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Sagiv E, Newland DM, Slee A, Olson AK, Portman MA. Real-world experience with edoxaban for anticoagulation in children at risk for coronary artery thrombosis. Cardiol Young 2024; 34:870-875. [PMID: 37921220 DOI: 10.1017/s1047951123003761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Direct oral anticoagulants have the potential to improve care in children requiring chronic anticoagulation. Edoxaban has favourable pharmacokinetics that could benefit younger patients but data on long-term safety and efficacy for specific paediatric indications are lacking. STUDY AIMS We present a single-centre experience using edoxaban in children who require chronic anticoagulation for large coronary artery aneurysms secondary to Kawasaki disease. METHODS Weight-based dosing of once-daily oral edoxaban was offered as alternative to standard anticoagulation for patients aged 1-18 years. Chart review was performed for a median follow-up period of 49 months on edoxaban. Steady-state pharmacokinetics and pharmacodynamics of edoxaban were also explored. RESULTS Sixteen patients on chronic therapy with edoxaban were included. No major bleeding events were reported. Two patients experienced coronary artery thrombosis after 23 and 38 months on edoxaban, 7 and 11 years after diagnosed with Kawasaki disease, respectively. This predicts 70% event-free rate at 12 years from diagnosis. Area under the curve estimates over the dosing interval of 24 hours were similar to those reported in adults. CONCLUSIONS Edoxaban use is feasible and well-tolerated for long-term use in paediatric population. We suggest appropriate exposure using weight-based once-daily dosing strategy that may be comparable to standard-of-care anticoagulation in prevention of coronary artery thrombosis. Larger studies are needed to evaluate long-term safety and efficacy of edoxaban in this population.
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Affiliation(s)
- Eyal Sagiv
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - David M Newland
- Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Aaron K Olson
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
- Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
| | - Michael A Portman
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
- Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
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Banbury S, Gebre K, Milgraum DM, Do N, Yan AC. Incomplete Kawasaki disease presenting with a cellulitis-like plaque: Lessons from an unusual presentation. Pediatr Dermatol 2024; 41:359-361. [PMID: 38241186 DOI: 10.1111/pde.15494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
Kawasaki disease (KD) is an acute small to medium-vessel vasculitis that primarily affects children under the age of 5 years. The cause of KD is unknown, but it is hypothesized to be a systemic inflammatory illness triggered by infections in genetically predisposed individuals. Diagnosis of incomplete KD is made in patients with prolonged fever without a source who do not meet diagnostic criteria but have some findings consistent with KD such as elevated inflammatory markers, transaminitis, and echocardiographic findings. We present a 7-year-old boy who developed 10 days of fevers and rash that began 3 days after his first dose of hepatitis A vaccination and had notable features of a peculiar cellulitis-like plaque and peripheral eosinophilia.
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Affiliation(s)
- Sara Banbury
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirubel Gebre
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Milgraum
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ngan Do
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Albert C Yan
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Groenland EH, Vendeville JPAC, Bots ML, Visseren FLJ, Musson REA, Spiering W. Validation of spot urine in estimating 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets in healthy adults. Blood Press 2023; 32:2170868. [PMID: 36752063 DOI: 10.1080/08037051.2023.2170868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE To evaluate the validity of spot urine assay methods in estimating the 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets. MATERIALS AND METHODS Twelve healthy volunteers were asked to adhere to 3 dietary sodium targets (3.3-5.0g/day,<3.3 g/day and >5.0 g/day) for three consecutive weeks and to measure salt excretion daily in spot urine samples using a self-monitoring device. On day 7 of each week, 24-h urine was collected to compare measured with estimated 24-h salt excretion (by the Kawasaki, Tanaka and INTERSALT equations). RESULTS Correlation coefficients relating measured and estimated 24-h sodium excretion were low and not significant for Kawasaki and INTERSALT and moderate for the Tanaka equation (τ 0.56-0.64,p<.05). Bland-Altman plots showed considerable differences between estimated and measured sodium excretion across all salt diets. Over 40% of the participants showed an absolute difference between measured and estimated 24-h sodium of more than 1000 mg/day. The correlation coefficients between 24-h and spot Na/K ratio were 0.67, 0.94 and 0.85(p<.05), and mean differences were 0.59, 0.06 and 0.48 for the intermediate, low and high sodium diets, respectively. CONCLUSION These findings do not support estimation of individual 24-h salt excretion from spot urine by the Kawasaki, Tanaka, or INTERSALT formula. Plain language summaryAccurate monitoring of salt intake is essential to improve BP control. At present, measurement of sodium and potassium excretion in multiple non-consecutive 24-h urinary collections is considered the gold standard for measuring dietary sodium intake. However, this method is burdensome, time-consuming and error prone.Therefore, we assessed and compared the validity of three formula-based approaches to estimate 24-h urinary sodium and potassium excretion and the Na/K ratio from spot urine samples measured by a self-monitoring device under three different sodium diets using 24-h urine collections as the reference.We conclude that use of three commonly used equations that estimate 24-h urinary sodium and potassium excretion result in substantial bias, poor precision and poor accuracy and are therefore not recommended. The Na/K ratio based on multiple casual urine samples may be a useful, low-burden, low-cost alternative method to 24-h urine collection for monitoring daily salt intake.
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Affiliation(s)
- Eline H Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jean-Paul A C Vendeville
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ruben E A Musson
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Hariri M, Ramezani AM, Shamshirgaran SM, Gholami A. Is a spot urine sample a good substitution to estimate 24-h urinary sodium excretion in a population ≥ 50 years old? A validation study. Eur J Nutr 2023; 62:3277-3286. [PMID: 37580619 DOI: 10.1007/s00394-023-03217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/18/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE A variety of prediction equations have been able to estimate 24-h urinary sodium excretion from spot urine samples; however, Iranians over the age of 50 have not been compared and verified. Using spot urine samples as a substitute for 24-h urine samples to estimate 24-h urine sodium excretion among the population age 50 and older are the purpose of this study. METHODS A 24-h urinary sodium excretion was studied by well-known Kawasaki, INTERSALT, Tanaka, and World Health Organization/Pan American Health Organization (WHO/PAHO) formulas. On 360 individuals, the mean bias, agreements between estimated and measured values, correlation, absolute and relative differences, and misclassification rates were evaluated for four equations. RESULTS As a result, the mean urinary sodium excretion for a 24-h period was 136.3 ± 52.21 mmol/24-h, which corresponds to a calculated intake of 9.1 ± 3.8 g of salt per day. According to the WHO/PAHO formula, the mean bias between measured values and estimated 24-h urinary sodium excretion is - 21.6 mg/day (95% confidence interval (CI) - 144.8, 101.6 mg/day), which is the smallest difference compared with the other three formulas. The lowest rate of individual misclassification of salt intake was 40% for WHO/PAHO, especially for those who consumed less than 9 g/day, while Kawasaki had the lowest misclassification rate at higher levels of salt intake. CONCLUSION As a result of our research, the WHO/PAHO equations accurately predict 24-h urinary sodium excretion among Iranians aged ≥ 50 more than other equations, both at the population level and at the individual level. However, further study is needed in regard to different ages in Iran.
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Affiliation(s)
- Mitra Hariri
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Amir M Ramezani
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Seyed Morteza Shamshirgaran
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Nie K, Yang S, Wang X. Editorial: Interaction between microbiota and immune in intestinal inflammatory diseases. Front Cell Infect Microbiol 2023; 13:1273282. [PMID: 37743855 PMCID: PMC10513057 DOI: 10.3389/fcimb.2023.1273282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Kai Nie
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, China
| | - Shiming Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoyan Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, China
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VAROL F, DEDEOĞLU R, KILIÇ A, BAKAR MT, ADROVİC A, ŞAHİN S, YILDIZ M, BARUT K, ÇAM H, KASAPÇOPUR Ö. Retrospective analysis of children diagnosed with Kawasaki disease. Turk J Med Sci 2023; 53:979-989. [PMID: 38031949 PMCID: PMC10760559 DOI: 10.55730/1300-0144.5662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/18/2023] [Accepted: 02/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The aim of our study was to evaluate the long-term impacts of Kawasaki disease on our patients regarding coronary involvement demographic characteristics, treatment regimens, and clinical course. METHODS Our study included 104 patients diagnosed and hospitalized with Kawasaki disease in our center, from January 2004 to January 2019. In our study, patients were divided into three groups according to coronary artery involvement. Patients in group 1 had no echocardiographic findings, while the ones in group 2 had coronary artery dilatation and ones in group 3 had coronary artery aneurysm (CAA). RESULTS Among 104 patients, the median age was 9.15 (3.0-22.0) years, and 61 of the patients were male while 43 of the patients were female. With a wide range of 1.50-16.50 years of follow-up time, the median diagnosis age of our patients was 31 months (3.0-164.0). Fever duration (median day 10 (5-21), p = 0.025) was statistically significantly higher in group 3. Blood C-reactive protein (CRP) levels, white blood cell (WBC) counts, and neutrophil counts were significantly higher in group 3. There was a statistically significant difference between patients in group 3 and group 2 in which the lowest strain deformation values were in the patients of group 3. In contrast to group 1, the time for initiation of IVIG therapy is significantly prolonged both in group 2 (median: 9.5 days, p = 0.028) and group 3 (median: 10 days, p = 0.036). DISCUSSION In our study, serum CRP levels, WBC count, and neutrophil count were higher in patients with coronary artery abnormalities, in agreement with the previous studies. In the light of our results, we consider that the most important determining factor for the development of coronary artery aneurysm is the time of intravenous immunoglobulin (IVIG) administration.
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Affiliation(s)
- Fatih VAROL
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Şehit Profesör Dr. İlhan Varank Training and Research Hospital, İstanbul,
Turkiye
| | - Reyhan DEDEOĞLU
- Department of Pediatric Cardiology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Aziz KILIÇ
- Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Murat T. BAKAR
- Department of Public Health, Medical School, Marmara University, İstanbul,
Turkiye
| | - Amra ADROVİC
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Sezgin ŞAHİN
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Mehmet YILDIZ
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Kenan BARUT
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Halit ÇAM
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Şehit Profesör Dr. İlhan Varank Training and Research Hospital, İstanbul,
Turkiye
| | - Özgür KASAPÇOPUR
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
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7
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Khoo MS, Ali A. Concomitant Kawasaki Disease and Rotavirus Infection-More Than Just a Coincidence: A Case Report. Trop Med Infect Dis 2023; 8:388. [PMID: 37624326 PMCID: PMC10457857 DOI: 10.3390/tropicalmed8080388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023] Open
Abstract
The definitive role of viral infections, such as rotavirus, in causing Kawasaki disease (KD) remains uncertain. However, the intriguing observation of concomitant rotavirus infection and KD suggests a potential association. This study aimed to investigate this relationship. We reported a case of concomitant KD and rotavirus infection complicated by hyponatraemia and anasarca. For the systematic review, we used three large databases, namely PubMed, Ovid, and Scopus, to search articles with the terms "Kawasaki" and "rotavirus". We also used Google Scholar as our secondary source. We included articles that fulfilled the following criteria: (i) articles reporting on children aged 18 and below; (ii) articles reporting on patients infected with rotavirus prior to or concomitant with KD; and (iii) articles written in English only. Three articles were included and analysed in combination with our reported patient. All patients exhibited gastrointestinal symptoms, including diarrhoea and vomiting, in addition to non-resolving fevers, which eventually manifested more signs and symptoms to support the diagnosis of KD. Stool samples from all patients revealed positive rotavirus antigens. Two patients (n = 2) were noted to have hyponatraemia and hypoalbuminaemia. Three (n = 3) manifested coronary artery abnormalities (CAA). Even though the relationship is not fully understood yet, it is known that the combination of these two pathologies can cause catastrophic immune responses and complications.
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Affiliation(s)
- Mohammad Shukri Khoo
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Children’s Specialist Hospital, The National University of Malaysia, Kuala Lumpur 56000, Malaysia;
- Research Centre, Universiti Kebangsaan Malaysia Children’s Specialist Hospital, The National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Adli Ali
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Children’s Specialist Hospital, The National University of Malaysia, Kuala Lumpur 56000, Malaysia;
- Research Centre, Universiti Kebangsaan Malaysia Children’s Specialist Hospital, The National University of Malaysia, Kuala Lumpur 56000, Malaysia
- Institute of IR4.0, The National University of Malaysia, Bangi 43600, Malaysia
- Infection and Immunology Health and Advanced Medicine Cluster, The National University of Malaysia, Kuala Lumpur 56000, Malaysia
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Padilla LA, Idigo AJ, Maxwell K, Lau Y, Wiener HW, Shrestha S. Seasonality and geographical distribution of Kawasaki disease among Black children in the Southeast United States. Front Pediatr 2023; 11:1203431. [PMID: 37441576 PMCID: PMC10333540 DOI: 10.3389/fped.2023.1203431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Kawasaki Disease (KD) is a leading cause of pediatric acquired heart disease in the United States, affecting up to 7,000 children annually. Seasonal variation, an epidemiological characteristic of KD, has previously been reported predominantly among Asian children; however, little is known about the epidemiology and seasonality of KD of Black children within the U.S. Methods Electronic medical records were abstracted from 529 hospitalized KD patients admitted to a single tertiary center in Alabama between 2005 and 2019. Medical charts were reviewed to confirm KD diagnosis following American Heart Association criteria. Cases were stratified by the month of diagnosis date to assess seasonality, and statewide distribution of incidence is reported at county level using geographical spatial analysis. Comparisons were performed between Black patients and White patients with KD. Results The average number of KD cases per year was 35. Approximately, 60% were males and 44% were White children (N = 234), 45% were Black children (N = 240) and 11% were other races (N = 55). Black children were younger than White children at KD admission (median age 32 vs. 41 months respectively, p = 0.02). Overall, the highest rates of cases occurred between January and April. When stratifying by race, cases started to rise in December among White children with the highest rates between February and April with a peak in March. Among Black children cases were high during the winter season (January-April) with a peak in April. Similarly high rates also occurred in June, July and November. There were no differences in geographical distribution of cases by race. Conclusion KD incidence among White children in Alabama follows a seasonal cycle similar to other regions in the U.S. However, sustained incidence and additional peaks outside of the usual KD seasonality were seen among Black children with KD. Further studies are needed to investigate differential triggers between races.
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Affiliation(s)
- Luz A. Padilla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Adeniyi J. Idigo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kathryn Maxwell
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yung Lau
- Department of Pediatric Cardiology, School of Medicine, University of Alabama at Birmingham and the Pediatric and Congenital Heart Center of Alabama, Children’s of Alabama, Birmingham, AL, United States
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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Sen S, Biswas A, Kundu C, Samanta M, Majumder S, Kundu T. Mortality indicators with clinical profile of multisystem inflammatory syndrome in children during SARS-CoV-2 second wave in India: A tertiary referral center experience. Indian J Public Health 2023; 67:271-277. [PMID: 37459024 DOI: 10.4103/ijph.ijph_1297_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background Post-COVID-19 cases are being reported with features of hyperinflammatory state causing multiple system dysfunctions in previously healthy children. Objectives To describe clinical characteristics, laboratory, and radiological profile of children affected with COVID-19-related multisystem inflammatory syndrome postsecond wave in India and compare them with respect to adverse outcome. Materials and Methods This prospective, observational study was conducted in the department of pediatrics of a tertiary care center in Eastern India over a period of 3 months. Demographic data, clinical details, biochemical parameters, and treatment with clinical outcome were recorded. Children who survived the clinical course were compared with those died during hospital stay. Results Thirty-five children with a median age of 4.8 (3.9) years were included who were admitted between June 16 and September 15, 2021. Only 17.14% had reverse transcription-polymerase chain reaction positivity previously with 77.14% had positive COVID-19 serology. Most common features were fever (100%), edema (68.6%), gastrointestinal (71.4%), mucocuteneous (65.7%), cardiovascular (57.1%), and neurological symptoms (45.7%). Twenty (57.1%) children had shock at presentation. Decreased ejection fraction (<55%) was the most common echocardiographic feature (37.14%) followed by coronary dilatation (20%). Majority (77.14%) of the patients required intensive care with inotrope requirement in 62.86% cases. Forty percent patients were intubated with mean duration of 9.94 (±10.5) days. All patients received methylprednisolone and 76% were given intravenous immunoglobulin. Tocilizumab was used in three patients. Nine patients died (25.7%) with overall median pediatric intensive care unit stay of 13 (14) days. Conclusion Of the parameters described, we have found shock, heart failure, neurological involvement at presentation, infancy, and laboratory parameters such as C-reactive protein, CPK, D-Dimer, and lactate dehydrogenase were the predictors of mortality.
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Affiliation(s)
- Sandipan Sen
- Senior Resident, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Arnab Biswas
- Associate Professor, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Chanchal Kundu
- Associate Professor, Department of Cardiology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Moumita Samanta
- Professor, Department of Paediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Srinanda Majumder
- Senior Resident, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Tirthankar Kundu
- Senior Resident, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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Jose J, Tierney ESS, Harahsheh AS, Dahdah N, Raghuveer G, Friedman KG, Khoury M, Hicar MD, Merves SA, Dallaire F, Farid P, Manlhiot C, Runeckles K, Misra N, Portman M, Ballweg JA, Lee S, Jain SS, Harris TH, Szmuszkovicz JR, Orr W, Larios G, McCrindle BW. COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry. Pediatr Cardiol 2023;:1-9. [PMID: 36786810 DOI: 10.1007/s00246-023-03109-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
To determine clinical differences for children with complete Kawasaki disease (KD) with and without evidence of preceding SARS-CoV-2 infection. From January 2020, contemporaneous patients with complete KD criteria were classified as either SARS-CoV-2 positive (KDCOVID+; confirmed household exposure, positive PCR and/or serology) or SARS-CoV-2 negative (KDCOVID-; negative testing and no exposure) and compared. Of 744 patients in the International Kawasaki Disease Registry, 52 were KDCOVID- and 61 were KDCOVID+. KDCOVID+ patients were older (median 5.5 vs. 3.7 years; p < 0.001), and all additionally met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C). They were more likely to have abdominal pain (60% vs. 35%; p = 0.008) and headache (38% vs. 10%; p < 0.001) and had significantly higher CRP, troponin, and BUN/creatinine, and lower hemoglobin, platelets, and lymphocytes. KDCOVID+ patients were more likely to have shock (41% vs. 6%; p < 0.001), ICU admission (62% vs. 10%; p < 0.001), lower left ventricular ejection fraction (mean lowest LVEF 53% vs. 60%; p < 0.001), and to have received inotropic support (60% vs. 10%; p < 0.001). Both groups received IVIG (2 doses in 22% vs. 18%; p = 0.63), but KDCOVID+ were more likely to have received steroids (85% vs. 35%; p < 0.001) and anakinra (60% vs. 10%; p = 0.002). KDCOVID- patients were more likely to have medium/large coronary artery aneurysms (CAA, 12% vs. 0%; p = 0.01). KDCOVID+ patients differ from KDCOVID-, have more severe disease, and greater evidence of myocardial involvement and cardiovascular dysfunction rather than CAA. These patients may be a distinct KD phenotype in the presence of a prevalent specific trigger.
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Tedla BA, Burns JC, Tremoulet AH, Shimizu C, Gordon JB, El-Said H, Golding F, Davis CK, Dummer KB. Exercise Stress Echocardiography in Kawasaki Disease Patients with Coronary Aneurysms. Pediatr Cardiol 2023; 44:381-7. [PMID: 36383234 DOI: 10.1007/s00246-022-03037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
The most significant sequelae of Kawasaki disease (KD) are coronary artery aneurysms, which can lead to risk of future myocardial ischemia. Exercise stress echocardiography allows for non-invasive assessment of myocardial dysfunction. We reviewed our single center experience with exercise stress echocardiography in patients with previous history of KD with coronary aneurysms. We reviewed the records of 53 KD patients who underwent exercise stress echocardiography from 2000 to 2020. Abnormal stress echocardiograms were defined as those showing no increase in biventricular systolic function post-exercise or regional wall motion abnormalities. Computed tomography angiography and cardiac magnetic resonance imaging were reviewed for patients with abnormal stress echocardiograms. Clinical data were reviewed and correlated with stress echocardiogram results. Of the 53 patients, three (5.7%) had an abnormal exercise stress echocardiogram. All three patients were classified as AHA Risk Level 4 or 5 by coronary Z-score (internal dimension normalized for body surface area) and were confirmed to have coronary aneurysms, stenosis, or myocardial tissue perfusion defects on advanced cardiac imaging that could account for the results seen on stress echocardiogram. Exercise stress echocardiography detected signs of myocardial ischemia in a subset of high-risk patients with Kawasaki disease and coronary aneurysms and may be considered as a useful screening tool for this complex patient cohort.
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12
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Aelami MH, Malek A, Saeidinia A. Coronavirus disease 2019-related Kawasaki syndrome: a case report. J Med Case Rep 2022; 16:432. [PMID: 36352417 PMCID: PMC9645345 DOI: 10.1186/s13256-022-03589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 has changed the pattern of some diseases in the world, especially in pediatrics. Despite data suggesting that the pediatric population is less affected by coronavirus disease-19 infection, new concerns have been raised owing to reported cases with hyperinflammatory conditions such as Kawasaki disease. CASE PRESENTATION We report herein the case of a pediatric patient diagnosed and treated for classic Kawasaki disease in the setting of confirmed coronavirus disease 2019 infection. She was an 8-year-old, previously healthy, and fully immunized Iranian girl who initially presented to the pediatric emergency department with 5 days of intermittent fever, followed by abdominal pain, nausea, and vomiting. She was admitted for fever and abdominal pain to the surgery service of Akbar Hospital with suspected appendicitis. CONCLUSIONS This case report may serve as a useful reference to other clinicians caring for pediatric patients affected by coronavirus disease 2019 infection. Standard therapeutic interventions for Kawasaki disease must be performed to prevent critical coronary aneurysm-related complications in the coronavirus disease 2019 era.
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Affiliation(s)
- Mohammad Hasan Aelami
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Malek
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Saeidinia
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Fakouri Boulevard, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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13
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Katz G, Wallace ZS. Environmental Triggers for Vasculitis. Rheum Dis Clin North Am 2022; 48:875-890. [PMID: 36333001 DOI: 10.1016/j.rdc.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic vasculitides are autoimmune diseases characterized by vascular inflammation. Most types of vasculitis are thought to result from antigen exposure in genetically susceptible individuals, suggesting a likely role for environmental triggers in these conditions. Seasonal and geographic variations in incidence provide insight into the potential role of environmental exposures in these diseases. Many data support infectious triggers in some vasculitides, whereas other studies have identified noninfectious triggers, such as airborne pollutants, silica, smoking, and heavy metals. We review the known and suspected environmental triggers in giant cell arteritis, Takayasu arteritis, polyarteritis nodosa, Kawasaki disease, and antineutrophil cytoplasmic antibody-associated vasculitis.
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Affiliation(s)
- Guy Katz
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Bulfinch 165, 55 Fruit Street, Boston, MA 02114, USA
| | - Zachary S Wallace
- Clinical Epidemiology Program, Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Boston, MA 02114, USA.
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14
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Sagiv E, Slee A, Buffone A, Choueiter NF, Dahdah NS, Portman MA. Etanercept with IVIg for acute Kawasaki disease: a long-term follow-up on the EATAK trial. Cardiol Young 2022;:1-6. [PMID: 35545881 DOI: 10.1017/S1047951122001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Etanercept as Adjunctive Treatment for Acute Kawasaki Disease, a phase-3 clinical trial, showed that etanercept reduced the prevalence of IVIg resistance in acute Kawasaki disease. In patients who presented with coronary artery involvement, it reduced the maximal size and short-term progression of coronary artery dilation. Following up with this patient group, we evaluated the potential long-term benefit of etanercept for coronary disease. METHODS Patients were followed for at least 1 year after the trial. The size of dilated arteries (z-score ≥ 2.5) was measured at each follow-up visit. The z-score and size change from baseline were evaluated at each visit and compared between patients who received etanercept versus placebo at the initial trial. RESULTS Forty patients who received etanercept (22) or placebo (18) in the Etanercept as Adjunctive Treatment for Acute Kawasaki Disease trial were included. All patients showed a persistent decrease in coronary artery size measurement: 23.3 versus 5.9% at the 6-month visit, 24 versus 13.1% at the 1-year visit, and 20.8 versus 19.3% at the ≥ 2-year visit for etanercept or placebo, respectively, with similar results for decrease in coronary artery z-scores. In a multivariate analysis, correcting for patients' growth, a greater size reduction for patients on the etanercept arm versus placebo was proved significant for the 6-month (p = 0.005) and the 1-year visits (p = 0.019) with a similar end outcome at the ≥ 2-year visit. DISCUSSION Primary adjunctive therapy with etanercept for children with acute Kawasaki disease does not change the end outcome of coronary artery disease but may promote earlier resolution of artery dilation.
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15
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Benovoy M, Dionne A, McCrindle BW, Manlhiot C, Ibrahim R, Dahdah N. Deep Learning-Based Approach to Automatically Assess Coronary Distensibility Following Kawasaki Disease. Pediatr Cardiol 2022; 43:807-15. [PMID: 34854943 DOI: 10.1007/s00246-021-02790-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
Kawasaki disease is an acute vasculitis affecting children, which can lead to coronary artery (CA) aneurysms. Optical coherence tomography (OCT) has identified CA wall damage in KD patients, but it is unclear if these findings correlate with any distensibility changes in the CA and how these changes evolve over time. This paper seeks to establish the link between OCT findings and vessel distensibility with a novel deep learning coronary artery segmentation system and use the segmentation framework to automatically analyze the temporal evolution of coronary stiffness over many years. 27 KD patients underwent catheterization with coronary angiography of the left coronary artery (LCA), followed by OCT of proximal and distal segments of the LCA. Changes in the CA caliber over the cardiac cycle were measured automatically and compared against OCT findings suggestive of KD-related vascular damage. In addition, 34 KD patients with regressed or persistent CA aneurysms were followed with serial CA angiography over an average of 14.5 years. Distensibility changes were calculated using a deep learning coronary artery segmentation framework and evaluated longitudinally. Distensibility in the coronary arteries after KD negatively correlated with increasing severity of OCT findings of KD-related vessel damage. KD patients have a significant increase in CA wall stiffness at 1 year after diagnosis, which then plateaus subsequently, compared to controls. Also, patients with persistent CA aneurysms have a statistically significant increase in wall stiffness over time in comparison to those with regressed CA aneurysms. Distensibility changes in the CA of KD patients calculated using our automated deep learning approach correlates with the severity of OCT findings of KD-related CA damage. This decreased distensibility peaks at 1 year in KD patients when following longitudinally and is more severe in those with persistent CA aneurysms.
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16
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Qazizadeh Z, Shahbaznejad L, Navaeifar MR, Rezai MS. Developing a National Minimum Data Set for Kawasaki Disease Registry in Iran. Front Pediatr 2022; 10:834306. [PMID: 35295705 PMCID: PMC8919186 DOI: 10.3389/fped.2022.834306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kawasaki Disease is an acute and self-limited systemic inflammatory and febrile illness, which is the most common cause of acquired heart disease in children in developed countries. The incidence of KD in Asian countries is high. But, data is not available from the Middle East. So, the aim of this study was to develop an MDS to set up a national registry for KD to estimate the burden of disease in Iran. MATERIALS AND METHODS This cross-sectional and descriptive study was conducted in 2020. Literature review, data collection from patients medical records, and expert panel approach were used to design this MDS. Data elements with a Content Validity Ratio (CVR) of more than 0.56 were selected as the MDS of the registry. RESULTS Overall, 99 data elements were recognized. Of which, 51 and 48 data elements were verified and rejected, respectively. Moreover, 17 data elements were added as required by experts. Eventually, 68 data elements were chosen as the MDS of the national KD registry of IRAN; of which, 17 and 51 data elements were classified as administrative and clinical data, respectively. CONCLUSIONS These precise, integrated, and comprehensive developed data elements and the national KD registry will lead to effective disease management and thus, improve the quality of care and, consequently, improve public health.
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Affiliation(s)
- Zainab Qazizadeh
- Mazandaran Population-Based Cancer Registry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Shahbaznejad
- 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
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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17
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Selamet Tierney ES, Runeckles K, Tremoulet AH, Dahdah N, Portman MA, Mackie AS, Harahsheh AS, Lang SM, Choueiter NF, Li JS, Manlhiot C, Low T, Mathew M, Friedman KG, Raghuveer G, Norozi K, Szmuszkovicz JR, McCrindle BW. Variation in Pharmacologic Management of Patients with Kawasaki Disease with Coronary Artery Aneurysms. J Pediatr 2022; 240:164-170.e1. [PMID: 34474088 DOI: 10.1016/j.jpeds.2021.08.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/23/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate practice variation in pharmacologic management in the International Kawasaki Disease Registry (IKDR). STUDY DESIGN Practice variation in intravenous immunoglobulin (IVIG) therapy, anti-inflammatory agents, statins, beta-blockers, antiplatelet therapy, and anticoagulation was described. RESULTS We included 1627 patients from 30 IKDR centers with maximum coronary artery aneurysm (CAA) z scores 2.5-4.99 in 848, 5.0-9.99 in 349, and ≥10.0 (large/giant) in 430 patients. All centers reported IVIG and acetylsalicylic acid (ASA) as primary therapy and use of additional IVIG or steroids as needed. In 23 out of 30 centers, (77%) infliximab was also used; 11 of these 23 centers reported using it in <10% of their patients, and 3 centers used it in >20% of patients. Nonsteroidal anti-inflammatory agents were used in >10% of patients in only nine centers. Beta-blocker (8.8%, all patients) and abciximab (3.6%, all patients) were mainly prescribed in patients with large/giant CAAs. Statins (2.7%, all patients) were mostly used in one center and only in patients with large/giant CAAs. ASA was the primary antiplatelet modality for 99% of patients, used in all centers. Clopidogrel (18%, all patients) was used in 24 centers, 11 of which used it in >50% of their patients with large/giant CAAs. CONCLUSIONS In the IKDR, IVIG and ASA therapy as primary therapy is universal with common use of a second dose of IVIG for persistent fever. There is practice variation among centers for adjunctive therapies and anticoagulation strategies, likely reflecting ongoing knowledge gaps. Randomized controlled trials nested in a high-quality collaborative registry may be an efficient strategy to reduce practice variation.
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Affiliation(s)
- Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, School of Medicine, Palo Alto, CA.
| | - Kyle Runeckles
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital-San Diego, San Diego, CA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Ashraf S Harahsheh
- Pediatrics-Cardiology, Children's National Hospital/George Washington University School of Medicine, Washington, DC
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Cedric Manlhiot
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tisiana Low
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mathew Mathew
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Kambiz Norozi
- Department of Pediatrics, Western University, London, Canada
| | | | - Brian W McCrindle
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Yu H, Ni C, Xia Y, Li J, Hang B, Han C, Xu Z, Luo M, Rong X, Zhu J, Chu M. Characteristics of Kawasaki Disease Before and After the COVID-19 Pandemic in a Large Pediatric Heart Disease Center. Front Pediatr 2022; 10:895408. [PMID: 35656374 PMCID: PMC9152138 DOI: 10.3389/fped.2022.895408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile systemic vasculitis of unknown etiology. After the pandemic of coronavirus disease 2019 (COVID-19), some children infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) showed clinical symptoms similar to KD, indicating a close relationship between KD and SARS-CoV-2. Therefore, we designed this retrospective study to analyze the characteristics of KD patients before and after the COVID-19 pandemic. METHODS We retrospectively collected demographic and laboratory data of KD patients in Yuying Children's Hospital of Wenzhou Medical University from 1 January 2015 to 31 December 2020. Yuying Children's Hospital of Wenzhou Medical University is located in eastern China and is the largest pediatric heart disease center in the region, which includes a population of nearly 10 million. We studied the characteristics of KD patients and analyzed the changes in these characteristics before and after the emergence of SARS-CoV-2 in this area. RESULTS The analysis revealed the following novel features: (1) Under the influence of the COVID-19 pandemic, the onset age of Kawasaki disease became younger. (2) After the occurrence of COVID-19, the hospitalization days of KD patients were shorter than before the pandemic. (3) After the occurrence of COVID-19, the albumin of KD patients was higher than before the pandemic. (4) The COVID-19 pandemic did not have a significant effect on the incidence of coronary artery lesions (CALs) in Kawasaki disease. CONCLUSION After the COVID-19 outbreak, the characteristics of KD patients showed a younger trend of age, shorter hospitalization days and higher levels of albumin, but the incidence of CALs did not change significantly.
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Affiliation(s)
- Huan Yu
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao Ni
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuhan Xia
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Li
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Biyao Hang
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cheng Han
- Department of Pediatrics, Guangyuan Central Hospital, Guangyuan, China
| | - Zhipeng Xu
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ming Luo
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xing Rong
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinshun Zhu
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Maoping Chu
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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19
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García-Aguilar H. Guide for cardiological referral for patients with paediatric multisystemic inflammatory syndrome and Kawasaki disease associated with SARS-CoV-2. Arch Cardiol Mex 2021; 91:040-046. [PMID: 33651785 PMCID: PMC10161866 DOI: 10.24875/acm.200002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present an institutional guide for a referral to the specialized care center and initial management of pediatric patients
infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with severe manifestations of pediatric inflammatory
multisystemic syndrome or symptoms similar to Kawasaki syndrome, and who must have a multidisciplinary approach
to ensure adequate treatment and safety for the team of Health.
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Affiliation(s)
- Humberto García-Aguilar
- Departamento de Cardiología Pediátrica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
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20
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Esmaeilzadeh H, Mortazavi N, Salehi A, Fatemian H, Dehghani SM, Vali M, Vardanjani HM. Effect of COVID-19 on Kawasaki Disease: Decrease Age of Onset and Increase Skin Manifestation. BMC Pediatr 2021; 21:571. [PMID: 34903208 PMCID: PMC8666466 DOI: 10.1186/s12887-021-03060-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Kawasaki Disease (KD) is the most common childhood vasculitis and cause of acquired heart disease for no apparent reason. There is some evidence indicating infectious agents as possible triggers for KD. During the COVID-19 pandemic, vasculitis has been a presentation of COVID-19 in children. We performed this study to assess the association between KD and COVID-19. We evaluated KD hospitalized children during February to September 2020 for COVID-19 (group one) and compared their demographic, clinical, laboratory, and echocardiographic findings with KD patients from the same period time in 2019 (group two). We also compared the same data in COVID-19 positive and COVID-19 negative KD patients in 2020 pandemic period in Shiraz Namazi referral hospital at southwest of Iran. RESULTS Thirty-two patients in group one compared with 44 patients in group two. Sixty-eight percent of group one KD patients were positive for COVID-19 during the pandemic period. KD Age of onset in the group one was lower than group two (4.38 years VS 5.5 years, P-value = 0.044). There was no difference in the demographic, clinical, laboratory, and echocardiographic features of the patients during and before the COVID-19 pandemic (p-value > 0.05). Moreover, Comparing COVID-19 positive and negative the incidence of rash was higher within COVID-19 positive cases (p < 0.05), and coronary artery abnormalities were more prevalent in COVID-19 negative cases (p < 0.05). CONCLUSION Admission rate of KD was almost similar during the COVID-19 pandemic but 68% of KD admitted patient were COVID-19 positive. Age of onset for KD during the COVID-19 pandemic was lower and skin manifestation was higher than the same period time in last year.
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Affiliation(s)
- Hossein Esmaeilzadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. .,MD/MPH Program, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Negar Mortazavi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Salehi
- MD/MPH Program, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Fatemian
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohsen Dehghani
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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21
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Henrina J, Putra ICS, Lawrensia S, Marta DS, Wijaya E, Saboe A, Cool CJ, Suciadi LP. Cardiac manifestations, treatment characteristics, and outcomes of paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2: A systematic review. Prog Pediatr Cardiol 2021; 63:101365. [PMID: 33584087 PMCID: PMC7871802 DOI: 10.1016/j.ppedcard.2021.101365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Paediatric inflammatory multisystem syndrome (PIMS) temporally associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (PIMS-TS) is a rare clinical syndrome associated with a multiorgan system dysfunction, especially acute cardiac injury, and mandates a higher level of care. AIM OF REVIEW To investigate cardiac manifestations, treatment characteristics, and outcomes of PIMS-TS. KEY SCIENTIFIC CONCEPTS OF REVIEW Twenty-six studies were included with 1228 pooled subjects, with a mean age of 8.6 years, which were dominated by male gender (53%), and African ethnicity (31%). 732 (38%) patients were reactive on a serological test, and 457 patients (45%) were positive on SARS-CoV-2 RT-PCR. ST-segment abnormalities were the most common ECG findings (16%, n/N: 34/212). Various markers of troponin and the pooled mean of BNP and NT-pro-BNP levels were elevated. Cardiomegaly and pericardial effusion (21.8%, n/N: 164/751) were the most common chest X-ray findings. In echocardiography, the majority of patients' left ventricular ejection fraction was reduced (59.0%, n/N: 180/305), with pericardial effusion/ pericarditis seen the most (17.44%, n/N: 221/1267), and Z score ≥ 2 in 28% (n/N: 42/139). Cardiac MRI findings were consistent with acute myocarditis. Intravenous immunoglobulin, corticosteroids, and vasoactive drugs were frequently utilized. The mean length of stay was 6 days, with most patients (71%, n/N: 834/1163) were admitted to the ICU. However, the overall prognosis was favorable, with 98% alive (n/N: 1235/1260), and more than 50% of patients experienced recovery of left ventricular systolic functions at discharge (116 out of 206 patients).
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Affiliation(s)
| | | | | | | | - Ellen Wijaya
- Department of Paediatrics, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
| | - Aninka Saboe
- Cardiology and Vascular Department of Padjadjaran University, Bandung, Indonesia
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22
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Türe M, Akın A, Ertaş F, Akın Oğuz A. A child case of Kawasaki with giant coronary aneurysm: percutaneous coronary intervention due to anterior myocardial infarction. Cardiol Young 2021; 31:1542-4. [PMID: 34412729 DOI: 10.1017/S1047951121003401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Kawasaki disease is usually self-limited, but it can lead to aneurysm, stenosis, thrombosis, and myocardial infarction in the coronary arteries. The most important complication of Kawasaki disease is coronary artery aneurysm. Coronary artery aneurysm or ectasia may be seen in 15-25% of patients who do not receive treatment. It develops in 5% of children who receive intravenous immunoglobulin at the appropriate time. Acute myocardial infarction is the most important cause of morbidity and mortality in Kawasaki patients with giant aneurysms. We present a 10-year-old girl who had a history of giant aneurysm in the coronary arteries and underwent percutaneous coronary intervention due to anterior myocardial infarction.
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23
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Theocharis P, Wong J, Pushparajah K, Mathur SK, Simpson JM, Pascall E, Cleary A, Stewart K, Adhvaryu K, Savis A, Kabir SR, Uy MP, Heard H, Peacock K, Miller O. Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 2021; 22:896-903. [PMID: 32766671 PMCID: PMC7454452 DOI: 10.1093/ehjci/jeaa212] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/26/2022] Open
Abstract
Aims Following the peak of the UK COVID-19 epidemic, a new multisystem inflammatory condition with significant cardiovascular effects emerged in young people. We utilized multimodality imaging to provide a detailed sequential description of the cardiac involvement. Methods and Results Twenty consecutive patients (mean age 10.6 ± 3.8 years) presenting to our institution underwent serial echocardiographic evaluation on admission (median day 5 of illness), the day coinciding with worst cardiac function (median day 7), and the day of discharge (median day 15). We performed cardiac computed tomography (CT) to assess coronary anatomy (median day 15) and cardiac magnetic resonance imaging (CMR) to assess dysfunction (median day 20). On admission, almost all patients displayed abnormal strain and tissue Doppler indices. Three-dimensional (3D) echocardiographic ejection fraction (EF) was <55% in half of the patients. Valvular regurgitation (75%) and small pericardial effusions (10%) were detected. Serial echocardiography demonstrated that the mean 3D EF deteriorated (54.7 ± 8.3% vs. 46.4 ± 8.6%, P = 0.017) before improving at discharge (P = 0.008). Left main coronary artery (LMCA) dimensions were significantly larger at discharge than at admission (Z score –0.11 ± 0.87 vs. 0.78 ± 1.23, P = 0.007). CT showed uniform coronary artery dilatation commonly affecting the LMCA (9/12). CMR detected abnormal strain in all patients with global dysfunction (EF <55%) in 35%, myocardial oedema in 50%, and subendocardial infarct in 5% (1/20) patients. Conclusions Pancarditis with cardiac dysfunction is common and associated with myocardial oedema. Patients require close monitoring due to coronary artery dilatation and the risk of thrombotic myocardial infarction.
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Affiliation(s)
| | - James Wong
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Sujeev K Mathur
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - John M Simpson
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Emma Pascall
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Aoife Cleary
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kirsty Stewart
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kaitav Adhvaryu
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Alex Savis
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Saleha R Kabir
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Mirasol Pernia Uy
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Hannah Heard
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kelly Peacock
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Owen Miller
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK.,Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, UK
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24
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Bukulmez H. Current Understanding of Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 and Its Distinction from Kawasaki Disease. Curr Rheumatol Rep 2021; 23:58. [PMID: 34216296 PMCID: PMC8254432 DOI: 10.1007/s11926-021-01028-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this article, I have reviewed current reports that explore differences and similarities between multisystem inflammatory syndrome in children (MIS-C) and other known multisystem inflammatory diseases seen in children, particularly Kawasaki disease. RECENT FINDINGS Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a human coronavirus causing the COVID-19 disease which emerged in China in December 2019 and spread rapidly to the entire country and quickly to other countries. Currently, there is a pandemic of SARS-CoV-2 infection that results in 20% of patients admitted to hospital with illness, with 3% developing intractable acute respiratory distress syndrome (ARDS) with high mortality. However, pediatric COVID-19 is still reported to be a mild disease, affecting only 8% of children. Pathogenesis in children is comparable to adults. There are suggested impaired activation of IFN-alpha and IFN regulator 3, decreased cell response causing impaired viral defense, yet the clinical course is mild, and almost all children recover from the infection without major complications. Interestingly, there is a subset of patients that develop a late but marked immunogenic response to COVID-19 and develop MIS-C. Clinical features of MIS-C resemble certain pediatric rheumatologic diseases, such as Kawasaki disease (mucocutaneous lymph node syndrome) which affects small-medium vessels. Other features of MIS-C resemble those of macrophage activation syndrome (MAS). However, recent research suggests distinct clinical and laboratory differences between MIS-C, Kawasaki disease, and MAS. Since the start of the SARS-CoV-2 pandemic, MIS-C has become the candidate for the most common cause of acquired heart disease in children.
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Affiliation(s)
- Hulya Bukulmez
- Department of Pediatrics, Division of Pediatric Rheumatology, Metro Health Medical Center, Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
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Zhang X, Liao H, Ye R, Li X, Gou Q, Zhang Z, Shi R, Meng Q, Zhuoma Z, Zhang H, Chen X. Assessment and validation of three spot urine assay methods for the estimation of 24-hour urinary sodium excretion in Chinese Tibetan adults living in the mountains. J Clin Hypertens (Greenwich) 2021; 23:1588-1598. [PMID: 34196446 PMCID: PMC8678802 DOI: 10.1111/jch.14312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
Twenty‐four‐hour urine collection is the gold standard method for the evaluation of salt intake, but it is often impractical in large‐scale investigations, especially in resource‐poor areas. Methods for the estimation of 24‐hour urinary sodium excretion (USE) using a spot urine sample have been established, but have not been validated in Chinese Tibetans. Therefore, the authors aimed to evaluate the Kawasaki, Tanaka, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) formulas for the prediction of 24‐hour USE in Chinese Tibetan adults. The authors analyzed the bias, correlation, agreements between estimated values and measured values, and the relative and absolute differences and misclassification at the individual level for the three methods in 323 Tibetan participants from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The mean biases between the measured values and the estimated 24‐hour USE using the Kawasaki, Tanaka, and INTERSALT methods were 5.4 mmol/day (95% confidence interval [CI]: 0.8–10.1 mmol/day), −40.8 mmol/day (95% CI: −44.6 to −36.9 mmol/day), and −57.1 mmol/day (95% CI: −61.9 to −52.4 mmol/day), respectively. The Pearson correlation coefficients for the relationships between the measured values and the estimated 24‐hour USE were 0.43 (Kawasaki), 0.38 (Tanaka), and 0.27 (INTERSALT), respectively (all p < .01). The intraclass correlation coefficients showed similar patterns to the correlation data: 0.47 for Kawasaki, 0.40 for Tanaka, and 0.27 for INTERSALT (all p < .01). The upper and lower limits of agreement between the measured values and the estimated 24‐hour USE were −92.6 and 81.8 mmol/day for the Kawasaki method, −28.5 and 110.0 mmol/day for the Tanaka method, and −28.4 and 142.7 mmol/day for the INTERSALT method. Compared with the other two methods, the percentage of individuals that were misclassified by using the Kawasaki method was 48.2%, while those for the Tanaka and INTERSAL methods was 72.1% and 75.5%, respectively. However, when an individual's salt intake was higher than 12.8 g/day, the misclassification rates of the Kawasaki, Tanaka, and INTERSALT methods were 20%, 90%, and 97.5%, respectively. Thus, the authors found that the Kawasaki equation may have performed better than the other equations at Chinese Tibetan population level assessment, but none of these equations are suitable for use or perform well at the individual level. A more accurate method of using a spot urine sample to evaluate individual 24‐hour USE for Tibetans is needed.
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Affiliation(s)
- Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Xinran Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qiling Gou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Rufeng Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qingtao Meng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zewong Zhuoma
- Luohuo County Health Bureau, Ganzi Tibetan Autonomous Prefecture, Luhuo, Sichuan Province, People's Republic of China
| | - Hengyu Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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26
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Osman RS, Salum HM, Noorani M. Kawasaki disease presenting after intussusception: a case report. J Med Case Rep 2021; 15:323. [PMID: 34158105 PMCID: PMC8220788 DOI: 10.1186/s13256-021-02942-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Kawasaki disease is a common vasculitis of unknown etiology that occurs mainly in preschool children. It manifests as a self-limited acute febrile illness with other features including extremity changes, cervical lymphadenopathy, oropharyngeal changes, truncal rash, and conjunctivitis. Intestinal involvement is not uncommon, with abdominal pain and vomiting being the most frequently reported symptoms. Intussusception has been described as a manifestation or complication of this disease, but few reports exist in literature. CASE PRESENTATION A 7-month-old boy of Asian origin who presented with vomiting and passage of bloody mucoid stool was diagnosed with intussusception that was successfully reduced during emergency laparotomy. The baby was discharged home post-surgery following clinical improvement. He was readmitted on the fourth postoperative day with fever, irritability, and diarrhea. He was investigated and treated for presumed intraabdominal sepsis with multiple antibiotics with no improvement. He gradually developed the mucocutaneous features of Kawasaki disease and was treated with intravenous immunoglobulin and aspirin with good outcome. CONCLUSION Intussusception and Kawasaki disease both commonly occur in children less than 2 years old. It is important to include Kawasaki disease as a differential diagnosis in children of this age who present with an acute febrile illness and gastrointestinal symptoms. A common underlying pathologic process could be contributing to both conditions.
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27
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Felsenstein S, Duong P, Lane S, Jones C, Pain CE, Hedrich CM. Cardiac pathology and outcomes vary between Kawasaki disease and PIMS-TS. Clin Immunol 2021; 229:108780. [PMID: 34118400 DOI: 10.1016/j.clim.2021.108780] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 01/19/2023]
Abstract
Overlapping clinical features promoted the discussion of whether Kawasaki disease (KD) and PIMS-TS share pathophysiological features and disease outcomes. Medical records from English patients with KD (2015-02/20, N = 27) and PIMS-TS (02/2020-21, N = 34) were accessed to extract information. Children with PIMS-TS were older and more frequently of minority ethnicity background. They patients more commonly exhibited cytopenias and hyperferritinemia, which associated with diffuse cardiac involvement and functional impairment. In some PIMS-TS cases, cardiac pathology developed late, but outcomes were more favorable. In both, KD and PIMS-TS, baseline coronary diameter was a predictor of outcomes. PIMS-TS treatment more frequently included respiratory and cardiovascular support, and corticosteroids with IVIG. Cardiac involvement in PIMS-TS may be the result of a cytokine storm. Though more severe and diffuse when compared to KD, cardiac involvement of PIMS-TS has a more favorable prognosis, which may, after recovery, mitigate the need for long-term follow up.
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Affiliation(s)
- Susanna Felsenstein
- Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
| | - Phuoc Duong
- Department of Cardiology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool 3BX, UK
| | - Caroline Jones
- Department of Cardiology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
| | - Clare E Pain
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
| | - Christian M Hedrich
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, UK; Department of Women's & Children's Health, Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK.
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Affiliation(s)
- Ranjev Kainth
- Department of Medical Education, King's College London Faculty of Life Sciences and Medicine, London, London, UK
| | - Priyen Shah
- Department of Infectious Diseases, Imperial College London, London, UK.,Department of Paediatrics, Whittington Health NHS Trust, London, UK
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Abstract
A 42-year-old man was referred for a week history of severe dysphagia, odynophagia, fever (39 °C), fatigue, abdominal pain, pharyngeal swelling, and multiple neck lymphadenopathies. The medical history reported a mild form of COVID-19 one month ago. The biology reported an unspecified inflammatory syndrome. The patient developed peritonitis, myocarditis, and hepatitis. A myocardium biopsy was performed. A diagnosis of Kawasaki-like disease (KLD) was performed. The occurrence of KLD in adults is rare but has to be known by otolaryngologists regarding the otolaryngological clinical presentation that may precede the multiple organ failure.
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Affiliation(s)
- Jérôme R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Rémi Hervochon
- Department of Otorhinolaryngology and Head and Neck Surgery, La Pitié Salpétrière, Paris, France
| | - Stéphane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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30
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Mardi P, Esmaeili M, Iravani P, Abdar ME, Pourrostami K, Qorbani M. Characteristics of Children With Kawasaki Disease-Like Signs in COVID-19 Pandemic: A Systematic Review. Front Pediatr 2021; 9:625377. [PMID: 33816398 PMCID: PMC8012548 DOI: 10.3389/fped.2021.625377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
Recent studies have shown that several children diagnosed with COVID-19 have developed Kawasaki Disease (KD)-like symptoms. This systematic review aims to assess the demographic, laboratory, and clinical characteristics of children with KD-like syndrome during the COVID-19 pandemic and evaluate efficacy of treatments and patients' outcome. A comprehensive search was carried out systematically through PubMed, Scopus, and Web of Science (WoS), medRxiv, and bioRxiv by two reviewers independently for all studies or preprints data on the demographic, laboratory, and clinical characteristics of children with K.D-like signs during the COVID-19 outbreak. Overall, 378 studies were identified by the systematic search, of which 25 studies were included in the study. The included studies involved 599 patients in total. Thirteen studies (52%) were case reports or case series, and the rest (48%) were cohort studies. In 19 studies, patients were diagnosed with Multisystem inflammatory syndrome in children (MIS-C). In 16 studies COVID-19 was diagnosed in all patients based on their polymerase chain reaction result, serological findings, and computed tomography results. Higher C-reactive protein and erythrocyte sedimentation rate level were the most prevalent laboratory findings. In most studies, patients had leucopenia with marked lymphopenia, hypoalbuminemia, and increased ferritin, as well as hyponatremia. Abnormal echocardiography and respiratory outcomes were the most common clinical outcomes. In 11 studies, all patients required intensive care unit admission. Findings of the present systematic review show that the incidence of KD-like syndrome in the COVID-19 pandemic increased significantly. Moreover, this study offers new insights in the KD-like syndrome pathogenesis and clinical spectrum during COVID-19 pandemic.
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Affiliation(s)
- Parham Mardi
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Marzieh Esmaeili
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Iravani
- Pediatrics Department, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Esmail Abdar
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Kumars Pourrostami
- Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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31
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Abstract
The COVID-19 pandemic has had a huge influence in almost all areas of life, affecting societies, economics, and health care systems worldwide. The paediatric cardiology community is no exception. As the challenging battle with COVID-19 continues, professionals from the Association for the European Paediatric and Congenital Cardiology receive many questions regarding COVID-19 in a Paediatric and Congenital Cardiology setting. The aim of this paper is to present the AEPC position on frequently asked questions based on the most recent scientific data, as well as to frame a discussion on how to take care of our patients during this unprecedented crisis. As the times are changing quickly and information regarding COVID-19 is very dynamic, continuous collection of evidence will help guide constructive decision-making.
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32
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Onyeaghala C, Alasia D, Eyaru O, Paul N, Maduka O, Osemwegie N, Ugwueze N, Ordu C, Igbosi E, Irabor M, Eyidia E. Multisystem inflammatory syndrome (MIS-C) in an adolescent Nigerian girl with COVID-19: A call for vigilance in Africa. Int J Infect Dis 2021; 105:124-129. [PMID: 33582372 PMCID: PMC7879102 DOI: 10.1016/j.ijid.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/10/2023] Open
Abstract
Most reports of Multisystem Inflammatory Syndrome (MIS-C) have come from Europe and North America. The paucity of reports in Africa is in contrast with the demographics of the series in New York, Paris and UK with children of African ancestry accounting for over 40% of all cases of MIS-C. With the global trend of higher prevalence of MIS-C in children of African ancestry, enhanced surveillance and awareness for this syndrome in children with COVID-19 in Africa are therefore important. A case report of a 12-year-old Nigerian girl with MIS-C is presented in line with the WHO global surveillance especially in areas were MIS-C is considered a rarity. This case report stimulates a call for vigilance and expanded effort at surveillance to promote early recognition and diagnosis of MIS-C in Nigeria and Africa. The favourable outcome and experience from this case will create awareness, expand knowledge, and support clinicians in Nigeria and the African continent in their approach to other potential cases.
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Affiliation(s)
- Chizaram Onyeaghala
- COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Datonye Alasia
- Internal Medicine, Faculty of Clinical Sciences, University of Port Harcourt, Nigeria; COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
| | - Orezioghene Eyaru
- Peadiatrics, Faculty of Clinical Sciences, University of Port Harcourt, Nigeria; COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Nsirimobu Paul
- Peadiatrics, Faculty of Clinical Sciences, University of Port Harcourt, Nigeria; COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Omosivie Maduka
- Public Health, Faculty of Clinical Sciences, University of Port Harcourt, Nigeria; COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Nosakhare Osemwegie
- Internal Medicine, Faculty of Clinical Sciences, University of Port Harcourt, Nigeria; COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Nkem Ugwueze
- COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Collins Ordu
- COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ebitei Igbosi
- COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Mary Irabor
- COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Emeka Eyidia
- COVID-19 response Team, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Abstract
Vasculitis is a challenging disease for paediatricians. Certain vasculitides are quite common in children whereas others are much rarer compared with adults. The most common vasculitides in childhood are IgA-associated vasculitis (Henoch-Schönlein purpura) and Kawasaki disease, which are usually self-limiting vasculitides although children do develop complications as a result. We now have much better knowledge of how to manage these patients and prevent the deleterious complications. This review provides an up-to-date discussion on childhood vasculitides, including diagnosis, treatment and follow-up strategies, together with a comparison with vasculitides in adults. It also discusses the newly defined monogenic vasculitides that often present during early childhood.
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Affiliation(s)
- Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
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34
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Schexnayder AG, Tang X, Collins RT, Schexnayder SM, Bolin EH. Pericardial Effusion in Children Admitted With Kawasaki Disease: A Multicenter Retrospective Cohort Study From the Pediatric Health Information System. Clin Pediatr (Phila) 2021; 60:9-15. [PMID: 33297737 DOI: 10.1177/0009922820927021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pericardial effusion (PCE) can be associated with Kawasaki disease (KD). We performed a multicenter, retrospective cohort study of the Pediatric Health Information System of children admitted with KD to determine the association between PCE and adverse outcomes. A total of 17 422 patients were in the cohort, of which 440 (3%) had PCE. PCE was associated with longer hospital length of stay (adjusted odds ratio [aOR] = 1.23; P < .01) and risk of readmission at 30 days (aOR = 1.42; P = .03). Black children were more likely to have a PCE (aOR = 1.54, P < .01) and longer length of stay (aOR = 1.05; P < .001). These data may support delayed discharge in children with PCE and KD in the hopes of preventing readmission. Special consideration needs to be given to how black children with KD are managed.
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Affiliation(s)
| | - Xinyu Tang
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
| | - R Thomas Collins
- Stanford University, Palo Alto, CA, USA.,Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Stephen M Schexnayder
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
| | - Elijah Holbrook Bolin
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
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35
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Taslakian EN, Wi CI, Seol HY, Boyce TG, Johnson JN, Ryu E, King KS, Juhn YJ, Choi BS. Long-term Incidence of Kawasaki Disease in a North American Community: A Population-Based Study. Pediatr Cardiol 2021; 42:1033-40. [PMID: 33712894 DOI: 10.1007/s00246-021-02577-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/25/2021] [Indexed: 11/03/2022]
Abstract
To assess the longitudinal incidence of Kawasaki disease (KD) within the well-defined predominantly White population of Olmsted County, MN. This retrospective cohort study used a population-based medical record linkage system and manual chart reviews to identify children with KD in Olmsted County, MN between January 1, 1979-December 31, 2016. Age- and gender-adjusted incidence rates were calculated using the 2010 U.S. White population. 124 children with KD were confirmed during the study period (median age 3.5, 61% male, 85% White, 9% Asian). The overall age- and gender-adjusted incidence rates for all ages and < 5 years old were 9.8 and 21.4 per 100,000 person-years, respectively. There was an overall increase in incidence up to 1994 followed by plateau, except among children between the ages of 1-5 years. There was also an overall increase in incidence among females compared to males. 24% of children had cardiac complications. While the overall incidence of KD in Olmsted County appears to be stable since 1994, the incidence of KD in subgroups of children 1-5 years old and females seems to have increased. Given the rising trends and one-quarter of children developing cardiac complications, further studies identifying factors driving these trends are warranted.
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36
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Maccora I, Calabri GB, Favilli S, Brambilla A, Trapani S, Marrani E, Simonini G. Long-term follow-up of coronary artery lesions in children in Kawasaki syndrome. Eur J Pediatr 2021; 180:271-275. [PMID: 32556506 DOI: 10.1007/s00431-020-03712-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
To describe clinical and epidemiological characteristics of a Kawasaki syndrome cohort. In a monocentric, retrospective, observational study, between February 1982 and August 2018, we enrolled 361 children, aged 1 month to 24.4 years. Coronary artery lesions were detected in 20.2% of patients: 16% had coronary ectasia, and 4.15% had coronary aneurisms. A significant difference regarding age at disease onset (p = 0.025), fever duration (p < 0.0001), CRP (p = 0.001) and day of first IVIG administration (p < 0.0001) was detected among group. A significant correlation between coronary artery lesions and disease onset < 6 months (p = 0.009), second IVIG dose (p < 0.001) and male gender (p = 0.038) has been detected. Median long-term follow-up was 10.2 years (1-36 years). At the last available follow-up, patients without coronary involvement and coronary ectasia had normal cardiological tests, conversely, in patients with aneurisms, 8/13 showed persistent aneurisms at echocardiography, one ECG repolarization alterations, and one ST depression at the peak of effort during ergometric test.Conclusion: Children with lower age, longer fever, higher level of CRP and retard in IVIG administration are at higher risk to develop coronary artery lesions. Our long-term follow-up analysis confirms, over 36 years of observation, the benign course of Kawasaki syndrome even in coronary artery lesion patients, if timely treated. What is already known about this topic? • Stopping cardiologic assessment in no risk patients results economically advantageous, timesaving and able to reduce emotional discomfort in children and their families. • Age at disease onset, fever duration, CRP level, and day of first IVIG administration are possible risk factors for coronary artery lesions What is New? • During 36 years of observation in real life, our study shows the benign course of Kawasaki syndrome without coronary artery lesions after 6-8 weeks from the disease onset. • Age < 6 months at disease onset is strongly related with coronary artery lesion development.
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Affiliation(s)
- Ilaria Maccora
- Pediatric Rheumatology Unit, School of Human Health Science, A. Meyer Children's University Hospital, University of Florence, Florence, Italy.
| | | | - Silvia Favilli
- Cardiology Unit, A. Meyer Children's University Hospital, Florence, Italy
| | - Alice Brambilla
- Cardiology Unit, A. Meyer Children's University Hospital, Florence, Italy
| | - Sandra Trapani
- Department of Paediatrics, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Edoardo Marrani
- Pediatric Rheumatology Unit, School of Human Health Science, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
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37
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Giani T, Koné-Paut I, Cimaz R, Galeotti C. Editorial: Pathogenesis, Clinical Findings, and Treatment Advances in Kawasaki Disease. Front Pediatr 2021; 9:781842. [PMID: 34760855 PMCID: PMC8573220 DOI: 10.3389/fped.2021.781842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Teresa Giani
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology and CEREMAIA, University of Paris Saclay, Bicêtre Hospital, APHP, Paris, France
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Caroline Galeotti
- Department of Pediatric Rheumatology and CEREMAIA, University of Paris Saclay, Bicêtre Hospital, APHP, Paris, France
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38
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Orlanski-Meyer E, Yogev D, Auerbach A, Megged O, Glikman D, Hashkes PJ, Bar-Meir M. Multisystem Inflammatory Syndrome in Children Associated With Severe Acute Respiratory Syndrome Coronavirus-2 in an 8-Week-Old Infant. J Pediatric Infect Dis Soc 2020; 9:781-784. [PMID: 33175159 PMCID: PMC7717298 DOI: 10.1093/jpids/piaa137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/31/2020] [Indexed: 12/25/2022]
Abstract
We describe an 8-week-old infant with severe gastrointestinal symptoms, significant hypoalbuminemia, and mild carditis following asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infant's symptoms, including their temporal appearance, were consistent with multisystem inflammatory syndrome in children (MIS-C). A unique finding on colonic histology which may shed light on the pathogenesis of MIS-C was identified. The patient improved significantly following several anti-inflammatory treatments. The lag between the presentation of MIS-C and initial SARS-CoV-2 exposure, which may often be asymptomatic, together with the young age of our patient, makes this a challenging diagnosis. Clinicians should be aware of this entity, even in the neonatal and infantile age groups, to facilitate timely identification and treatment.
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Affiliation(s)
- Esther Orlanski-Meyer
- Institute of Pediatric Gastroenterology and Nutrition, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Corresponding Author: Esther Orlanski-Meyer, MD, Tel: 972-52-802-0855,
| | - Dotan Yogev
- Institute of Pediatric Gastroenterology and Nutrition, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Hadassah Hebrew University Medical School
| | - Adi Auerbach
- Pediatric Endocrinology unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Pediatric Infectious Diseases unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Hadassah Hebrew University Medical School
| | - Daniel Glikman
- Padeh-Poriya Medical Center and The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Philip J Hashkes
- Pediatric Rheumatology Unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Hadassah Hebrew University Medical School
| | - Maskit Bar-Meir
- Pediatric Infectious Diseases unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Hadassah Hebrew University Medical School
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39
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Pratap K, Gardner LS, Gillis D, Newman M, Wainwright D, Prentice R. Hepatic predominant presentation of Kawasaki disease in adolescence case report and review of literature. BMC Gastroenterol 2020; 20:352. [PMID: 33109118 PMCID: PMC7590489 DOI: 10.1186/s12876-020-01461-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kawasaki Disease (KD) is the most common paediatric vasculitis affecting small to medium arteries. Although the average age of diagnosis is 3.4 years with a well-defined clinical presentation, older patients with KD including adolescent and adult patients demonstrate a less classical presentation with prominent findings including hepatitis, cervical lymphadenopathy, and arthralgia. We describe a case of an adolescent presentation of Kawasaki Disease presenting with a predominantly cholestatic hepatic picture. CASE PRESENTATION We describe a case of KD in a 16-year-old Caucasian female with predominately hepatic disease that showed resistance to intravenous immunoglobulin (IVIG). The formal diagnosis of KD was made on her 8th day of symptoms. She displayed classical symptoms commencing with fever, followed by peripheral desquamation, strawberry tongue, cervical lymphadenopathy. She became clinically jaundiced with evidence of hepatic artery narrowing on ultrasound that resolved with treatment. Her disease was biphasic and required further IVIG for non-hepatic symptoms. She did not develop coronary aneurysms. CONCLUSION Significant hepatic dysfunction with clinical jaundice is rare in KD without associated gall bladder hydrops and tends to occur in older patients. We describe such a case and review the five described cases in the literature. Diagnostic delay is more common in adolescent patients and given that the prognosis of KD is closely correlated to diagnostic timing and provision of care, it is important to consider Kawasaki Disease in older demographics especially with undiagnosed hepatic disease.
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Affiliation(s)
- Krishan Pratap
- Department of Clinical Immunology and Allergy, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Logan S Gardner
- Department of Clinical Immunology and Allergy, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
- School of Medicine, University of Queensland, Brisbane, Australia.
| | - David Gillis
- Department of Clinical Immunology and Allergy, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | | | - Dana Wainwright
- Department of Clinical Immunology and Allergy, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - Roger Prentice
- Department of Clinical Immunology and Allergy, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
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40
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Rekhtman S, Tannenbaum R, Strunk A, Birabaharan M, Wright S, Garg A. Mucocutaneous disease and related clinical characteristics in hospitalized children and adolescents with COVID-19 and multisystem inflammatory syndrome in children. J Am Acad Dermatol 2020; 84:408-414. [PMID: 33323343 PMCID: PMC7585496 DOI: 10.1016/j.jaad.2020.10.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022]
Abstract
Background Little is known about mucocutaneous disease in acutely ill children and adolescents with COVID-19 and multisystem inflammatory syndrome in children (MIS-C). Objective To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C. Methods Descriptive cohort study of prospectively and consecutively hospitalized eligible patients between May 11, 2020 and June 5, 2020. Results In COVID-19 patients, 4 of 12 (33%) had rash and/or mucositis, including erythema, morbilliform pattern, and lip mucositis. In MIS-C patients, 9 of 19 (47%) had rash and/or mucositis, including erythema, morbilliform, retiform purpura, targetoid and urticarial patterns, along with acral edema, lip mucositis, tongue papillitis, and conjunctivitis. COVID-19 patients with rash had less frequent respiratory symptoms, pediatric intensive care unit admission, invasive ventilation, and shorter stay versus COVID-19 patients without rash. MIS-C patients with rash had less frequent pediatric intensive care unit admission, shock, ventilation, as well as lower levels of C-reactive protein, ferritin, D-dimer, and troponin (vs MIS-C without rash). Neutrophil-to-lymphocyte ratio was similar for patients with and without rash in both groups. None of the MIS-C patients met criteria for Kawasaki disease. Limitations Small sample sizes. Conclusions Mucocutaneous disease is common among children and adolescents with COVID-19 and MIS-C. Laboratory trends observed in patients with rash may prognosticate a less severe course.
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Affiliation(s)
- Sergey Rekhtman
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Rachel Tannenbaum
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Morgan Birabaharan
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Shari Wright
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
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41
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Nelson C, Ishimine P, Hayden SR, Correia M, Wardi G. Multisystem Inflammatory Syndrome in Children (MIS-C) in an Adolescent that Developed Coronary Aneurysms: A Case Report and Review of the Literature. J Emerg Med 2020; 59:699-704. [PMID: 33011038 PMCID: PMC7527793 DOI: 10.1016/j.jemermed.2020.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
Background A small subset of pediatric patients develop a rare syndrome associated with Coronavirus Disease 2019 (COVID-19) infection called multisystem inflammatory syndrome in children (MIS-C). This syndrome shares characteristics with Kawasaki disease. Case Report A 15-year-old girl presented to our Emergency Department (ED) with fevers and malaise. She was diagnosed on her initial visit with an acute viral syndrome and discharged with a COVID polymerase chain reaction test pending, which was subsequently negative. She returned 3 days later with persistent fever, conjunctivitis, and a symmetric targetoid rash over her palms. She had no adenopathy, but her erythrocyte sedimentation rate and C-reactive protein were both significantly elevated at 90 mm/h and 19.61 mg/dL, respectively. The patient was then transferred to the regional children's hospital due to a clinical suspicion for MIS-C, and subsequent COVID-19 immunoglobulin G testing was positive. She had been empirically started on intravenous immunoglobulin in addition to 81 mg aspirin daily. Initial echocardiograms showed mild dilatation of the left main coronary artery, and on repeat echocardiogram, a right coronary artery aneurysm was also identified. Oral prednisone therapy (5 mg) was initiated and the patient was discharged on a continued prednisone taper. Why Should an Emergency Physician Be Aware of This? We present a case of a 15-year-old girl who presented to the ED with MIS-C who developed coronary aneurysms despite early therapy, to increase awareness among emergency physicians of this emerging condition.
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Affiliation(s)
- Cole Nelson
- Department of Emergency Medicine, University of California at San Diego, San Diego, California
| | - Paul Ishimine
- Department of Emergency Medicine, University of California at San Diego, San Diego, California; Division of Emergency Medicine, Rady Children's Hospital, San Diego, California
| | - Stephen R Hayden
- Department of Emergency Medicine, University of California at San Diego, San Diego, California
| | - Matthew Correia
- Department of Emergency Medicine, University of California at San Diego, San Diego, California
| | - Gabriel Wardi
- Department of Emergency Medicine, University of California at San Diego, San Diego, California; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California at San Diego, San Diego, California
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42
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Ronconi G, Teté G, Kritas SK, Gallenga CE, Caraffa A, Ross R, Conti P. SARS-CoV-2, which induces COVID-19, causes kawasaki-like disease in children: role of pro-inflammatory and anti-inflammatory cytokines. J BIOL REG HOMEOS AG 2020; 34:767-773. [PMID: 32476380 DOI: 10.23812/editorial-ronconi-e-59] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute severe respiratory syndrome coronavirus-2 (SARS-CoV-2) caused a global pandemic coronavirus disease 2019 (COVID-19). In humans, SARS-CoV-2 infection leads to acute respiratory distress syndrome which presents edema, hemorrhage, intra-alveolar fibrin deposition, and vascular changes characterized by thrombus formation, micro-angiopathy and thrombosis. These clinical signs are mediated by pro-inflammatory cytokines. In recent studies it has been noted that COVID-19 pandemic can affect patients of all ages, including children (even if less severely) who were initially thought to be immune. Kawasaki disease is an autoimmune acute febrile inflammatory condition, which primarily affects young children. The disease can present immunodeficiency with the inability of the immune system to fight inflammatory pathogens and leads to fever, rash, alterations of the mucous membranes, conjunctiva infection, pharyngeal erythema, adenopathy, and inflammation. In the COVID-19 period, virus infection aggravates the condition of Kawasaki disease, but it has also been noted that children affected by SARS-V-2 may develop a disease similar to Kawasaki's illness. However, it is uncertain whether the virus alone can give Kawasaki disease-like forms. As in COVID-19, Kawasaki disease and its similar forms are mediated by pro-inflammatory cytokines produced by innate immunity cells such as macrophages and mast cells (MCs). In light of the above, it is therefore pertinent to think that by blocking pro-inflammatory cytokines with new anti-inflammatory cytokines, such as IL-37 and IL-38, it is possible to alleviate the symptoms of the disease and have a new available therapeutic tool. However, since Kawasaki and Kawasaki-like diseases present immunodeficiency, treatment with anti-inflammatory/immunosuppressant molecules must be applied very carefully.
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Affiliation(s)
- G Ronconi
- Clinica dei Pazienti del Territorio, Fondazione Policlinico Gemelli, Rome, Italy
| | - G Teté
- Specialization School in Oral Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - S K Kritas
- Department of Microbiology and Infectious Diseases, School of Veterinary Medicine, Aristotle University of Thessaloniki, Macedonia, Greece
| | - C E Gallenga
- Department of Biomedical Sciences and Specialist Surgery, Section of Ophthalmology, University of Ferrara, Ferrara, Italy
| | - Al Caraffa
- School of Pharmacy, University of Camerino, Camerino, Italy
| | - R Ross
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA
| | - P Conti
- Postgraduate Medical School, University of Chieti, Chieti, Italy
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43
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Shulman ST, Takahashi M. In Memoriam: Dr Tomisaku Kawasaki. J Pediatric Infect Dis Soc 2020; 9:piaa081. [PMID: 32706369 DOI: 10.1093/jpids/piaa081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Stanford T Shulman
- Virginia H. Rogers Professor, Division of Pediatric Infectious Disease, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Masato Takahashi
- Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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44
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Ferrero P, Piazza I, Bonino C, Ciuffreda M. Patterns of myocardial involvement in children during COVID-19 pandemic: Early experience from northern Italy. Ann Pediatr Cardiol 2020; 13:230-233. [PMID: 32863659 PMCID: PMC7437629 DOI: 10.4103/apc.apc_77_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/15/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022] Open
Abstract
There is limited information about coronavirus disease 2019 (COVID-19) in the pediatric population. Preliminary data suggest a not insignificant prevalence of cardiac involvement. Here, we report our early experience with COVID-19 in the pediatric population. These patients display exceptionally high levels of acute-phase reactants. The clinical syndrome in these patients is somewhat similar to Kawasaki disease with or without myocardial involvement. In some cases, the presentation mimics typical myocarditis. Severe myocardial involvement is associated with transient electrocardiographic and echocardiographic abnormalities. These findings may be due to the cardiotropic nature of the virus or may be the result of an immunologic response to the infection.
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Affiliation(s)
- Paolo Ferrero
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Isabelle Piazza
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of studies of Milan, Italy
| | - Caterina Bonino
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Matteo Ciuffreda
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
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45
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Abstract
A hyperinflammatory response to COVID-19 is being described in children. While this presents, and responds to management, similar to that of Kawasaki Disease it is being coined a new entity. But is it really? We explore how this phenomenon may be Kawasaki Disease with a new trigger.
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46
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Cason RK, Ponniah UP, Makil ES, Niu MC. Atypical recurrent Kawasaki disease with retropharyngeal involvement: A case study and literature review. Ann Pediatr Cardiol 2020; 13:244-247. [PMID: 32863663 PMCID: PMC7437624 DOI: 10.4103/apc.apc_89_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/16/2019] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Kawasaki disease (KD) is a systemic inflammatory condition primarily affecting young children. We present an adolescent male with two episodes of complete KD between the age of 2 and 14 years. At age 14, he presented with findings suggestive of a retropharyngeal abscess. This was later determined to be a recurrence of KD, diagnosed after the development of coronary artery aneurysms. Our case reinforces the role of maintaining a high index of suspicion for KD, both in patients with prior KD episodes and in those with persistent fever who do not fulfill the diagnostic criteria for typical KD. This is particularly important for patients presenting with atypical symptoms not commonly associated with KD, such as inflammation of the retropharyngeal and parapharyngeal spaces.
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Affiliation(s)
- Rachel K Cason
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Umakumaran P Ponniah
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Elizabeth S Makil
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mary C Niu
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Pediatrics, University of Utah Health Sciences Center, Primary Children's Hospital, Salt Lake City, Utah, USA
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47
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Della Paolera S, Valencic E, Piscianz E, Moressa V, Tommasini A, Sagredini R, Kiren V, Comar M, Taddio A. Case Report: Use of Anakinra in Multisystem Inflammatory Syndrome During COVID-19 Pandemic. Front Pediatr 2020; 8:624248. [PMID: 33708752 PMCID: PMC7940350 DOI: 10.3389/fped.2020.624248] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022] Open
Abstract
During COVID-19 outbreak, a large number of children with severe inflammatory disease has been reported. This condition, named Pediatric Multi-inflammatory Syndrome temporally associated with COVID-19 (PIMS-TS) or Multisystem Inflammatory Syndrome associated with Coronavirus Disease 2019 (MIS-C), shares some clinical features with Kawasaki disease and is frequently complicated by myocarditis or shock. It has been suggested that MIS-C belongs to the group of cytokine storm syndromes triggered by SARS-CoV-2 infection. So far, intravenous immunoglobulin (IVIG) and systemic glucocorticoids are the most common therapeutic approaches reported in this group of patients. However, the use of anakinra in patients with severe forms of COVID-19 is showing promising results. Here we reported two patients with multisystem inflammatory syndrome complicated with shock. Both the patients presented a poor response to IVIG and systemic glucocorticoids and received anakinra. Treatment with IL-1 receptor antagonist showed a rapid improvement of clinical conditions and biochemical analysis in both patients and demonstrated a good safety profile. Thus, we look forward for future controlled clinical trials with the aim to demonstrate the effectiveness of anakinra in patients with MIS-C and established precise criteria for its use.
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Affiliation(s)
- Sara Della Paolera
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Erica Valencic
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elisa Piscianz
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Valentina Moressa
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alberto Tommasini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Raffaella Sagredini
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Valentina Kiren
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manola Comar
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Taddio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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48
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Abstract
A 10-year-old male with prolonged fever, rash, and conjunctivitis presented to the emergency department with concern for Kawasaki disease, found to have myocarditis and PCR positive for SARS-CoV-2.
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Affiliation(s)
- Joanne S Chiu
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
- Division of Cardiology, Department of Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
| | - Manuella Lahoud-Rahme
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Division of Cardiology, Department of Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - David Schaffer
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ari Cohen
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret Samuels-Kalow
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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49
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Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG, Jyothish D, Kanthimathinathan HK, Welch SB, Hackett S, Al-Abadi E, Scholefield BR, Chikermane A. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol 2020; 41:1391-1401. [PMID: 32529358 PMCID: PMC7289638 DOI: 10.1007/s00246-020-02391-2] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2" (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children's hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4-11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes.
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Affiliation(s)
- Tristan Ramcharan
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Oscar Nolan
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Chui Yi Lai
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Nanda Prabhu
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | | | - Alex G. Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT UK
| | - Deepthi Jyothish
- Department of Paediatrics, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK
| | - Hari Krishnan Kanthimathinathan
- Paediatric Intensive Care Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK ,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - Steven B. Welch
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS UK
| | - Scott Hackett
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS UK
| | - Eslam Al-Abadi
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK ,Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK
| | - Barnaby R. Scholefield
- Paediatric Intensive Care Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK ,Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
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50
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Duignan S, Doyle SL, McMahon CJ. Refractory Kawasaki disease: diagnostic and management challenges. Pediatric Health Med Ther 2019; 10:131-139. [PMID: 31802968 PMCID: PMC6826175 DOI: 10.2147/phmt.s165935] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/23/2019] [Indexed: 01/27/2023]
Abstract
Kawasaki disease (KD), an acute, self-limiting, medium-sized arterial vasculitis, is now the most common cause of acquired heart disease in childhood in the developed world. In this review, we discuss the diagnosis of KD, predicting resistance to traditional therapy and treatment options in refractory or high-risk disease. We also highlight ongoing clinical trials and other potential avenues of research which may prove beneficial in managing children, especially those with resistant KD.
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Affiliation(s)
- Sophie Duignan
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Dublin 12, Ireland.,Department of Immunology, National Children's Research Centre, Dublin, Ireland
| | - Sarah L Doyle
- Department of Immunology, National Children's Research Centre, Dublin, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Dublin 12, Ireland.,Department of Immunology, National Children's Research Centre, Dublin, Ireland
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