398 DOI: 10.1038/s41598-023-27694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Kawasaki disease (KD) is one of the most common vasculitides of early childhood. There are no previous studies on KD in Cyprus. The aim of this study was to evaluate the epidemiology of KD in Cyprus, risk factors for resistance to treatment and the development of cardiac complications. This is a retrospective multicenter study of pediatric patients with KD hospitalized between January 2000 and-December 2019. The data were collected from medical records. A total of 136 patients with KD were included in the study. 83% of patients were < 5 years of age and 10% were < 6 months. Thirty patients (22%) developed coronary artery lesions. Serum sodium ≤ 133 mmol/L, albumin ≤ 3.2 g/dl, ALT ≥ 80 U/L and neutrophils percentage ≥ 80% at diagnosis, were identified as risk factors for resistance to IVIG. Clinical and epidemiological characteristics of KD in Cyprus population were similar to those reported in the literature. Although the majority of cases received appropriate treatment in time, cardiac complications still occurred.
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Affiliation(s)
- Maria G. Koliou
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus ,grid.6603.30000000121167908Medical School, University of Cyprus, Nicosia, Cyprus ,5 Agiou Symeou Street, 2037 Strovolos, Nicosia, Cyprus
| | - Athina Aristidou
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus
| | - Stella Mazeri
- grid.4305.20000 0004 1936 7988Epidemiology and Public Health, Roslin Institute, Royal Dick School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, UK
| | - Elena Georgiou
- grid.452654.40000 0004 0474 1236Paediatric Department, Limassol General Hospital, Limassol, Cyprus
| | - Maria Agathocleous
- grid.452654.40000 0004 0474 1236Paediatric Department, Limassol General Hospital, Limassol, Cyprus
| | - Marianna Kousparou
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus
| | - Avraam Elia
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus
| | - Antonis Jossif
- Paedi Center for Specialized Paediatrics, Athalassis 178, Strovolos 2024, Nicosia, Cyprus
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Huang H, Dong J, Wang S, Shen Y, Zheng Y, Jiang J, Zeng B, Li X, Yang F, Ma S, He Y, Lin F, Chen C, Chen Q, Lv H. Prediction Model Risk-of-Bias Assessment Tool for coronary artery lesions in Kawasaki disease. Front Cardiovasc Med 2022; 9:1014067. [PMID: 36312287 PMCID: PMC9606216 DOI: 10.3389/fcvm.2022.1014067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To review and critically appraise articles on prediction models for coronary artery lesions (CALs) in Kawasaki disease included in PubMed, Embase, and Web of Science databases from January 1, 1980, to December 23, 2021. Materials and methods Study screening, data extraction, and quality assessment were performed by two independent reviewers, with a statistics expert resolving discrepancies. Articles that developed or validated a prediction model for CALs in Kawasaki disease were included. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist was used to extract data from different articles, and Prediction Model Risk-of-Bias Assessment Tool (PROBAST) was used to assess the bias risk in different prediction models. We screened 19 studies from a pool of 881 articles. Results The studies included 73-5,151 patients. In most studies, univariable logistic regression was used to develop prediction models. In two studies, external data were used to validate the developing model. The most commonly included predictors were C-reactive protein (CRP) level, male sex, and fever duration. All studies had a high bias risk, mostly because of small sample size, improper handling of missing data, and inappropriate descriptions of model performance and the evaluation model. Conclusion The prediction models were suitable for the subjects included in the studies, but were poorly effective in other populations. The phenomenon may partly be due to the bias risk in prediction models. Future models should address these problems and PROBAST should be used to guide study design.
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Affiliation(s)
- Hongbiao Huang
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China,Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jinfeng Dong
- Department of Hematology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Shuhui Wang
- Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yiming Zheng
- Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jiaqi Jiang
- Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bihe Zeng
- Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuan Li
- Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fang Yang
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Shurong Ma
- Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ying He
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Fan Lin
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Chunqiang Chen
- Department of Pediatrics, Fuqing City Hospital Affiliated to Fujian Medical University, Fuqing, Fujian, China
| | - Qiaobin Chen
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China,Qiaobin Chen,
| | - Haitao Lv
- Department of Pediatrics, Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China,*Correspondence: Haitao Lv, ,
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Rostami-Maskopaee F, Ladomenou F, Razavi-Amoli SK, Navaeifar MR, Hajialibeig A, Shahbaznejad L, Hosseinzadeh F, Haghighi Aski B, Manafi Anari A, Mohammadi M, Rahmati MB, Shorafa E, Abootalebi S, Rezai MS. Clinical characteristics and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection in Iran: A multicenter study. PLoS One 2022; 17:e0274104. [PMID: 36137147 PMCID: PMC9498965 DOI: 10.1371/journal.pone.0274104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives This study aimed to assess the clinical characteristics, treatment and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 in five different geographical regions of Iran. Methods In this multicenter observational study, patients <21 years were included between March 2020 and October 2021. By Disease Control and Prevention (CDC) checklist, demographic characteristics, comorbidities, clinical signs and symptoms, laboratory and radiology findings, and treatment were collected. Statistical analysis was using Chi-square and t-test in STATA14. Results In total 225 patients with median age of 55 (26–96) months were included that 59.56% boys. 57.33% were admitted to the PICU with a median of 7 days (4–10). 95.56% of patients were discharged with recovery and the rest died. All of the patients in our study were included based on the MIS-C criteria. However, some patients had Kawasaki symptoms, so we compared the clinical and epidemiological characteristics of the two groups. Conjunctival injection, cervical lymphadenopathy>1.5 cm diameter, and strawberry tongue in Kawasaki-like MIS-C patients were higher than of MIS-C patients, and this difference was significant(p<0.001). The most common comorbidity was obesity (24.86%). Most patients tested for COVID-19 and about 60% of the patients had a positive test by serology or reverse transcription-polymerase chain reaction (RT-PCR). Gastrointestinal (88.89%) and hematologic signs (84.44%) were most common. Most drugs used in patients were IVIG and steroids. 88.07% and 61.29% of the patients had at least one problem in echocardiography and lung CT, respectively. Conclusions The best outcome was seen in patients who were treated with both IVIG and steroids on the first days of admission. Myocarditis was common in two groups of patients. According to most patients had echocardiography abnormal, screening of heart function is recommended for patients.
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Affiliation(s)
- Fereshteh Rostami-Maskopaee
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Mohammad Reza Navaeifar
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Azin Hajialibeig
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Shahbaznejad
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Hosseinzadeh
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Behzad Haghighi Aski
- Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Manafi Anari
- Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Mohammadi
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Bagher Rahmati
- Department of Pediatrics, School of Medicine, Bandar Abbas University of Medical Sciences, Bandar Abbas, Iran
| | - Eslam Shorafa
- Division of Intensive Care Unit, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedenarjes Abootalebi
- Division of Intensive Care Unit, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- * E-mail:
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10
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Grasa CD, Fernández-Cooke E, Domínguez-Rodríguez S, Aracil-Santos J, Barrios Tascon A, Sánchez-Manubens J, Mercader B, Antón J, Nuñez E, Villalobos E, Bustillo M, Camacho M, Oltra Benavent M, Giralt G, Bello Naranjo AM, Rocandio B, Calvo C. Risk scores for Kawasaki disease, a management tool developed by the KAWA-RACE cohort. Clin Rheumatol 2022; 41:3759-3768. [PMID: 35939163 DOI: 10.1007/s10067-022-06319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVES Asian scores developed to predict unresponsiveness to intravenous immunoglobulin (IVIG) or development of coronary artery aneurysms (CAA) in patients with Kawasaki disease (KD) are not appropriate in Western populations. The purpose of this study is to develop 2 scores, to predict unresponsiveness to IVIG and development of CAA, appropriate for Spanish population. METHOD Data of 625 Spanish children with KD collected retrospectively (2011-2016) were used to identify variables to develop the 2 scores of interest: unresponsiveness to IVIG and development of CAA. A statistical model selected best variables to create the scores, and scores were validated with data from 98 patients collected prospectively. RESULTS From 625 patients of the retrospective cohort, final analysis was performed in 439 subjects: 37 developed CAA, and 212 were unresponsive to IVIG. For the score to predict CAA, a cutoff ≥ 8 was considered for high risk, considering a score system with a different weight for each of the eight variables. External validation showed a sensitivity of 22% and a specificity of 75%. The score to predict unresponsiveness to IVIG established a cutoff ≥ 8 for high risk, considering a score system with a different weight for each of the nine variables. External validation showed a sensitivity of 78% and a specificity of 50%. CONCLUSIONS Two risk scores for KD were developed from Spanish population, to predict development of CAA and unresponsiveness to IVIG; validation in other cohorts could help to implement these tools in the management of KD in other Western populations.
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Affiliation(s)
- Carlos D Grasa
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
- IdiPaz, Institute for Health Research from La Paz Hospital, Madrid, Spain
- CIBERINFEC, CIBER of Infectious Diseases in Spain (Instituto de Salud Carlos III - ISCIII), Seville, Spain
| | - Elisa Fernández-Cooke
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trial Unit (UPIC), Department of Pediatrics, Hospital Universitario 12 Octubre, Avda. Córdoba s/n., 28041, Madrid, Spain.
- imas12, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain.
- RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain.
| | - Sara Domínguez-Rodríguez
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trial Unit (UPIC), Department of Pediatrics, Hospital Universitario 12 Octubre, Avda. Córdoba s/n., 28041, Madrid, Spain
- imas12, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Javier Aracil-Santos
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
| | - Ana Barrios Tascon
- Department of Pediatrics, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | - Judith Sánchez-Manubens
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
- Department of Pediatric Rheumatology, Hospital Parc Tauli, Sabadell, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | - Esmeralda Nuñez
- Pediatric Rheumatology Unit, Department of Pediatrics, Hospital Regional Universitario, Malaga, Spain
| | | | - Matilde Bustillo
- Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain
| | - Marisol Camacho
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Department of Pediatrics, Hospital Virgen del Rocio, Sevilla, Spain
| | - Manuel Oltra Benavent
- Department of Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Giralt
- Department of Pediatric Cardiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ana Maria Bello Naranjo
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Canarias, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario Donostia, San Sebastian, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
- IdiPaz, Institute for Health Research from La Paz Hospital, Madrid, Spain
- CIBERINFEC, CIBER of Infectious Diseases in Spain (Instituto de Salud Carlos III - ISCIII), Seville, Spain
- RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain
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11
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Alsager K, Khatri Vadlamudi N, Jadavji T, Bettinger JA, Constantinescu C, Vaudry W, Tan B, Sauvé L, Sadarangani M, Halperin SA, Top KA. Kawasaki disease following immunization reported to the Canadian Immunization Monitoring Program ACTive (IMPACT) from 2013 to 2018. Hum Vaccin Immunother 2022; 18:2088215. [PMID: 35797728 PMCID: PMC9621042 DOI: 10.1080/21645515.2022.2088215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis primarily affecting children younger than 5 y of age that has been reported as an adverse event following immunization (AEFI). The Canadian Immunization Monitoring Program ACTive (IMPACT) conducts active surveillance for KD following immunization across Canada. We characterized KD cases reported to IMPACT between 2013 and 2018. Cases admitted to an IMPACT hospital with a physician diagnosis of complete or incomplete KD with onset 0–42 d following vaccination were reviewed. Cases meeting the Brighton Collaboration case definition (BCCD) levels of diagnostic certainty levels 1 a/b, 2a/b or 3a-e were defined as KD cases. Demographic and vaccination characteristics were compared between KD cases and non-cases. Of 84 cases reviewed, 58 met the BCCD: 47 (81%) cases met level 1a (Complete KD), 8 (14%) met level 1b (Incomplete KD), 2 (3%) met level 2a, and 1 (2%) met level 2c (Probable KD). Median age at admission was 13 months (interquartile range 7–26 months). A median of 9.5 cases were reported per year (range 4–14). Thirty-one (53%) KD cases were temporally associated with diphtheria-tetanus acellular pertussis containing vaccinations, followed by 21 (36%) cases with pneumococcal conjugate vaccines. Symptom onset was 0–14 d after vaccination in 32 (55%) cases. Echocardiogram results were available for 43 (74%) cases with 22 reported as abnormal. Age, sex, interval to symptom onset, and vaccines received were similar between KD cases and non-cases. No safety signals were detected in these data.
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Affiliation(s)
- Khaled Alsager
- for the IMPACT Investigators Division of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
| | - Nirma Khatri Vadlamudi
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Taj Jadavji
- for the IMPACT Investigators Division of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Cora Constantinescu
- for the IMPACT Investigators Division of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
| | - Wendry Vaudry
- Division of Infectious Diseases, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Ben Tan
- Division of Infectious Diseases, Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, SK, Canada
| | - Laura Sauvé
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Scott A Halperin
- Department of Pediatrics, Dalhousie University, and Canadian Center for Vaccinology, IWK Health, Halifax, NS, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, and Canadian Center for Vaccinology, IWK Health, Halifax, NS, Canada
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12
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Lao S, Zhou T, Kuo HC, Zhong G, Zeng W. Risk Factors for Coronary Artery Lesionsin Kawasaki Disease Independent of Antibiotic Use in Chinese Children. Front Public Health 2022; 10:817613. [PMID: 35602151 PMCID: PMC9118346 DOI: 10.3389/fpubh.2022.817613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To study the impact of antibiotics used in Kawasaki disease (KD) with coronary artery lesions (CAL) and identify independent risk factors. Methodology This study reviewed the records of 287 KD patients between the years 2016 and 2020. Patients were grouped by their outcome, the CAL group, and a no-coronary artery lesions (NCAL) group, and stratified by the use of antibiotics. We collected clinical and laboratory data before the intravenous immunoglobulin (IVIG) treatment. Results The two groups of KD patients with and without CAL were compared. The results showed that there are significant differences between groups which were erythrocyte count (p = 0.045) and hemoglobin (p = 0.005), red blood cell-specific volume (p = 0.001), immature granular cells percentage (p = 0.006), total protein (p = 0.045), albumin (p = 0.041), alkaline phosphatase (p = 0.023), and chlorine (p = 0.006). After multivariate logistic regression, neutrophil granulocyte percentage (odds ratio [OR] = 1.200, 95% confidence interval [CI]: 1.008-1.428, p = 0.040), lymphocyte percentage (p = 0.028, OR = 1.243, 95% CI: 1.024-1.508, p = 0.028) and total protein (OR = 4.414, 95% CI: 1.092-17.846, p = 0.037) were found to be independent risk factors for CAL. After analyzing the cases with a history of antibiotic use, multivariate analysis showed no indicators were considered independent risk factors for CAL. Conclusion Neutrophil granulocyte percentage, Lymphocyte percentage and total protein were independent risks for CAL in KD without antibiotics use history. The use of antibiotics affected physiological indicators of KD patients.
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Affiliation(s)
- Sixian Lao
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Guangzhou, China
| | - Tao Zhou
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Guoping Zhong
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Guangzhou, China
| | - Weiwei Zeng
- The Second People's Hospital of Longgang District, Shenzhen, China
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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13
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Liu XP, Huang YH, Tsai YC, Liu SF, Kuo HC. Comparison of Laboratory Data between Children with Kawasaki Disease and COVID-19. CHILDREN 2022; 9:children9050638. [PMID: 35626814 PMCID: PMC9139634 DOI: 10.3390/children9050638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 12/18/2022]
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The severity differs between adults and children, with lower death rates and decreased severity for individuals under the age of 20 years. Increased cases of Kawasaki disease (KD) have been reported from New York City and some areas of Italy and the U.K., with almost a 6–10 times increase when compared to previous years. We conducted this study to compare characteristics and laboratory data between KD and COVID-19 in children. Methods: We obtained a total of 24 children with COVID-19 from a literature review and 268 KD cases from our hospital via retrospective chart review. Results: We found that patients with KD have higher levels of white blood cells (WBCs), platelets, neutrophil percentage, C-reactive protein (CRP), procalcitonin, and aspartate aminotransferase (AST) and a higher body temperature, while patients with COVID-19 have a higher age, hemoglobin levels, and lymphocyte percentage. After performing multiple logistic regression analysis, we found that age, WBCs, platelets, procalcitonin, and AST are identical markers for distinguishing COVID-19 from KD in children. Conclusion: In this COVID-19 pandemic period, clinicians should pay attention to children with COVID-19 infection when high WBC, platelet, procalcitonin, and AST values are present in order to provide early diagnosis for KD or multisystem inflammatory syndrome in children (MIS-C).
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Affiliation(s)
- Xiao-Ping Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518102, China;
| | - Ying-Hsien Huang
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yuh-Chyn Tsai
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
| | - Shih-Feng Liu
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
- Correspondence: (S.-F.L.); (H.-C.K.); Tel.: +886-77317123 (ext. 8199) (S.-F.L.); +886-77317123 (ext. 8795) (H.-C.K.); Fax: +886-773224942 (S.-F.L.); +886-77338009 (H.-C.K.)
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
- Correspondence: (S.-F.L.); (H.-C.K.); Tel.: +886-77317123 (ext. 8199) (S.-F.L.); +886-77317123 (ext. 8795) (H.-C.K.); Fax: +886-773224942 (S.-F.L.); +886-77338009 (H.-C.K.)
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14
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van Stijn D, Korbee JM, Netea SA, de Winter VC, Zwinderman KAH, Kuipers IM, Kuijpers TW. Treatment and Coronary Artery Aneurysm Formation in Kawasaki Disease: A Per-Day Risk Analysis. J Pediatr 2022; 243:167-172.e1. [PMID: 34968497 DOI: 10.1016/j.jpeds.2021.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/02/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess whether 'treatment day' is a significant predicting factor in Kawasaki disease and imposes a risk for coronary artery aneurysms (CAAs) in a per-day analysis. CAA formation can be reduced from 25% to 10% when treated with intravenous immunoglobulin (IVIG). STUDY DESIGN Patient data from (n = 1016) a single center were collected for an observational cohort study. After exclusions, we retrospectively analyzed 776 patients in total. A multivariate analysis was performed with treatment day as a continuous variable (n = 691). Patients were categorized as no enlargement, small CAA, medium CAA, and giant CAA. RESULTS Late treatment per-day was a significant predicting factor for the development of larger CAAs. ORs for medium and giant CAAs per delayed day were 1.1 (95% CI 1.1-1.2) P < .05 and 1.2 (95% CI 1.1-1.2) P < .05, respectively. CONCLUSION We showed that every day of delay in treatment of patients with Kawasaki disease inherently carries a risk of medium and giant aneurysm formation. There was no cut-off point for treatment day that could mark a safe zone.
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Affiliation(s)
- Diana van Stijn
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Justin M Korbee
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stejara A Netea
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vera C de Winter
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Department of Public Health and Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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15
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Shahbaznejad L, Hosseininasab A, Mahboobi L, Mohammadi H, Esmaeili H, Farrokhi Far SM, Alipour MR, Sedighi I, Mansour Ghanaei R, Sobouti B, Taremiha A, Malek AR, Ghadiri K, Soleimani G, Tabasizadeh H, Ghadimi Moghadam A, Barak M, Salehi Abarghouei F, Hashemian H, Daryani Nezhad H, Sherkatolabbasieh HR, Abedini-Varamini M, Rahmati MB, Movahedi FS, Rezai MS. Epidemiological data of national Kawasaki disease registry in Iran, 2007-2019. Front Pediatr 2022; 10:988371. [PMID: 36714641 PMCID: PMC9875885 DOI: 10.3389/fped.2022.988371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Kawasaki disease(KD) is a vasculitis of childhood that tends to influence the coronary arteries. There is no national data about the prevalence of KD in Iran. This study aimed to perform a national registry in Iran for 13 years. METHODS In this retrospective study, the data for KD extracted from medical records of <19 year-old patients admitted to tertiary hospitals in Iran between 2007 and 2019 were recorded in the national KD registry system. Age, admission date, gender, location, and presence of KD criteria, laboratory and echocardiography findings, and treatment modalities were evaluated. Complete KD was considered if ≥4 clinical criteria of the KD existed and otherwise, incomplete KD was considered. RESULTS Data from 1,682 KD patients including 999(59.39%) boys and 683(40.61%) girls and male/female ratio of 1.46 were evaluated. The mean age was 3.08 ± 2.49 years and 1465(87%) were living in urban regions. The yearly incidence of the disease was between 2.62 to 3.03 from 2015 to 2019. The highest age-specific incidence was observed in children <1-year-old. Incomplete and resistant KD included 1,321(78.54%) and 9(0.54%) patients, respectively. Abnormal echocardiography was detected in 619(36.80%) patients. Leukocytosis, with dominancy of neutrophils, anemia, thrombocytosis and increased ESR and CRP were the most noticeable laboratory findings. No death due to KD disease was reported. CONCLUSION Based on this study, most of the KD cases are presented with atypical presentation in Iran. So, increasing awareness of primary healthcare workers by educating and updating their data is very important in timely diagnosis and management of the disease.
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Affiliation(s)
- Leila Shahbaznejad
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Hosseininasab
- Research Center of Tropical and Infectious Diseases, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Mahboobi
- Department of Pediatrics, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamid Mohammadi
- Neonatal Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Esmaeili
- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mohammad Reza Alipour
- Cardiovascular Research Center, Afshar Heart Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Iraj Sedighi
- Department of Pediatrics, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Roxana Mansour Ghanaei
- Pediatric Infections Research Center, Research Institute for Children Health, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Sobouti
- Department of Pediatrics, School of Medicine, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Taremiha
- Department of Pediatrics, School of Medicine, Qods Teaching Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Abdol Reza Malek
- Department of Pediatrics, School of Medicine, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Keyghobad Ghadiri
- Infectious Diseases Research Center, Research Institute for Health, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Gholamreza Soleimani
- Children and Adolescents Health Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamed Tabasizadeh
- Department of Clinical Sciences, School of Medicine, Imam Hossein Hospital, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Manouchehr Barak
- Department of Pediatrics, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Houman Hashemian
- Department of Pediatrics, School of Medicine, 17 Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Hamid Reza Sherkatolabbasieh
- Department of Pediatrics, School of Medicine Shahid Rahimi Hospital, Shahid Madani Hospital, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Masoumeh Abedini-Varamini
- Department of Pediatrics, School of Medicine, Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Bagher Rahmati
- Department of Pediatric Infectious Diseases, Children's Clinical Research Development Center, Hormozgan University of Medical Sciences, Bandar abbas, Iran
| | - Faezeh Sadat Movahedi
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Ajmi H, Ghorbel S, Ezzi O, Mabrouk S, Mansour K, Kahloul N, Chemli J, Zouari N, Mejaouel H, Boughammoura L, Abroug S. [Coronary artery aneurysm in Kawasaki disease and its risk factors : a retrospective study about 65 Tunisian children]. Ann Cardiol Angeiol (Paris) 2021; 71:86-89. [PMID: 34753596 DOI: 10.1016/j.ancard.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Kawasaki syndrome (KS) is a systemic vasculitis of unknown etiology that affects medium and small blood vessels. The aim of our study is to analyze coronary artery lesions in children with KS and their risk factors. MATERIAL AND METHODS All children under the age of 15 years-old presenting KS and admitted in the pediatric department of three university hospital (Sahloul hospital, and Farhat Hached hospital of Sousse, Ibn El Jazzar hospital of Kairoun) from January 2000 to December 2018 were included. RESULTS Sixty-five patients were included in our study. The mean age at diagnosis was of 29.9 months [2-120 months] and the sex ratio was of 1.7. Echocardiography was performed in all patients. It showed coronary dilation in 37% of patients with coronary artery diameter of 4.2 mm on average [3.2-7mm]. The coronary aneurysm was small in 19 cases and medium in 5 cases. No giant aneurysm has been identified. In univariate analysis, the predictors of coronary artery lesions were male sex, atypical form, fever duration more than 10 days, hepatic cytolysis, thrombocytosis and anemia. In multivariate analysis, only the last four parameters were the predictive factors of the coronary artery involvement. CONCLUSION Several risk factors can be used to determine which children are predisposed to develop coronary dilations. In case of patient with risk factors, intravenous immunoglobulins should be initiated early to avoid these serious complications.
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Affiliation(s)
- Houda Ajmi
- Service de pédiatrie, CHU Sahloul4054, Sousse, Tunisie.
| | - Sameh Ghorbel
- Service de pédiatrie, CHU Farhat Hached, 4031, Sousse, Tunisie
| | - Olfa Ezzi
- Service d'épidémiologie, CHU Farhat Hached, 4031, Sousse, Tunisie
| | - Sameh Mabrouk
- Service de pédiatrie, CHU Sahloul4054, Sousse, Tunisie
| | - Kais Mansour
- Service de pédiatrie, CHU Sahloul4054, Sousse, Tunisie
| | - Najoua Kahloul
- Service de pédiatrie, CHU Farhat Hached, 4031, Sousse, Tunisie
| | - Jalel Chemli
- Service de pédiatrie, CHU Sahloul4054, Sousse, Tunisie
| | - Noura Zouari
- Service de pédiatrie, CHU Sahloul4054, Sousse, Tunisie
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Barrios-Tascón A, Miura M, Domínguez-Rodríguez S, Fernández-Cooke E, Sarquella-Brugada G, Tagarro A. Ventricular Repolarization Parameters and Coronary Involvement in Kawasaki Disease. J Pediatr 2021; 236:108-112.e5. [PMID: 34004190 DOI: 10.1016/j.jpeds.2021.05.023] [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: 02/08/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate electrocardiogram markers to predict coronary involvement in patients with Kawasaki disease by assessing measures of ventricular repolarization parameters on the 12-lead electrocardiogram. STUDY DESIGN This cross-sectional study included 180 Spanish and Japanese patients ≤14 years of age with Kawasaki disease, with or without coronary involvement, from 2011 to 2016. We manually measured the Tp-Te/QT ratio and QTc interval (with Bazett's formula) in 12-lead electrocardiogram in the acute and recovery period and explored their potential association with coronary involvement. RESULTS No association was found between Tp-Te/QT ratio obtained manually in V5 and V6 leads and coronary involvement in the acute (V5:0.25 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .80; V6:0.24 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .86) or the recovery (V5: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.19-0.25], P = .68; V6: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.17-0.25], P = .50) period. By contrast, QTc in V5 and V6 was significantly lower in patients with Kawasaki disease and coronary involvement in the acute period (V5: 378 ms [IQR, 364-395 ms] vs 390 ms [IQR, 371-411 ms], P = .04; V6: 377 ms [IQR, 364-392 ms] vs 390 ms [IQR, 371-410 ms], P = .01). A QTc interval of <385 ms in lead V6 was associated with a 2.5-fold increased risk of coronary involvement (OR, 2.5; 95% CI, 1.2-5.3; P = .02). CONCLUSIONS Manually measured QTc interval may be a marker of coronary disease in the acute period of Kawasaki disease.
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Affiliation(s)
- Ana Barrios-Tascón
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain.
| | - Masaru Miura
- Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Elisa Fernández-Cooke
- Traslational Research Network in Pediatric Infectious Diseases, Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Alfredo Tagarro
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain; Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
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Masuda H, Ae R, Koshimizu TA, Matsumura M, Kosami K, Hayashida K, Makino N, Matsubara Y, Sasahara T, Nakamura Y. Serum sodium level associated with coronary artery lesions in patients with Kawasaki disease. Clin Rheumatol 2021; 41:137-145. [PMID: 34363547 DOI: 10.1007/s10067-021-05881-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION/OBJECTIVES Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) identified after acute Kawasaki disease (KD). However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children. We hypothesized the association of serum sodium level with CAL complications differs between infants and older patients with KD. METHODS We analyzed 21,610 population-based patients who developed KD throughout Japan during 2013-2014. We performed multivariable logistic regression analyses to evaluate the association between serum sodium and CAL complications. Additionally, we stratified the serum sodium distribution associated with CAL complications by infants and older patients. RESULTS CALs were identified in 158 (3.6%) infants and 302 (1.8%) older patients. Infants were more likely to develop CALs when within the normal sodium range compared with older patients (75% vs. 29%), whereas most older patients developed CALs with a sodium level lower than the reference interval. Serum sodium ≤ 130 mEq/L indicated significantly higher risk for development of CALs in both groups (adjusted odds ratio [95% confidence intervals] = 3.21 [1.65-6.25] in infants and 1.74 [1.18-2.57] in older patients). CONCLUSIONS Serum sodium distribution associated with CAL complications differed greatly between infants and older patients. Older patients developed CALs with sodium levels lower than the reference interval; however, among infants, hyponatremia was not necessarily a risk factor for developing coronary artery lesion. When considering risk assessments for CALs using serum sodium levels, infants with KD should be distinguished from older patients. Key Points • Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) among patients with Kawasaki disease. • However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children. • Most infants developed CALs within the normal sodium range, whereas older patients developed at a range lower than the reference interval. • These findings highlight that when considering risk assessments for CALs using serum sodium levels, infants should be distinguished from older patients.
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Affiliation(s)
- Hiroya Masuda
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan.,Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan.
| | - Taka-Aki Koshimizu
- Division of Molecular Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Kanako Hayashida
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan.,Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Nobuko Makino
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Yuri Matsubara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Teppei Sasahara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
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Mat Bah MN, Alias EY, Razak H, Sapian MH, Foo FH, Abdullah N. Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country. Eur J Pediatr 2021; 180:2599-2606. [PMID: 34086103 DOI: 10.1007/s00431-021-04135-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022]
Abstract
Data on Kawasaki disease from tropical countries are scarce. Hence, this population-based study aims to determine the epidemiology, clinical characteristics, and outcome of Kawasaki disease in children enrolled in the Kawasaki disease registry between 2006 and 2019 in Southern Malaysia. Diagnosis of Kawasaki disease was made using standard criteria. Primary outcome measure was a coronary artery aneurysm. Multivariable logistic regression was used to analyze the associated risk factors for coronary artery aneurysm. There were 661 Kawasaki disease, with 27% incomplete and 11% atypical presentations. Male-to-female ratio was 2:1, and median age of diagnosis was 1.4 years (interquartile range 9 to 32 months). Incidence in children of less than 5 years was 14.8 (95% confidence interval [CI]: 13.6 to 16.0) per 100,000 population, higher in males (19/100,000) and Chinese (22/100,000), with a gradual increase from 5.7/100,000 in 2006 to 19.6/100,000 in 2019, p < 0.001. Incidence in children between 5 and 9 years old was 1.3 (95% CI: 0.9 to 1.6) per 100,000 population and remained stable over time. There was a seasonal pattern with peak incidence during the rainy season. Out of 625 intravenous immunoglobulins (IVIG)-treated Kawasaki disease, 7.4% were resistant, and 9% had coronary artery aneurysms. Atypical presentation, male sex, late diagnosis, and IVIG resistance were independent risk factors for coronary artery aneurysms.Conclusions: Despite the tropical climate, Kawasaki disease epidemiology is similar to non-tropic regions with seasonal patterns and a rising incidence. Atypical presentation, male sex, late diagnosis, and IVIG resistance were significantly associated with coronary artery aneurysms. What is Known: • Kawasaki disease predominantly occurs in males, children less than 5 years old, and the Asian population. • Male sex, late diagnosis, incomplete Kawasaki disease, and IVIG resistance were associated with coronary artery aneurysms. What is New: • In multi-ethnic Asian countries such as Malaysia, ethnic Chinese have a higher prevalence of Kawasaki disease compared to other ethnicities. • Kawasaki disease with atypical presentation can occur in both complete and incomplete Kawasaki disease and is significantly associated with a coronary artery aneurysm.
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Affiliation(s)
- Mohd Nizam Mat Bah
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia.
| | - Emieliyuza Yusnita Alias
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Hasliza Razak
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Mohd Hanafi Sapian
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Fang Han Foo
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Nisah Abdullah
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
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Fernández Alcalde C, Granados Fernández M, Nieves Moreno M, Calvo Rey C, Falces Romero I, Noval Martín S. COVID-19 ocular findings in children: a case series. World J Pediatr 2021; 17:329-334. [PMID: 33619650 PMCID: PMC7899207 DOI: 10.1007/s12519-021-00418-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Celia Fernández Alcalde
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España.
| | - Maria Granados Fernández
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España
| | - Maria Nieves Moreno
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España
| | - Cristina Calvo Rey
- Paediatric and Infectious Diseases Department, Hospital Universitario La Paz and Fundación Idipaz, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Iker Falces Romero
- Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Susana Noval Martín
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España
- Universidad Autónoma de Madrid, Madrid, Spain
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21
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Alghamdi KT, Waggass RA, Aga SS, Alrohaili AA, Alaidroos AH, Alghamdi MD, Algamdi MK, Alghamdi AT. The Most Common Clinical Features of Kawasaki Disease Patients in King Abdulaziz Medical City. Cureus 2021; 13:e15127. [PMID: 34159029 PMCID: PMC8212913 DOI: 10.7759/cureus.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute idiopathic vasculitis affecting the small and medium-sized arteries especially coronary artery (CA). it occurs in childhood mostly below five years of age. Objective This study aims to identify the most common clinical features among KD patients in King Abdulaziz Medical City in Jeddah, Saudi Arabia from 1/1/1982 to 31/12/2018. Methods A case series study was conducted in all KD patients that were admitted to the King Abdulaziz Medical City from 1/1/1982 to 31/12/2018 except those who were diagnosed in other hospitals or whose diagnosis has later changed. The identification of patient was done by using the International Classification of Diseases (ICD) coding for KD (ICD9 446.1). Our data consisted of the patient’s file number, age at presentation, gender, whether the patients received IVIG treatment or not, number of days of fever before starting IVIG treatment, response to IVIG treatment, season in which the symptoms started and clinical features based on body’s system. Result The study included 18 patients, 11 males showed that (55.6%) of patients met the criteria of typical KD and most of them were less than five years old. In addition, most patients were reported to have polymorphous rash, cough, irritability, vomiting, and a murmur. All patients who received intravenous immunoglobulin (IVIG) treatment which demonstrated an improvement even though those who started the treatment after 10 days of fever. Conclusion In typical KD patients, the distribution of the clinical features was almost identical. However, there were some variations in them among atypical KD patients. Moreover, Evan though KD in our region is not common as in Japan, the incidence of giant aneurism was higher. In addition to that, this study and other study conducted in Saudi Arabia found that screened patients reported tachycardia more than patients in Japan. Recommendation As KD is still idiopathic, we recommend more details to be collected from the patients, especially consanguinity as it is common in Saudi Arabia
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Affiliation(s)
- Khalid Talal Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | | | - Syed Sameer Aga
- Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Abdulaziz Ahmed Alrohaili
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Ali Hassan Alaidroos
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Mohammed Dakhilallah Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Mohannd Khalid Algamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
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22
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Lima-Setta F, Magalhães-Barbosa MCD, Rodrigues-Santos G, Figueiredo EADN, Jacques MDL, Zeitel RDS, Sapolnik R, Borges CTDS, Lanziotti VS, Castro REVD, Bellinat APN, Silva TPD, Oliveira FRCD, Reis BCSD, Castro NADASR, Macedo JHGC, Scarlato ACCP, Riveiro PM, Mota ICFD, Lorenzo VB, Lucena NMLD, Azevedo ZMAD, Cunha AJLA, Prata-Barbosa A. Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study. J Pediatr (Rio J) 2021; 97:354-361. [PMID: 33186512 PMCID: PMC7649656 DOI: 10.1016/j.jped.2020.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C. METHOD Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively. RESULTS Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4-10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. d-Dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5-6.5). The median length of PICU stay was six days (IQR 5-11), and one death occurred (1.8%). CONCLUSIONS Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.
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Affiliation(s)
- Fernanda Lima-Setta
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Instituto Fernandes Figueira, Unidade de Pacientes Graves, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | - Gustavo Rodrigues-Santos
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | | | - Melissa de Lorena Jacques
- Pediatric ICU, Hospital Quinta D'Or, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio José L A Cunha
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Zheng X, Li J, Yue P, Liu L, Li J, Zhou K, Hua Y, Li Y. Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?-Current evidence based on a meta-analysis. PLoS One 2021; 16:e0248812. [PMID: 33764989 PMCID: PMC7993784 DOI: 10.1371/journal.pone.0248812] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Coronary artery lesion (CAL) caused by Kawasaki disease (KD) is a leading cause of acquired heart disease in children. Initial treatment of intravenous immunoglobulin (IVIG) can reduce the incidence of CAL. Although most of the current studies have shown a certain correlation between CAL and IVIG resistance, the conclusions are not completely consistent. Thus, we performed this meta-analysis to evaluate the association between IVIG resistance and CAL in KD. Methods PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure through April 21, 2020 were searched to detect relevant studies. Data analysis was performed with STATA 15.1. Results A total of 53 relevant studies were eligible to this analysis, including 30312 KD patients, of which 4750 were IVIG resistance and 25562 were responders. There was a significant difference found between IVIG resistance and IVIG response groups in the incidence of CAL (P < 0.001, odds ratio (OR), 3.89; 95% confidence interval (CI) (3.18, 4.75)). The heterogeneity test results showed that the I2 value was 74.8%. The meta-regression analysis showed that the study regions might be the sources of heterogeneity. The subgroup analysis suggested that the incidence of CAL in the IVIG resistance group was still higher than that in the IVIG response group under different regions, IVIG resistance diagnostic criteria, CAL diagnostic criteria, and study types. Meanwhile, the sensitivity analysis did not find any significant impact from every single study. Conclusions This is the first meta-analysis to reveal the incidence of CAL was associated with IVIG resistance in KD patients. Further well-designed studies with uniform criteria are needed to evaluate the incidence of CAL in IVIG resistant patients.
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Affiliation(s)
- Xiaolan Zheng
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinhui Li
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Yue
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Liu
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiawen Li
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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24
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Qian G, Xu L, Qin J, Huang H, Zhu L, Tang Y, Li X, Ma J, Ma Y, Ding Y, Lv H. Leukocyte proteomics coupled with serum metabolomics identifies novel biomarkers and abnormal amino acid metabolism in Kawasaki disease. J Proteomics 2021; 239:104183. [PMID: 33737236 DOI: 10.1016/j.jprot.2021.104183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is a systemic vasculitis that can lead to severe cardiovascular complications, whereas the development and clinical usage of specific biomarkers might help diagnose KD and avoid certain complications. To this end, the molecular profiles of acute KD patients with coronary artery lesions (CAL) were first investigated through leukocyte proteomics and serum metabolomics assays. A total of 269 differentially abundant proteins and 35 differentially abundant metabolites with the top fold-changed levels were identified in acute KD patients compared to those in the healthy controls. Among them, several highly promising candidate marker proteins and metabolites indicative of KD progression were further analysed, such as the increased proteins ALPL, NAMPT, and S100P, as well as the decreased proteins C1QB and apolipoprotein family members. Moreover, metabolites, including succinic acid, dGMP, hyaluronic acid, L-tryptophan, propionylcarnitine, inosine, and phosphorylcholine, were found to be highly accurate at distinguishing between KD patients and healthy controls. Interestingly, the abnormal expression levels of a distinct set of proteins and metabolites in acute KD patients can be restored to normal levels upon intravenous immunoglobulin (IVIG) treatment. Overall, this work has revealed novel biomarkers and abnormal amino-acid metabolism as a prominent feature involved in KD patients with CAL. SIGNIFICANCE: KD is frequently concomitant with the development of life-threatening coronary vasculitis. Here, the profiles of leukocyte proteomics and serum metabolomics in acute KD patients with CALs were first investigated, and several hub molecules identified here could be used as supplemental biomarkers for KD diagnosis. Moreover, the metabolomic abnormalities especially the amino acids are particularly prominent in KD patients. Interestingly, the abnormal expression levels of a distinct set of proteins and metabolites in acute KD patients can be restored to normal levels upon IVIG treatment. Therefore, these findings might help understand the IVIG activities and also the underlying mechanisms of IVIG-resistant patients, thereby providing a new perspective for the exploration of mechanisms related to KD.
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Affiliation(s)
- Guanghui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu Province 215025, China.
| | - Lei Xu
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu Province 215025, China
| | - Jie Qin
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu Province 215025, China
| | - Hongbiao Huang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu Province 215025, China
| | - Liyan Zhu
- Medical College of Soochow University, Suzhou 215123, China
| | - Yunjia Tang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Jin Ma
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Yingying Ma
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu Province 215025, China
| | - Yueyue Ding
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou 215025, China.
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou 215025, China.
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Fernández-Cooke E, Grasa CD, Domínguez-Rodríguez S, Barrios Tascón A, Sánchez-Manubens J, Anton J, Mercader B, Villalobos E, Camacho M, Navarro Gómez ML, Oltra Benavent M, Giralt G, Bustillo M, Bello Naranjo AM, Rocandio B, Rodríguez-González M, Núñez Cuadros E, Aracil Santos J, Moreno D, Calvo C. Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain. Front Pediatr 2021; 8:617039. [PMID: 33537269 PMCID: PMC7849209 DOI: 10.3389/fped.2020.617039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.
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Affiliation(s)
- Elisa Fernández-Cooke
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Carlos D. Grasa
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Ana Barrios Tascón
- Department of Pediatrics, Hospital Universitario Infanta Sofia, Madrid, Spain
| | - Judith Sánchez-Manubens
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Anton
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Enrique Villalobos
- Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marisol Camacho
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Department of Pediatrics, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Manuel Oltra Benavent
- Department of Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Giralt
- Pediatric Cardiology Unit, Department of Pediatrics, Hospital Universitario Vall d'Hebron Barcelona, Barcelona, Spain
| | - Matilde Bustillo
- Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ana María Bello Naranjo
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Canarias, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario de Donostia, Guipuzcoa, Spain
| | | | | | - Javier Aracil Santos
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - David Moreno
- Department of Pediatrics, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
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Peng Y, Liu X, Duan Z, Cai S, Duan J, Zhou Y. Age-related differences in clinical characteristics of Kawasaki disease. Braz J Med Biol Res 2021; 54:e10281. [PMID: 33470389 PMCID: PMC7812906 DOI: 10.1590/1414-431x202010281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/09/2020] [Indexed: 01/27/2023] Open
Abstract
This study aimed to examine and summarize clinical characteristics of Kawasaki disease (KD) at different ages to further strengthen clinicians understanding of children with KD, improving the level of diagnosis, and reducing coronary artery complications of KD. A total of 398 patients with KD who were diagnosed between January 2016 and December 2017 were reviewed retrospectively. These participants were allocated into three groups according to age: group A (<1 year, n=62), group B (≥1 and <5 years, n=286), and group C (≥5 years, n=50). Clinical manifestations, laboratory results, and echocardiographic findings were compared among the groups. Most (71.86%) patients with KD were aged 1-5 years. The prevalence of cervical lymphadenopathy was lowest in group A. The duration of fever before admission was longest in group A. The rate of cervical lymphadenopathy and laboratory data were different among the groups. Group A had higher frequencies of gastrointestinal involvement, neurological symptoms, and redness at the Bacillus Calmette-Guerin inoculation site than the other groups. Infants aged <1 year with KD often have a longer duration of fever before admission, a lower prevalence of cervical lymphadenopathy, and a higher prevalence of gastrointestinal and neurological symptoms.
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Affiliation(s)
- Yu Peng
- Jiangxi Province Children's Hospital, Department of Rheumatology, NanchangJiangxiChinaDepartment of Rheumatology, Jiangxi Province Children's Hospital, Nanchang, Jiangxi, China
| | - Xiaohui Liu
- Jiangxi Province Children's Hospital, Department of Rheumatology, NanchangJiangxiChinaDepartment of Rheumatology, Jiangxi Province Children's Hospital, Nanchang, Jiangxi, China
| | - Zhao Duan
- Jiangxi Province Children's Hospital, Department of Rheumatology, NanchangJiangxiChinaDepartment of Rheumatology, Jiangxi Province Children's Hospital, Nanchang, Jiangxi, China
| | - Sufen Cai
- Jiangxi Province Children's Hospital, Department of Rheumatology, NanchangJiangxiChinaDepartment of Rheumatology, Jiangxi Province Children's Hospital, Nanchang, Jiangxi, China
| | - Junkai Duan
- Jiangxi Province Children's Hospital, Department of Cardiology, NanchangJiangxiChinaDepartment of Cardiology, Jiangxi Province Children's Hospital, Nanchang, Jiangxi, China
| | - Yulan Zhou
- The First Affiliated Hospital of Nanchang University, Department of Hematology, NanchangJiangxiChinaDepartment of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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27
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Khanna S, Garikapati K, Goh DSL, Cho K, Lo P, Bhojaraja MV, Tarafdar S. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord 2021; 21:7. [PMID: 33407141 PMCID: PMC7788693 DOI: 10.1186/s12872-020-01813-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki's disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.
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Affiliation(s)
- Shaun Khanna
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
| | - Kartheek Garikapati
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Daniel S L Goh
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Kenneth Cho
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Phillip Lo
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | | | - Surjit Tarafdar
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
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Abstract
Aim of the review: To review major epidemiological aspects of Kawasaki disease (KD) in Europe, describing demographic characteristics, revising its incidence along with time trends and geographic variations, and describing migration studies to provide clues about its etiology. Recent findings: The annual incidence of KD in Europe is about 10-15 per 100,000 children under 5 years old and seems to be relatively stable over time and space. Demographic characteristics are in line with those in other countries of the world, with a higher incidence in children from Asia and possibly North African origin. All studies performed across Europe found a coherent seasonal distribution of KD onset peaking from winter to early spring. This seasonal distribution was consistent over the years and suggests a climate-related environmental trigger. The occurrence of peaks during pandemics, microbiological findings and a possible link with southerly winds support the hypothesis of an airborne infectious agent. Neither other airborne agents such as pollutants or pollens nor urbanization and industrialization seem to have major effect on the etiology. Conclusion: Discrepancies in KD incidence rates across studies were due more to methodological differences, variation in definitions and awareness of the disease than a real increase in incidence. Genetic predisposition is undeniable in KD, but environmental factors seem to play a pivotal role. Several lines of evidence support a non-exclusive airborne infectious agent with a protective immune response by the host as a key factor in inducing the inflammatory cascade responsible for symptoms and complications.
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Affiliation(s)
- Maryam Piram
- Department of Pediatrics, Research Centre of the Sainte Justine University Hospital, Sainte Justine University Hospital, University of Montreal, Montreal, QC, Canada.,Centre for Epidemiology and Population Health (CESP), University Paris-Saclay, Le Kremlin Bicêtre, France
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29
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Mehta R, Joshi V, Joshi P, Bhondve A, Otiv M, Udani S, Mohite M, Sarang B, Andankar P, Bagade A, Sadawarte S, Lad S, Suryawanshi P, Dhongade A. A multicenter study of clinical and biochemical profiles, treatments, and short-term outcomes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection from Western India. JOURNAL OF PEDIATRIC CRITICAL CARE 2021. [DOI: 10.4103/jpcc.jpcc_60_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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30
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Koné-Paut I, Tellier S, Belot A, Brochard K, Guitton C, Marie I, Meinzer U, Cherqaoui B, Galeotti C, Boukhedouni N, Agostini H, Arditi M, Lambert V, Piedvache C. Phase II Open Label Study of Anakinra in Intravenous Immunoglobulin-Resistant Kawasaki Disease. Arthritis Rheumatol 2020; 73:151-161. [PMID: 32779863 DOI: 10.1002/art.41481] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Anakinra has been shown to be successful in preventing and treating cardiovascular lesions both in experimental murine models of Kawasaki disease (KD) and in several studies on intravenous immunoglobulin (IVIG)- and steroid-resistant patients with KD. This study was undertaken to determine the safety of blocking interleukin-1 in patients with IVIG-resistant KD. METHODS Sixteen patients were included in the present study. Patients with KD who were not responsive to 1 or more courses of 2 mg/kg of IVIG received anakinra by subcutaneous daily injections. Starting doses were 2 mg/kg of IVIG (4 mg/kg in patients who were age <8 months and who weighed ≥5 kilograms), and the dose was increased up to 6 mg/kg every 24 hours if the patient's body temperature remained >38°C, indicative of a fever. Treatment duration was 14 days. The last visit was on day 45. Primary outcome was abatement of fever. Secondary measures included disease activity, coronary artery Z score, and C-reactive protein (CRP) levels. RESULTS Seventy-five percent of patients in the intention-to-treat group and 87.5% in the per-protocol group became afebrile within 48 hours of the last escalation dose of anakinra. Reduction of disease activity by 50% was indicated on 93.3% (95% confidence interval [95% CI] 68.1-99.8%) of physician evaluations and on 100% (95% CI 73.5-100%) of parent evaluations. CRP values normalized by day 30. At the initial screening, 12 of 16 patients had a maximum coronary artery Z score of >2, and 10 of 16 patients had a maximum Z score of >2.5. At day 45, 5 of 10 patients (50% [95% CI 18.7-81.3%]) and 6 of 12 patients (50% [95% CI 21.1-78.9%]) had achieved coronary artery Z scores of <2.5 and <2, respectively. Five serious adverse events were observed in 3 patients, but no serious infections or deaths occurred. CONCLUSION Anakinra was well tolerated in the study patients and may have some efficacy in reducing fever, markers of systemic inflammation, and coronary artery dilatation in individuals with IVIG-refractory KD.
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Affiliation(s)
- Isabelle Koné-Paut
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Alexandre Belot
- University of Lyon, International Center for Research in Infectious Diseases, INSERM U1111, ENS, Lyon, France
| | | | - Corinne Guitton
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | - Isabelle Marie
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Bilade Cherqaoui
- CeRéMAIA, Bicêtre Hospital, AP-HP, University of Paris Sud Saclay, INSERM U1173, Paris, France
| | - Caroline Galeotti
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Helene Agostini
- AP-HP, University of Paris Saclay, Bicêtre Hospital, Paris, France
| | - Moshe Arditi
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Virginie Lambert
- Institut Mutualiste Montsouris and Bicêtre Hospital, AP-HP, University of Paris Sud Saclay, Paris, France
| | - Céline Piedvache
- AP-HP, University of Paris Saclay, Bicêtre Hospital, Paris, France
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31
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Carter MJ, Fish M, Jennings A, Doores KJ, Wellman P, Seow J, Acors S, Graham C, Timms E, Kenny J, Neil S, Malim MH, Tibby SM, Shankar-Hari M. Peripheral immunophenotypes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Nat Med 2020; 26:1701-1707. [PMID: 32812012 DOI: 10.1038/s41591-020-1054-6] [Citation(s) in RCA: 290] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
Recent reports highlight a new clinical syndrome in children related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)1-multisystem inflammatory syndrome in children (MIS-C)-which comprises multiorgan dysfunction and systemic inflammation2-13. We performed peripheral leukocyte phenotyping in 25 children with MIS-C, in the acute (n = 23; worst illness within 72 h of admission), resolution (n = 14; clinical improvement) and convalescent (n = 10; first outpatient visit) phases of the illness and used samples from seven age-matched healthy controls for comparisons. Among the MIS-C cohort, 17 (68%) children were SARS-CoV-2 seropositive, suggesting previous SARS-CoV-2 infections14,15, and these children had more severe disease. In the acute phase of MIS-C, we observed high levels of interleukin-1β (IL-1β), IL-6, IL-8, IL-10, IL-17, interferon-γ and differential T and B cell subset lymphopenia. High CD64 expression on neutrophils and monocytes, and high HLA-DR expression on γδ and CD4+CCR7+ T cells in the acute phase, suggested that these immune cell populations were activated. Antigen-presenting cells had low HLA-DR and CD86 expression, potentially indicative of impaired antigen presentation. These features normalized over the resolution and convalescence phases. Overall, MIS-C presents as an immunopathogenic illness1 and appears distinct from Kawasaki disease.
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Affiliation(s)
- Michael J Carter
- Department of Women and Children's Health, King's College London, London, UK
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Matthew Fish
- Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Aislinn Jennings
- Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Paul Wellman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Jeffrey Seow
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Sam Acors
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Emma Timms
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Julia Kenny
- Department of Women and Children's Health, King's College London, London, UK
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Stuart Neil
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Shane M Tibby
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK.
| | - Manu Shankar-Hari
- Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK.
- School of Immunology and Microbial Sciences, King's College London, London, UK.
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32
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Rodríguez Y, Novelli L, Rojas M, De Santis M, Acosta-Ampudia Y, Monsalve DM, Ramírez-Santana C, Costanzo A, Ridgway WM, Ansari AA, Gershwin ME, Selmi C, Anaya JM. Autoinflammatory and autoimmune conditions at the crossroad of COVID-19. J Autoimmun 2020; 114:102506. [PMID: 32563547 PMCID: PMC7296326 DOI: 10.1016/j.jaut.2020.102506] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has been categorized as evolving in overlapping phases. First, there is a viral phase that may well be asymptomatic or mild in the majority, perhaps 80% of patients. The pathophysiological mechanisms resulting in minimal disease in this initial phase are not well known. In the remaining 20% of cases, the disease may become severe and/or critical. In most patients of this latter group, there is a phase characterized by the hyperresponsiveness of the immune system. A third phase corresponds to a state of hypercoagulability. Finally, in the fourth stage organ injury and failure occur. Appearance of autoinflammatory/autoimmune phenomena in patients with COVID-19 calls attention for the development of new strategies for the management of life-threatening conditions in critically ill patients. Antiphospholipid syndrome, autoimmune cytopenia, Guillain-Barré syndrome and Kawasaki disease have each been reported in patients with COVID-19. Here we present a scoping review of the relevant immunological findings in COVID-19 as well as the current reports about autoinflammatory/autoimmune conditions associated with the disease. These observations have crucial therapeutic implications since immunomodulatory drugs are at present the most likely best candidates for COVID-19 therapy. Clinicians should be aware of these conditions in patients with COVID-19, and these observations should be considered in the current development of vaccines.
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Affiliation(s)
- Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Lucia Novelli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center (IRCCS), Rozzano, Milan, Italy
| | - Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Maria De Santis
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center (IRCCS), Rozzano, Milan, Italy
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Antonio Costanzo
- Dermatology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - William M Ridgway
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA, USA
| | - Aftab A Ansari
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA, USA.
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center (IRCCS), Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy.
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia.
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33
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Paediatric Inflammatory Multisystem Syndrome Temporally-Associated with SARS-CoV-2 Infection: An Overview. Intensive Care Med 2020; 47:90-93. [PMID: 33057783 PMCID: PMC7556601 DOI: 10.1007/s00134-020-06273-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/30/2020] [Indexed: 01/19/2023]
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Piram M, Darce Bello M, Tellier S, Di Filippo S, Boralevi F, Madhi F, Meinzer U, Cimaz R, Piedvache C, Koné-Paut I. Defining the risk of first intravenous immunoglobulin unresponsiveness in non-Asian patients with Kawasaki disease. Sci Rep 2020; 10:3125. [PMID: 32080307 PMCID: PMC7033244 DOI: 10.1038/s41598-020-59972-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
About 10–20% of patients with Kawasaki disease (KD) are unresponsive to intravenous immunoglobulin (IVIg) and are at increased risk of coronary artery abnormalities (CAAs). Early identification is critical to initiate aggressive therapies, but available scoring systems lack sensitivity in non-Japanese populations. We investigated the accuracy of 3 Japanese scoring systems and studied factors associated with IVIg unresponsiveness in a large multiethnic French population of children with KD to build a new scoring system. Children admitted for KD between 2011–2014 in 65 centers were enrolled. Factors associated with second line-treatment; i.e. unresponsiveness to initial IVIg treatment, were analyzed by multivariate regression analysis. The performance of our score and the Kobayashi, Egami and Sano scores were compared in our population and in ethnic subgroups. Overall, 465 children were reported by 84 physicians; 425 were classified with KD (55% European Caucasian, 12% North African/Middle Eastern, 10% African/Afro-Caribbean, 3% Asian and 11% mixed). Eighty patients (23%) needed second-line treatment. Japanese scores had poor performance in our whole population (sensitivity 14–61%). On multivariate regression analysis, predictors of secondary treatment after initial IVIG were hepatomegaly, ALT level ≥30 IU/L, lymphocyte count <2400/mm3 and time to treatment <5 days. The best sensitivity (77%) and specificity (60%) of this model was with 1 point per variable and cut-off ≥2 points. The sensitivity remained good in our 3 main ethnic subgroups (74–88%). We identified predictors of IVIg resistance and built a new score with good sensitivity and acceptable specificity in a non-Asian population.
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Affiliation(s)
- Maryam Piram
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, 1018, Le Kremlin Bicêtre, France. .,AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France.
| | - Martha Darce Bello
- AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France
| | - Stéphanie Tellier
- CHU de de Toulouse, Paediatric Rheumatology, Nephrology and Internal medicine, Toulouse, France
| | | | | | | | - Ulrich Meinzer
- APHP, CHU Robert Debré, Paediatrics,Paediatric Internal Medicine,Rheumatology and Infectious Diseases, RAISE, Paris, France
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Celine Piedvache
- APHP, CHU de Bicêtre, Clinical Research Unit, Le Kremlin Bicêtre, France
| | - Isabelle Koné-Paut
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, 1018, Le Kremlin Bicêtre, France.,AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France
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Wang Z, Geng PL. CD32a polymorphism rs1801274 affects the risk of Kawasaki disease. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2020; 48:620-626. [PMID: 32072832 DOI: 10.1080/21691401.2019.1645156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: To analyze the impact of CD32a polymorphism rs1801274 on the occurrence of Kawasaki disease (KD) through the meta-analysis.Methods: The correlation between CD32a polymorphism rs1801274 and the susceptibility to KD was appraised using summarized odds ratios (ORs) with their 95% confidence intervals (95% CIs). Besides, stratification analyses were further implemented on the basis of ethnicity and control source, respectively. Between-study heterogeneity was checked adopting chi-square-based Q test, with p < .05 as significant level. And results from Q test determined which model would be employed for OR calculation, fixed- or random-effects. Sensitivity analysis was accomplished to test the stability of final results. Potential publication bias among included studies was investigated using Begg's funnel plot and Egger's test. If publication bias was significant, its influence on overall estimates would be measured adopting the trim-and-fill method.Results: CD32a polymorphism rs1801274 significantly increased KD risk in total analysis under the comparisons of AA vs. GG, AA + AG vs. GG, AA vs. GG + AG, A vs. G and AG vs. GG (OR = 2.69, 95% CI = 1.39-5.20; OR = 2.00, 95% CI = 1.23-3.26; OR = 1.90, 95% CI = 1.23-2.94; OR = 1.77, 95% CI = 1.34-2.34; OR = 1.53, 95% CI = 1.07-2.19). After stratification analysis by ethnicity, similar tendency was also observed in Caucasian and Asian subgroups under corresponding genetic models. And parallel results were replicated in population-based and other-source subgroups after stratified analysis by control source, under some contrasts.Conclusion: CD32a polymorphism rs1801274 has strong relation to KD onset, and the presence of its A allele could elevate the disease incidence.
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Affiliation(s)
- Zhiyong Wang
- Department of Pediatrics, Weifang Maternal and Child Health Hospital, Weifang, China
| | - Pei-Liang Geng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Chang LS, Kuo HC. The role of corticosteroids in the treatment of Kawasaki disease. Expert Rev Anti Infect Ther 2020; 18:155-164. [DOI: 10.1080/14787210.2020.1713752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ling-Sai Chang
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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