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Zhang RL, Lo HH, Lei C, Ip N, Chen J, Law BYK. Current pharmacological intervention and development of targeting IVIG resistance in Kawasaki disease. Curr Opin Pharmacol 2020; 54:72-81. [PMID: 32956895 PMCID: PMC7500898 DOI: 10.1016/j.coph.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
Kawasaki disease is an acute childhood self-limited vasculitis, causing the swelling or inflammation of medium-sized arteries, eventually leading to cardiovascular problems such as coronary artery aneurysms. Acetylsalicylic acid combined with intravenous immunoglobulin (IVIG) is the standard treatment of Kawasaki disease (KD). However, a rising number of IVIG resistant cases were reported with severe disease complications such as the KD Shock Syndrome or KD-Macrophage activation syndrome. Recent reports have depicted the overlapped number of children with SARS-CoV-2 and KD, which was called multisystem inflammatory syndrome. Simultaneously, the incidence rate of KD-like diseases are increased after the outbreak of COVID-19, suggesting the virus may be associated with KD. New intervention is important to overcome the problem of IVIG treatment resistance. This review aims to introduce the current pharmacological intervention and possible resistance genes for the discovery of new drug for IVIG resistant KD.
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Affiliation(s)
- Rui Long Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, SAR China
| | - Hang Hong Lo
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, SAR China
| | - Cheng Lei
- Department of Pediatrics, Kiang Wu Hospital, Macao, SAR China
| | - Nikki Ip
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, SAR China
| | - Juan Chen
- The Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education, Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
| | - Betty Yuen-Kwan Law
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, SAR China.
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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: 26] [Impact Index Per Article: 6.5] [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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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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van Stijn D, Slegers A, Zaaijer H, Kuijpers T. Lower CMV and EBV Exposure in Children With Kawasaki Disease Suggests an Under-Challenged Immune System. Front Pediatr 2020; 8:627957. [PMID: 33585370 PMCID: PMC7873854 DOI: 10.3389/fped.2020.627957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Kawasaki Disease (KD) is a pediatric vasculitis of which the pathogenesis is unclear. The hypothesis is that genetically pre-disposed children develop KD when they encounter a pathogen which remains most often unidentified or pathogen derived factors. Since age is a dominant factor, prior immune status in children could influence their reactivity and hence the acquisition of KD. We hypothesized that systemic immune responses early in life could protect against developing KD. With this study we tested whether the incidence of previous systemic cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infection is lower in children with KD compared to healthy age-matched controls. Methods and Results: We compared 86 KD patients with an age-matched control group regarding CMV and EBV VCA IgG measurements (taken before or 9 months after IVIG treatment). We found that both CMV and EBV had an almost 2-fold lower seroprevalence in the KD population than in the control group. Conclusions: We suggest that an under-challenged immune system causes an altered immune reactivity which may affect the response to a pathological trigger causing KD in susceptible children.
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Affiliation(s)
- Diana van Stijn
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Annemarie Slegers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Hans Zaaijer
- Laboratory of Clinical Virology, Department of Medical Microbiology, Center for Infection and Immunity Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Taco Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Zhang Q, Liao Y, Du J. Kawasaki disease shock syndrome: A report of two cases and literature review. Pediatr Investig 2019; 3:81-85. [PMID: 32851296 PMCID: PMC7331343 DOI: 10.1002/ped4.12127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/26/2019] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Kawasaki disease shock syndrome (KDSS) is a rare Kawasaki disease (KD) manifestation. The pediatricians are not aware of the full range of clinical characteristics of KDSS. OBJECTIVE We aimed to investigate the clinical features, diagnosis and treatment of KDSS in two patients and we included a literature review. METHODS We collected and analyzed the clinical data for two patients with KDSS. Additionally, using "Kawasaki diseases shock syndrome" as a key phrase, we searched PubMed, Biotechnology Information and Wanfang Data Knowledge Service Platform databases for any similar reports between January 2009 and March 2017. RESULTS Both of our patients diagnosed with KD developed sustained hypotension during the course of intravenous immunoglobulin treatment, as well as hypoalbuminemia, and increased C-reactive protein and brain natriuretic peptide levels during hypotension. Both patients responded well to fluid resuscitation and inotropic support. No aneurysms formed in either patient during follow-up. We reviewed two related studies in Chinese and 11 studies in English. INTERPRETATION KD may present with severe shock, and requires proper diagnosis and rapid treatment. The prognosis for most patients with KDSS is excellent.
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Affiliation(s)
- Qingyou Zhang
- Department of PediatricsPeking University First HospitalBeijingChina
| | - Ying Liao
- Department of PediatricsPeking University First HospitalBeijingChina
| | - Junbao Du
- Department of PediatricsPeking University First HospitalBeijingChina
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Late Treatment and Recurrence of Kawasaki Disease in a Moroccan Infant. Case Rep Pediatr 2019; 2019:3904932. [PMID: 30956834 PMCID: PMC6425317 DOI: 10.1155/2019/3904932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/13/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction While the diagnosis of typical form of Kawasaki disease (KD) is obvious, this multifaceted disease continues to surprise us. We report the case of a recurrent Kawasaki disease in an infant. Case At the age of 13 months, the infant was diagnosed with complete Kawasaki disease; he presented with prolonged fever, bilateral conjunctivitis, enanthem, exanthema, edema of the lower limb, peeling, and biological inflammatory syndrome. He was treated with intravenous immunoglobulin (IVIG) associated with a high dose of aspirin and then an antiplatelet dose with a good clinical-biological evolution. The echocardiography was normal. Seven months later, the patient was again admitted, in a similar picture: a prolonged fever evolving for 7 days, bilateral conjunctivitis, enanthem, cervical adenopathy of 1.5 cm/1 cm, scarlatiniform erythema, pruriginous of the trunk and limb, and peeling of the toes, with indurated edema of the hands and feet. The rest of the examination was normal except the irritability. The diagnosis of recurrent KD was made according the five criteria of the American Heart Association. The echocardiography was normal again. The infant received IVIG with good outcome. Conclusion Despite its rarity, the possibility of recurrence of KD should be known by clinicians, so as not to delay the specific management of vasculitis whose stakes in terms of prevention of coronary artery lesions are well known. Our case confirms the possibility of this recurrence.
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Gamez-Gonzalez LB, Moribe-Quintero I, Cisneros-Castolo M, Varela-Ortiz J, Muñoz-Ramírez M, Garrido-García M, Yamazaki-Nakashimada M. Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease. Pediatr Int 2018; 60:781-790. [PMID: 29888440 DOI: 10.1111/ped.13614] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 01/20/2018] [Accepted: 06/07/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Kawasaki disease shock syndrome (KDSS) is an uncommon presentation of Kawasaki disease (KD). KDSS has been associated with more severe markers of inflammation, coronary abnormalities and i.v. immunoglobulin (IVIG) resistance. METHODS A retrospective, descriptive study of children with KDSS in two hospitals was performed. Relevant articles about KD and shock were collected, and demographic data, clinical presentation, laboratory variables, echocardiogram findings, treatment and special features were analyzed when available. Twelve patients diagnosed with KDSS were retrospectively reviewed from two centers in Mexico, along with 91 additional cases from the literature. RESULTS Seventy-two patients presented with complete KD (69.9%), and 30.1% (31/103) had unusual KD manifestations. The most frequent diagnosis at the time of admission was toxic shock syndrome (TSS; n = 20). Sixteen of the 20 had coronary artery abnormalities. Overall, abnormalities in the coronary arteries were documented in 65% of the patients. The mortality rate was 6.8%. CONCLUSION The presence of coronary aneurysms was significantly and positively correlated with male gender, IVIG resistance, inotrope treatment, cardiac failure, abdominal pain and neurological symptoms. IVIG-resistant patients had higher neutrophil : lymphocyte ratio. Abdominal symptoms, hypoalbuminemia and elevated C-reactive protein were present in almost all of the patients. Multisystem involvement with atypical presentation in KDSS is frequent. An important differential diagnosis is TSS. Mechanical ventilation, gastrointestinal and neurological symptoms were associated with IVIG resistance and the presence of coronary aneurysms. The first line of treatment includes IVIG and pulse corticosteroids; in severe cases, infliximab, anakinra, cyclosporine or plasmapheresis are alternative treatment options.
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Affiliation(s)
| | - Isabel Moribe-Quintero
- Clinical Immunology Department, National Institute of Pediatrics, Médica Sur Hospital, Mexico City, Mexico
| | | | | | - Mireya Muñoz-Ramírez
- Intensive Care Unit, National Institute of Pediatrics, Médica Sur Hospital, Mexico City, Mexico
| | - Martin Garrido-García
- Cardiology Department, National Institute of Pediatrics, Médica Sur Hospital, Mexico City, Mexico
| | - Marco Yamazaki-Nakashimada
- Clinical Immunology Department, National Institute of Pediatrics, Médica Sur Hospital, Mexico City, Mexico
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Singh S, Vignesh P, Burgner D. The epidemiology of Kawasaki disease: a global update. Arch Dis Child 2015; 100:1084-8. [PMID: 26111818 DOI: 10.1136/archdischild-2014-307536] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/02/2015] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is a childhood vasculitis and the most frequent cause of paediatric acquired heart disease in North America, Europe and Japan. It is increasingly recognised in rapidly industrialising countries such as China and India where it may replace rheumatic heart disease as the most common cause of acquired heart disease in children. We review the current global epidemiology of KD and discuss some public health implications.
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Affiliation(s)
- Surjit Singh
- Paediatric Allergy Immunology Unit, Advanced Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Paediatric Allergy Immunology Unit, Advanced Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia Department of Paediatrics, Melbourne University, Parkville, Victoria, Australia Department of Paediatrics, Paediatric Infectious Diseases Department, Monash University, Monash Children's Hospital, Clayton, Victoria, Australia
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