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Jiao W, Wei L, Jiao F, Pjetraj D, Feng J, Wang J, Catassi C, Gatti S. Very early onset of coronary artery aneurysm in a 3-month infant with Kawasaki disease: a case report and literature review. Ital J Pediatr 2023; 49:60. [PMID: 37270515 DOI: 10.1186/s13052-023-01478-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a medium vessel vasculitis, of unknown etiology, typically presenting in children younger than 5 years of age. Prolonged fever (at least five days) is a major clinical criterion of KD, while cardiac involvement may occur in up to 25% of patients, generally in the second week of the disease. CASE PRESENTATION We describe the case of KD developing in a 3-month infant, with an early occurrence of coronary artery aneurysm after only 3 days of fever, complicated by thrombosis, requiring aggressive treatments. CONCLUSIONS Time of development of cardiac complications can be different in young infants with KD and both diagnostic criteria and treatment indications should be individualized in this class of age.
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Affiliation(s)
- Wenyan Jiao
- Department of Psychology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Li Wei
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Fuyong Jiao
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Dorina Pjetraj
- Department of Pediatrics, Polytechnic University of Marche, Via Filippo Corridoni 11, 60123, Ancona, Italy
| | - Jianying Feng
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Jvyan Wang
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Carlo Catassi
- Department of Pediatrics, Polytechnic University of Marche, Via Filippo Corridoni 11, 60123, Ancona, Italy
| | - Simona Gatti
- Department of Pediatrics, Polytechnic University of Marche, Via Filippo Corridoni 11, 60123, Ancona, Italy.
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Kim HJ, Yun SW, Yu JJ, Yoon KL, Lee KY, Kil HR, Kim GB, Han MK, Song MS, Lee HD, Ha KS, Sohn S, Ebata R, Hamada H, Suzuki H, Kamatani Y, Kubo M, Ito K, Onouchi Y, Hong YM, Jang GY, Lee JK. Identification of LEF1 as a Susceptibility Locus for Kawasaki Disease in Patients Younger than 6 Months of Age. Genomics Inform 2018; 16:36-41. [PMID: 30304924 PMCID: PMC6187808 DOI: 10.5808/gi.2018.16.2.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/11/2018] [Indexed: 01/25/2023] Open
Abstract
Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (LEF1) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; pcombined = 1.10 × 10-5), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the LEF1 gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the LEF1 gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.
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Affiliation(s)
- Hea-Ji Kim
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Jeong Jin Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Kyung Lim Yoon
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Kyung-Yil Lee
- Department of Pediatrics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Korea
| | - Hong-Ryang Kil
- Department of Pediatrics, Chungnam National University Hospital, Daejeon 35015, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Myung-Ki Han
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan 47392, Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Pusan National University Hospital, Busan 49241, Korea
| | - Kee Soo Ha
- Department of Pediatrics, Korea University Ansan Hospital, Ansan 15355, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University Hospital, Seoul 07985, Korea
| | - Ryota Ebata
- Department of Pediatrics, Chiba-University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Tokyo Women's Medical University Yachivo Medical Center, Yachivo 276-8524, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Kaoru Ito
- Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Yoshihiro Onouchi
- Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University Hospital, Seoul 07985, Korea
| | - Gi Young Jang
- Department of Pediatrics, Korea University Ansan Hospital, Ansan 15355, Korea
| | - Jong-Keuk Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea
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Satoh K, Wakejima Y, Gau M, Kiguchi T, Matsuda N, Takasawa R, Takasawa K, Nishioka M, Shimohira M. Risk of coronary artery lesions in young infants with Kawasaki disease: need for a new diagnostic method. Int J Rheum Dis 2017; 21:746-754. [DOI: 10.1111/1756-185x.13223] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Kaoru Satoh
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Yoko Wakejima
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Maki Gau
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Tomoyuki Kiguchi
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Nozomi Matsuda
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Reiko Takasawa
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Kei Takasawa
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
- Department of Pediatrics and Developmental Biology; Tokyo Medical and Dental University; Tokyo Japan
| | - Masato Nishioka
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
| | - Masayuki Shimohira
- Department of Pediatrics; Kawaguchi Municipal Medical Center; Kawaguchi Saitama Japan
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Yoon YM, Yun HW, Kim SH. Clinical Characteristics of Kawasaki Disease in Infants Younger than Six Months: A Single-Center Study. Korean Circ J 2016; 46:550-5. [PMID: 27482265 PMCID: PMC4965435 DOI: 10.4070/kcj.2016.46.4.550] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/12/2015] [Accepted: 10/27/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Kawasaki disease (KD) is the leading cause of acquired heart disease, which predominantly occurs in children under the age of 5 years. However, there are fewer cases of KD in infants younger than 6 months, which makes it difficult to diagnose. We investigated the clinical manifestations of KD in this age group and compared them with those in the older age group. SUBJECTS AND METHODS We retrospectively reviewed the medical records of 239 patients with KD admitted to the Hallym Sacred Heart Hospital from January 2013 to June 2015. The data were categorized into 2 groups by age: Group A (≤6 months, n=26) and Group B (>6 months, n=213). RESULTS Group A had a longer hospitalization period than Group B (6.69 vs. 5.19 days, p=0.002). Group A had fewer clinical manifestations upon admission, due to which there was a higher incidence of incomplete KD (1.88 vs. 3.54 of the diagnostic criteria, p<0.05; and 19.2% vs. 4.2% incomplete KD incidence, p=0.002). The rate of cardiac complications was higher in Group A (30.8% vs. 11.7%, p=0.011). CONCLUSION The rate of cardiac complications of the patients younger than 6 months was significantly higher than that of the older patients. Therefore, infants younger than 6 months with unexplained fever for more than 5 days should be suspected as having KD, even if the principal clinical features are not fully presented. Echocardiography must be appropriately used for diagnosis of KD in suspected patients.
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Affiliation(s)
- You Min Yoon
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hye Won Yun
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung Hye Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
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Singh S, Agarwal S, Bhattad S, Gupta A, Suri D, Rawat A, Singhal M, Rohit M. Kawasaki disease in infants below 6 months: a clinical conundrum? Int J Rheum Dis 2016; 19:924-8. [PMID: 26990891 DOI: 10.1111/1756-185x.12854] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Kawasaki disease (KD) is a medium vessel vasculitis of childhood. In infancy KD is often characterized by incomplete and atypical forms. There is paucity of literature on KD in children below 6 months and there are no data from any developing country. This study defines the profile of children with KD below 6 months at our centre. METHODS During January 1994 to March 2015, 460 children were diagnosed with KD and 17 (3.6%) were below 6 months. Diagnosis was based on American Heart Association (AHA) criteria. All children were treated with intravenous immunoglobulin and aspirin; three also received infliximab. RESULTS Mucosal changes were present in 11 patients (64%); extremity changes in 11 (64%); rash in nine (53%); conjunctival injection in eight (47%); and cervical lymphadenopathy in three (17%). Irritability was noted in 15 patients (88%); four (23%) had respiratory symptoms; and two (11%) had bacille Calmette-Guérin scar reactivation. Fifteen (88%) had incomplete KD. Twelve patients were diagnosed beyond day 10 of illness. Thrombocytopenia was seen in four. Coronary artery abnormalities were present in six (35%) patients. Two children died from disease-related complications - one of these had giant coronary artery aneurysms. CONCLUSION Our data show that incomplete forms of KD are commonly seen in children below 6 months of age, thereby resulting in delayed diagnoses. Pediatricians need to have a high index of suspicion of KD when dealing with a young infant with unexplained fever beyond 5 days. The AHA criteria appear to be inadequate for diagnosing KD in infants below 6 months.
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Affiliation(s)
- Surjit Singh
- Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India. ,
| | - Sikha Agarwal
- Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India
| | - Sagar Bhattad
- Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India
| | - Anju Gupta
- Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India
| | - Deepti Suri
- Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manojkumar Rohit
- Department ofCardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Aoyagi R, Hamada H, Sato Y, Suzuki H, Onouchi Y, Ebata R, Nagashima K, Terauchi M, Terai M, Hanaoka H, Hata A. Study protocol for a phase III multicentre, randomised, open-label, blinded-end point trial to evaluate the efficacy and safety of immunoglobulin plus cyclosporin A in patients with severe Kawasaki disease (KAICA Trial). BMJ Open 2015; 5:e009562. [PMID: 26628527 PMCID: PMC4679944 DOI: 10.1136/bmjopen-2015-009562] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown aetiology that predominantly affects infants and young children. We hypothesise that cyclosporin A (CsA) may be effective in treating KD by regulating the Ca(2+)/NFAT signalling pathway. This trial compares the current standard therapy of intravenous immunoglobulin (IVIG) and the combined IVIG+CsA therapy in paediatric patients with severe KD. METHODS AND ANALYSIS This trial is a phase III, multicentre, randomised, open-label, blinded-end point trial that evaluates the efficacy and safety of IVIG+CsA therapy. Patients with severe KD who satisfy the eligibility criteria are randomised (1:1) to receive either CsA (5 mg/kg/day for 5 days; Neoral) plus high-dose IVIG (2 g/kg for 24 h and aspirin 30 mg/kg/day), or high-dose IVIG alone (2 g/kg for 24 h and aspirin 30 mg/kg/day). The primary end point is the frequency of occurrence of coronary artery abnormalities during the trial period. An independent end point review committee will be in charge of the trial assessment. ETHICS AND DISSEMINATION The protocol was approved by the Institutional Review Board of each institution. The trial was notified and registered at the Pharmaceutical and Medical Devices Agency, in Japan. The trial is currently on-going and is scheduled to finish in April 2017. The findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER JMA-IIA00174; Pre-results.
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Affiliation(s)
- Reiko Aoyagi
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Yasunori Sato
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryota Ebata
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kengo Nagashima
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Moe Terauchi
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Masaru Terai
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Akira Hata
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
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Yeom JS, Woo HO, Park JS, Park ES, Seo JH, Youn HS. Kawasaki disease in infants. KOREAN JOURNAL OF PEDIATRICS 2013; 56:377-82. [PMID: 24223598 PMCID: PMC3819680 DOI: 10.3345/kjp.2013.56.9.377] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/12/2013] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is an acute febrile illness that is the predominant cause of pediatric acquired heart disease in infants and young children. Because the diagnosis of KD depends on clinical manifestations, incomplete cases are difficult to diagnose, especially in infants younger than 1 year. Incomplete clinical manifestations in infants are related with the development of KD-associated coronary artery abnormalities. Because the diagnosis of infantile KD is difficult and complications are numerous, early suspicion and evaluation are necessary.
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Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyang Ok Woo
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji Sook Park
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eun Sil Park
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Lee EJ, Park YW, Hong YM, Lee JS, Han JW. Epidemiology of Kawasaki disease in infants 3 months of age and younger. KOREAN JOURNAL OF PEDIATRICS 2012; 55:202-5. [PMID: 22745644 PMCID: PMC3382700 DOI: 10.3345/kjp.2012.55.6.202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/15/2011] [Accepted: 12/27/2011] [Indexed: 11/27/2022]
Abstract
Purpose This study investigated the epidemiology of Kawasaki disease (KD) in infants ≤3-month-old. Methods To study the epidemiology of KD in Korea, data for 27,851 KD patients were collected on a 3-year basis between 2000 and 2008 in a retrospective survey. From this, data for 609 KD patients ≤3-month-old were analyzed and compared with the data for KD patients >3-month-old. Results The 609 KD patients ≤3-month-old (385 males and 224 females) constituted 2.2% of the KD patients. They included 25 infants <1-month-old, 198 infants ≤1- to 2-month-old, and 386 infants >2- and 3-months-old. The ratio of males to females was 1.72:1. The incidence of coronary artery (CA) dilatation (19.9% vs. 18.7%) and CA aneurysms (3.4% vs. 2.6%) detected by echocardiography did not differ significantly between patients with KD younger and older than 3-month-old. Conclusion Compared with the data for the KD patients >3-month-old, the data for the 609 patients ≤3-month-old did not show a significantly higher incidence of CA dilatation or CA aneurysms.
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Affiliation(s)
- Eun Jung Lee
- Department of Pediatrics, The Catholic University of Korea School of Medicine, Seoul, Korea
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