1
|
Pan Y, Jiao FY. Application of artificial intelligence in the diagnosis and treatment of Kawasaki disease. World J Clin Cases 2024; 12:5304-5307. [PMID: 39156094 PMCID: PMC11238697 DOI: 10.12998/wjcc.v12.i23.5304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/15/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
This editorial provides commentary on an article titled "Potential and limitations of ChatGPT and generative artificial intelligence (AI) in medical safety education" recently published in the World Journal of Clinical Cases. AI has enormous potential for various applications in the field of Kawasaki disease (KD). One is machine learning (ML) to assist in the diagnosis of KD, and clinical prediction models have been constructed worldwide using ML; the second is using a gene signal calculation toolbox to identify KD, which can be used to monitor key clinical features and laboratory parameters of disease severity; and the third is using deep learning (DL) to assist in cardiac ultrasound detection. The performance of the DL algorithm is similar to that of experienced cardiac experts in detecting coronary artery lesions to promoting the diagnosis of KD. To effectively utilize AI in the diagnosis and treatment process of KD, it is crucial to improve the accuracy of AI decision-making using more medical data, while addressing issues related to patient personal information protection and AI decision-making responsibility. AI progress is expected to provide patients with accurate and effective medical services that will positively impact the diagnosis and treatment of KD in the future.
Collapse
Affiliation(s)
- Yan Pan
- Department of Pediatrics, The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei Province, China
| | - Fu-Yong Jiao
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Shaanxi Provincial People's Hospital, Xi’an 710000, Shaanxi Province, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Pan Y, Jiao FY. Relationship between Kawasaki disease and abdominal pain. World J Clin Cases 2024; 12:2932-2934. [PMID: 38898859 PMCID: PMC11185365 DOI: 10.12998/wjcc.v12.i17.2932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
This editorial presents an analysis of an article recently published in the World Journal of Clinical Cases. Kawasaki disease (KD) is a well-known pediatric vasculitis characterized by fever, rash, conjunctivitis, oral mucosal changes, and swelling of the extremities. This editorial aims to delve into the intricate relationship between KD and abdominal pain, drawing insights from recent research findings to provide a comprehensive understanding and potential avenues for future investigation.
Collapse
Affiliation(s)
- Yan Pan
- Department of Pediatrics, The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei Province, China
| | - Fu-Yong Jiao
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Children's Hospital, Shaanxi Provincial People's Hospital of Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
| |
Collapse
|
4
|
Li C, Liu YC, Zhang DR, Han YX, Chen BJ, Long Y, Wu C. A machine learning model for distinguishing Kawasaki disease from sepsis. Sci Rep 2023; 13:12553. [PMID: 37532772 PMCID: PMC10397201 DOI: 10.1038/s41598-023-39745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/30/2023] [Indexed: 08/04/2023] Open
Abstract
KD is an acute systemic vasculitis that most commonly affects children under 5 years old. Sepsis is a systemic inflammatory response syndrome caused by infection. The main clinical manifestations of both are fever, and laboratory tests include elevated WBC count, C-reactive protein, and procalcitonin. However, the two treatments are very different. Therefore, it is necessary to establish a dynamic nomogram based on clinical data to help clinicians make timely diagnoses and decision-making. In this study, we analyzed 299 KD patients and 309 sepsis patients. We collected patients' age, sex, height, weight, BMI, and 33 biological parameters of a routine blood test. After dividing the patients into a training set and validation set, the least absolute shrinkage and selection operator method, support vector machine and receiver operating characteristic curve were used to select significant factors and construct the nomogram. The performance of the nomogram was evaluated by discrimination and calibration. The decision curve analysis was used to assess the clinical usefulness of the nomogram. This nomogram shows that height, WBC, monocyte, eosinophil, lymphocyte to monocyte count ratio (LMR), PA, GGT and platelet are independent predictors of the KD diagnostic model. The c-index of the nomogram in the training set and validation is 0.926 and 0.878, which describes good discrimination. The nomogram is well calibrated. The decision curve analysis showed that the nomogram has better clinical application value and decision-making assistance ability. The nomogram has good performance of distinguishing KD from sepsis and is helpful for clinical pediatricians to make early clinical decisions.
Collapse
Affiliation(s)
- Chi Li
- Department of Gastroenterology, Children's Hospital of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei, 230000, Anhui, China
| | - Yu-Chen Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, 230000, Anhui, China
| | - De-Ran Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, 230000, Anhui, China
| | - Yan-Xun Han
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, 230000, Anhui, China
| | - Bang-Jie Chen
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, 230000, Anhui, China
| | - Yun Long
- Department of Gastroenterology, Children's Hospital of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei, 230000, Anhui, China
| | - Cheng Wu
- Department of Gastroenterology, Children's Hospital of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei, 230000, Anhui, China.
| |
Collapse
|
5
|
Tan W, Jing L, Wang Y, Li W. A global bibliometric analysis on Kawasaki disease research over the last 5 years (2017-2021). Front Public Health 2023; 10:1075659. [PMID: 36703854 PMCID: PMC9871775 DOI: 10.3389/fpubh.2022.1075659] [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: 10/20/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Background Kawasaki disease (KD) is a systemic vasculitis of unknown etiology that mainly affects children. We aim to conduct a bibliometric analysis to explore the latest research hotspots and trends of KD. Method By using the keywords "Kawasaki disease," "Kawasaki syndrome", and "Mucocutaneous Lymph Node Syndrome," the Web of Science (WOS) and Scopus databases were searched for publications related to KD from 2017 to 2021. Author, country and journal submissions were classified and evaluated using Biblioshiny software (using R language). VOSviewer (version 1.6.18) was used to visualize the relevant network relationships. Result According to the search strategy, 5,848 and 6,804 KD studies were published in WOS and Scopus, respectively. The results showed an overall increasing trend in the number of publications and citations during the study period. The three most influential institutions in the WOS were St. Marianna University, Kawasaki Medical School and The University of Tokyo in Japan, while in Scopus, Harvard Medical School, University of California and Tehran University of Medical Sciences were the most influential institutions. The most influential authors of the two databases are Goodman SG, Kazunori Kataoka, and Takeshi Kimura of the WOS and Marx Nikolau and Wang Y, Burns JC, and Newburger JW of the Scopus, respectively. And Scientific Reports and Frontiers in Pediatrics were the most critical journals. The most cited documents were the WOS document by McCrindle et al. and the Scopus document by Benjamin et al. published in 2017, while the keywords in the last few years were focused on "COVID-19," "multisystem inflammatory syndrome," and "pandemic." Conclusion This bibliometric analysis summarizes for the first time the research progress in KD (2017-2021), providing a qualitative and quantitative assessment of KD research bibliometric information. In the field, researchers mainly from Japan and USA are dominant, followed by China. It is recommended to pay close attention to the latest hot spots, such as "COVID-19" and "multisystem inflammatory syndrome." These results provide a more intuitive and convenient way for researchers to obtain the latest information on KD.
Collapse
Affiliation(s)
- Weifu Tan
- Department of Neonatology, The First Clinical Medical College of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China,Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Liao Jing
- Department of Neonatology, The First Clinical Medical College of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China,Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Yunxiao Wang
- Department of Neonatology, The First Clinical Medical College of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China,Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Wei Li
- Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China,*Correspondence: Wei Li ✉
| |
Collapse
|
6
|
Association of ITPKC gene polymorphisms rs28493229 and rs2290692 in North Indian children with Kawasaki disease. Pediatr Res 2022; 92:1090-1098. [PMID: 34952936 DOI: 10.1038/s41390-021-01830-x] [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: 03/30/2021] [Revised: 08/18/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Single-nucleotide polymorphisms (SNPs) of several genes are linked to the etiopathogenesis of Kawasaki disease (KD). Association of SNPs of inositol 1,4,5-triphosphate-3-kinase C (ITPKC) gene with susceptibility to KD and coronary artery lesions (CALs) has been observed in children of certain ethnicities, but not from others. The present study was planned to explore this genetic association in the North Indian cohort. METHODS Fifty children with KD and 50 age- and sex-matched controls were studied for two SNPs (rs28493229 and rs2290692) of the ITPKC gene using polymerase chain reaction and restriction fragment length polymorphism. Findings were confirmed by Sanger sequencing. A meta-analysis was also carried out for GG and CC genotypes of the SNPs. RESULTS There was significant association between KD susceptibility and CG + GG genotype of rs2290692 (p = 0.015, odds ratio = 4.1, 95% confidence interval = 1.38-13.83). None of the single alleles or genotypes of the SNPs of ITPKC were, however, significantly associated with KD susceptibility. A meta-analysis also did not show any significant association of these SNPs to KD susceptibility. CONCLUSIONS Our findings suggest that ITPKC gene SNPs (rs28493229 and rs2290692) did not have a significant association with susceptibility to KD in children from North India. Larger multicentric studies incorporating different ethnicities are required to understand the genetic basis of KD. IMPACT While SNP rs28493229 of the ITPKC gene is not found to be associated with susceptibility to KD, the combined genotype of SNP rs2290692 is shown to be associated. Impact of ITPKC gene SNP on KD is different across different races and ethnicities. We could find an association of the combined genotype of rs2290692 with it in the Indian population. This study highlights that phenotype and genotypic association of KD varies with ethnicities. Larger multicentric studies are required to reach a conclusion regarding the genetic association of KD.
Collapse
|
7
|
Das KG, Bhattarai D, Kaur A, Kaur A, Kumrah R, Srivastava P, Rawat A, Singh S. Association of single nucleotide polymorphism rs113420705 of CASP3 in children with Kawasaki disease from North India. J Family Med Prim Care 2022; 11:5404-5409. [PMID: 36505637 PMCID: PMC9731064 DOI: 10.4103/jfmpc.jfmpc_177_22] [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] [Received: 01/21/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background Kawasaki disease is a pediatric, systemic, vasculitic disorder. Its exact etiology is still unknown. Genetic polymorphisms are being investigated as susceptibility factor for this disorder. These are likely to vary among different populations. Aim To investigate the association of single nucleotide polymorphism (SNP) rs113420705 of CASP3 in Kawasaki disease (KD) from North India. Settings and Design Observational, case-control study. Methods Polymerase chain reaction and bidirectional Sanger sequencing was used for determining genotypes of SNP rs113420705 in 45 cases of KD and 50 healthy age- and sex-matched controls. Allele and genotype frequencies were assessed and compared between the groups. Results Among 45 cases, 32 had TT (71.1%), 13 had CT (28.9%) and none had CC genotype of SNP rs113420705. No significant differences in allele, genotype, or carrier frequencies of rs113420705 were found between the two groups. A comparison was also made between subgroups of KD with coronary abnormality (7 children; 15.5%) and KD with normal coronaries (38 children; 84.4%). The C allele was significantly overexpressed in KD with coronary abnormality group (P = 0.005). However, no difference was noted in the genotype frequencies. Conclusion CT genotype of rs113420705 of CASP3 showed a trend to significance with the occurrence of KD in children in North India. However, we could not establish any association between minor allele C and susceptibility to KD. C allele appeared to be over expressed in children with KD with coronary abnormalities. Larger studies will help us to reach conclusive evidence applicable to all ethnicities.
Collapse
Affiliation(s)
- K Gokul Das
- Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmagat Bhattarai
- Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupriya Kaur
- Genetic Metabolic Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Anupriya Kaur, Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012, India. E-mail:
| | - Anit Kaur
- Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajni Kumrah
- Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Srivastava
- Genetic Metabolic Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Mahajan A, Yadav S, Maheshwari A, Mahto D, Divya K, Ackshaya R, Meena H, Shakya S, Kumar V. Profile of Children with Kawasaki Disease Associated with Tropical Infections. Indian J Pediatr 2022; 89:759-764. [PMID: 34935098 PMCID: PMC8691965 DOI: 10.1007/s12098-021-03953-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe various infectious triggers for Kawasaki disease (KD) in India. METHODS A series of 10 children with diagnosed infections who developed KD during their course of illness has been presented. They were diagnosed by the American Heart Association (AHA) 2017 guidelines. Echocardiography was done to check for coronary artery dilation. Treatment was instituted as per standard protocol. RESULTS Kawasaki disease was diagnosed in 8 boys and 2 girls, aged 1 mo to 11 y. These children were being treated for dengue, chikungunya, SARS-CoV-2, hepatitis A, tuberculosis, brucellosis, disseminated staphylococcal sepsis, scrub typhus, and enteric fever. CONCLUSIONS Kawasaki disease has been associated with infectious triggers. It should be considered in febrile patients with mucocutaneous involvement or in nonresponsive sepsis, despite adequate therapy.
Collapse
Affiliation(s)
- Akanksha Mahajan
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| | - Sidharth Yadav
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| | - Anu Maheshwari
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India.
| | - Deonath Mahto
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| | - Kakarla Divya
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| | - R Ackshaya
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| | - Himanshu Meena
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| | - Sakshi Shakya
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| | - Virendra Kumar
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, 110001, India
| |
Collapse
|
9
|
Abstract
The many forms of vasculitis are characterized by inflammation of blood vessels, leading to potentially long-term sequelae including vision loss, aneurysm formation and kidney failure. Accurate estimation of the incidence and prevalence has been hampered by the absence of reliable diagnostic criteria and the rarity of these conditions; however, much progress has been made over the past two decades, although data are still lacking from many parts of the world including the Indian subcontinent, China, Africa and South America. Giant cell arteritis occurs in those aged 50 years and over and seems to mainly affect persons of northern European ancestry, whereas Takayasu arteritis occurs mainly in those aged under 40 years. By contrast, Kawasaki disease mainly occurs in children aged under 5 years and is most common in children of Asian ancestry, and IgA vasculitis occurs in children and adolescents. Although much less common than giant cell arteritis, the different forms of antineutrophil cytoplasmic antibody-associated vasculitis are being increasingly recognized in most populations and occur more frequently with increasing age. Behçet syndrome occurs most commonly along the ancient silk road between Europe and China. Much work needs to be done to better understand the influence of ethnicity, geographical location, environment and social factors on the development of vasculitis.
Collapse
Affiliation(s)
- Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology and Behçet's Disease Research Centre, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Division of Rheumatology, Lund University and Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
10
|
Tsuboya N, Makino H, Mitani Y, Ito M, Ohya K, Morimoto M, Hanaki R, Yodoya N, Ohashi H, Sawada H, Sugiyama K, Hirayama M. Erythema and Induration of Bacillus Calmette-Guérin Scar Associated With Multisystem Inflammatory Syndrome in Children in Japan: A Case Report. Front Pediatr 2022; 10:849473. [PMID: 35359902 PMCID: PMC8963203 DOI: 10.3389/fped.2022.849473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare febrile disorder with multisystem organ involvement temporally associated with coronavirus 2019 infection (COVID-19) and frequently exhibits features mimicking Kawasaki disease (KD), another febrile disorder in children. The pathogenesis and the full clinical spectrum of MIS-C is poorly understood: It is still unclear whether MIS-C and KD are different syndromes or represent a common spectrum. The erythema and induration of Bacillus Calmette-Guérin (BCG) scar is one of the characteristic findings of KD, and is useful for the diagnosis in countries where BCG vaccination is mandated in infancy. Furthermore, such findings in BCG scar were also reported after SARS-CoV-2 vaccination, which may be related to molecular mimicry. However, there are no reports of changes at the BCG scar in MIS-C cases. Here, we report a case of MIS-C in a 3-year-old Hispanic boy in Japan, with erythema and induration at the BCG scar. The patient received BCG vaccination at 16 months of age in Japan. Four weeks before the onset, he had positive polymerase chain reaction (PCR) results for SARS-CoV-2 following household outbreak, although he was asymptomatic. He presented with fever and gastrointestinal symptoms, followed by the appearance of all six principal findings of complete KD. He exhibited congestive heart failure, following intravenous immunoglobulin (IVIG) therapy. He was diagnosed with MIS-C based on characteristic mucocutaneous and gastrointestinal symptoms, decreased cardiac function, and coagulopathy, in addition to laboratory data consistent with MIS-C. The BCG finding was present from the early stage of the disease. The patient was refractory to two doses of IVIGs, and the third IVIG plus prednisolone resulted in defervescence and improvement in heart failure. No coronary involvement was observed. This is the first case of erythema and induration at the BCG scar associated with MIS-C accompanied by KD features, which may give clinical and mechanistic insights in the understanding of the disease. Since the full spectrum of MIS-C is still evolving and both of them are syndromes with overlapped clinical features, further studies are warranted for deep phenotyping of MIS-C with KD features relative to KD in countries with mandatory BCG programs in infancy.
Collapse
Affiliation(s)
- Naoki Tsuboya
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hirotoshi Makino
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Michiko Ito
- Department of Pediatrics, Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Kazunobu Ohya
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mari Morimoto
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryo Hanaki
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Noriko Yodoya
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroyuki Ohashi
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hirofumi Sawada
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kenji Sugiyama
- Department of Pediatrics, Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
11
|
Shaanxi Provincial Diagnosis and Treatment Center of Kawasaki Disease. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:867-876. [PMID: 34535199 PMCID: PMC8480171 DOI: 10.7499/j.issn.1008-8830.2107110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 12/19/2022]
Abstract
Kawasaki disease is an acute, self-limited vascuitis that mainly occurs in children under 5 years of age. Intravenous immunoglobulin (IVIG) has become an effective treatment regimen, which can effectively reduce the incidence of cardiovascular complications. However, there has been no consensus or clinical guidelines for the application of IVIG in children with Kawasaki disease till now. This consensus is developed based on the current research progress on the application of IVIG in children with Kawasaki disease in China and overseas, with reference to the diagnosis and treatment guidelines for Kawasaki disease in China and overseas, and the opinions of experts. This consensus provides recommendations on the clinical application strategy of IVIG in children with Kawasaki disease and the prevention and treatment of its adverse reactions. Citation.
Collapse
|
12
|
Wang L, Zhang S, Ma J, Ni J, Wang J, Li X, Mu Z, Han W, He G, Ma L, Shah J, Shah J, Jiao F. Kawasaki Disease- Management Strategies Given Symptoms Overlap to COVID-19: A Review. JNMA J Nepal Med Assoc 2021; 59:417-424. [PMID: 34508537 PMCID: PMC8369595 DOI: 10.31729/jnma.5698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/07/2021] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease is an acute, self-limiting vasculitis in children. Early treatment is necessary to prevent cardiovascular complications. The acute phase of Kawasaki disease may present with hemodynamic instability. An association between viral respiratory infections and Kawasaki disease has been reported. Studies have shown that Kawasaki and Kawasaki-like disease may be associated with and have symptoms overlapping COVID-19. Children with COVID-19 may present as Kawasaki-like disease with pediatric inflammatory multisystem syndrome, or macrophage activation syndrome. Clinicians need to be aware of the early diagnosis and management of Kawasaki disease to prevent the development of coronary artery aneurysms. The symptoms overlap of multisystem inflammatory disease seen in COVID-19 adds to the difficulties in timely diagnosis and treatment. Children with Kawasaki disease require regular follow-up plans for coronary artery aneurysms. This adds to the difficulties during the changed environment of COVID-19 for control and prevention. Missed diagnosis and early treatment of Kawasaki disease with immunoglobulin and aspirin results in the development of coronary artery aneurysm in up to 25% of cases, with grave consequences. Here, we briefly review the management of typical and atypical Kawasaki disease which has symptoms overlapping with the multisystem inflammatory disease as seen in COVID-19.
Collapse
Affiliation(s)
- Linna Wang
- Xi'an Medical University, Xi'an, 710068, China
| | - Sheng Zhang
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Ji Ma
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Jing Ni
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Juyan Wang
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Xiaohong Li
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Zhilong Mu
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Wei Han
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Gaitao He
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Lei Ma
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Jenifei Shah
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jay Shah
- Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Fuyong Jiao
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| |
Collapse
|
13
|
Bhattad S, Gupta S, Israni N, Mohanty S. Profile of Kawasaki disease at a tertiary care center in India. Ann Pediatr Cardiol 2021; 14:187-191. [PMID: 34103858 PMCID: PMC8174629 DOI: 10.4103/apc.apc_57_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/21/2020] [Accepted: 12/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background Kawasaki disease (KD) is the most common cause of acquired heart disease in developed countries. KD is increasingly being reported from India; however, studies involving the large number of patients are few. Methods All children presenting to the center from January 2017 to December 2019, diagnosed to have KD, were retrospectively included in the study. Clinical and laboratory profiles, including echocardiograms, were reviewed. Factors contributing to intravenous immunoglobulin (IVIg) refractoriness and the development of coronary artery abnormalities (CAA) were assessed. Results A total of 39 children with KD presented to the center during the study. While 32 received initial treatment at our center, seven were referred after the initial IVIg infusion. The age range was 2 months to 11 years (mean 42.15 ± 38.51 months). More than two-thirds of the cohort was male (n = 27/39). Mucosal involvement was the commonest clinical abnormality for the group, followed by rash. Hemoglobin was significantly lower in the group with coronary artery involvement (P = 0.001). CAA (61.5%), incomplete KD, and atypical features were much more common in infants compared to the rest. Refractoriness to treatment was significantly more common in infants (P = 0.029). Conclusions A significant proportion of infants with KD had cardiac involvement. Infants were more likely to have IVIg-resistant disease.
Collapse
Affiliation(s)
- Sagar Bhattad
- Department of Pediatrics, Division of Pediatric Rheumatology and Immunology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sandip Gupta
- Department of Pediatrics, Division of Pediatric Intensive Care, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Neha Israni
- Department of Pediatrics, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sweta Mohanty
- Department of Cardiac Sciences, Division of Pediatric Cardiology, Aster CMI Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
14
|
The Platelet microRNA Profile of Kawasaki Disease: Identification of Novel Diagnostic Biomarkers. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9061568. [PMID: 32733962 PMCID: PMC7383328 DOI: 10.1155/2020/9061568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 12/22/2022]
Abstract
Challenging diagnosis and unknown etiology of Kawasaki disease (KD) increase the coronary artery lesions incidence. microRNAs (miRNAs) are the most promising biomarkers because of their stability in peripheral blood and noninvasive measurement procedure, whose potential utility have been proved in cancers. To explore the utility of differentially expressed (DE) miRNAs as early diagnostic markers, 44 patients (25 incomplete KD and 19 complete KD) and 31 febrile controls were recruited for small RNA sequencing. From all the 1922 expressed miRNA, 210 DE miRNAs were found between KD and febrile control groups. Though platelet miRNA profiles of complete KD incomplete KD were much similar through cluster analysis, the DE miRNAs were not identical. Eight DE miRNAs were validated by real-time quantitative PCR (qRT-PCR) in complete or incomplete KD groups using a normalizer, miR-126-3p, which was identified by geNorm and NormFinder tools. The expression level of miRNAs continuous changed over time was observed and the function analysis showed the potential role of miRNAs as therapeutic biomarkers. Additionally, the prediction model for KD showed a sensitivity of 78.8% and a specificity of 71.4%, respectively. This study used small RNA sequencing to identify miRNA biomarkers KD diagnosis based on a large sample size. Our findings shine a light on the understanding of molecular pathogenesis of KD and may improve the accuracy of KD diagnosis and prognosis in clinical.
Collapse
|
15
|
Arora K, Guleria S, Jindal AK, Rawat A, Singh S. Platelets in Kawasaki disease: Is this only a numbers game or something beyond? Genes Dis 2020; 7:62-66. [PMID: 32181276 PMCID: PMC7063415 DOI: 10.1016/j.gendis.2019.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/30/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is a medium vessel vasculitis with predilection to cause coronary artery abnormalities. KD is now the most common cause of acquired heart disease in developed countries. Thrombocytosis is consistently found in patients with KD, usually in 2nd to 3rd week of illness. Thrombocytopenia has occasionally been reported in the acute phase of KD. An increase or decrease in platelet number in patients with KD was initially considered to be a benign phenomenon. However, recent literature on platelet biology in KD has suggested that platelets are not only increasing but are rather activated. This phenomenon has been found to increase the risk of thrombosis in these patients. Similarly a fall in platelet counts during acute stage of KD has also been found to be associated with increased severity of disease. In this review, we update on the current best understanding about pathogenic role of platelets in patients with KD.
Collapse
Affiliation(s)
| | | | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | |
Collapse
|
16
|
Elakabawi K, Lin J, Jiao F, Guo N, Yuan Z. Kawasaki Disease: Global Burden and Genetic Background. Cardiol Res 2020; 11:9-14. [PMID: 32095191 PMCID: PMC7011927 DOI: 10.14740/cr993] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022] Open
Abstract
Kawasaki disease (KD) is a childhood vasculitides associated with serious coronary artery lesions. It is the most common cause of pediatric acquired heart disease in developed countries, and is increasingly reported from many rapidly industrializing developing countries. The incidence varies widely among different nations and is highest in North-East Asian countries, where almost 1 in 100 children in Japan having the disease by age of 5, where the lowest incidence reported in sub-Saharan Africa. The etiology of KD is still uncertain; interaction between a genetic predisposition and several environmental and immunological factors has been hypothesized. Several susceptibility genes were identified to be associated with the development of KD and increased risk of coronary artery lesions. Gene-gene associations and alteration of deoxyribonucleic acid (DNA) methylation are also found to play key roles in the pathogenesis and prognosis of KD. This article will focus on the global epidemiological patterns of KD, and the currently known genetic predisposition.
Collapse
Affiliation(s)
- Karim Elakabawi
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.,Cardiovascular Department, Benha University, Benha 13518, Egypt.,These two authors contributed equally
| | - Jing Lin
- Department of Child and Adolescent Health Science Center, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.,These two authors contributed equally
| | - Fuyong Jiao
- Children's Hospital, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China
| | - Ning Guo
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Zuyi Yuan
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| |
Collapse
|
17
|
Riancho-Zarrabeitia L, Rasilla DF, Royé D, Fdez-Arroyabe P, Santurtún A. Kawasaki disease in Spanish paediatric population and synoptic weather types: an observational study. Rheumatol Int 2018; 38:1259-1266. [PMID: 29846788 DOI: 10.1007/s00296-018-4066-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/25/2018] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is a vasculitis of unelucidated pathogenesis that usually occurs in paediatric patients. In this study we analyse the temporal pattern and geographical distribution of the disease in Spain, and its relationship with atmospheric circulation patterns. We performed a retrospective study in which we collected all hospital admissions due to KD in the country between 2005 and 2015 and explored their relationship with demographic and geographical characteristics. Moreover, we calculated daily surface atmospheric patterns over Spain to study the relationship between weather types (WT) and KD Admissions. The average admission rate for KD in the paediatric population was 3.90 per 100,000, with a male to female ratio of 1.56:1. The highest rate of admissions was found in the 0-4-year-old group, with an incidence of 11.7 cases per 100,000. Admissions followed an annual cyclic pattern with a peak of incidence in January (p = 0.022) and a nadir in September. There was an upwards trend in the number of KD admissions in male sex during the study period (p = 0.004). However, there were marked geographical differences in the incidence rate. Finally, the analysis of the relationship between the WT and the number of admissions by KD revealed no statistically significant association. KD admissions follow a peculiar seasonal and spatial distribution, that suggest the involvement of environmental factors in the disease; however, the absence of an association with WT should be interpreted with caution and regional studies should be done to explore this relationship.
Collapse
Affiliation(s)
| | | | - Dominic Royé
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pablo Fdez-Arroyabe
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Santurtún
- Unit of Legal Medicine, Pharmacology and Physiology Department, University of Cantabria, Av Cardenal Herrera Oria s/n, 39011, Santander, Spain.
| |
Collapse
|
18
|
Mărginean CO, Meliț LE, Gozar L, Mărginean CD, Mărginean MO. Incomplete Refractory Kawasaki Disease in an Infant-A Case Report and a Review of the Literature. Front Pediatr 2018; 6:210. [PMID: 30101141 PMCID: PMC6074057 DOI: 10.3389/fped.2018.00210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/09/2018] [Indexed: 12/23/2022] Open
Abstract
Kawasaki disease (KD) is a febrile vasculitis, which is commonly defined by fever and at least four specific clinical symptoms. Incomplete KD is defined by suggestive echocardiographic findings with an incomplete clinical picture. Refractory KD is diagnosed in patients resistant to intravenous immunoglobulin (IVIG). We report the case of a 6-month-old male infant admitted to our clinic for persistent fever and onset of a generalized polymorphous rash, accompanied by high fever, rhinorrhea, and cough for the past 7 days. The laboratory tests, on the day of admission, revealed leukocytosis with neutrophilia, anemia, thrombocytosis, hypernatremia, hypoalbuminemia, elevated C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Echocardiography showed dilation of the left anterior descending coronary artery (LAD). Based on all these findings, we established the diagnosis of KD, and we initiated IVIG and intravenous pulsed methylprednisolone, with an initial favorable outcome. However, the symptoms reappeared, and we administered a second higher single dose of IVIG, but without any clinical improvement. Moreover, the laboratory parameters and echocardiographic findings worsened. We reinitiated a longer course of intravenous methylprednisolone in a smaller dose, which had a favorable impact on the clinical, laboratory, and echocardiographic parameters. Multiple uncertainties exist related to the management of refractory KD despite the wide spectrum of therapeutic options that have been proposed. Our case demonstrates that in patients refractory to aggressive initial therapy, low or moderate doses of steroid given daily may be helpful.
Collapse
Affiliation(s)
- Cristina O Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy TîrguMures, Târgu Mures, Romania
| | - Lorena E Meliț
- Department of Pediatrics, University of Medicine and Pharmacy TîrguMures, Târgu Mures, Romania
| | - Liliana Gozar
- Department of Pediatric Cardiology, University of Medicine and Pharmacy TîrguMures, Târgu Mures, Romania
| | - Cristian Dan Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy TîrguMures, Târgu Mures, Romania
| | - Maria O Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy TîrguMures, Târgu Mures, Romania
| |
Collapse
|