Epidemiologic and clinical characteristics of Kawasaki disease in Shaanxi Province, China, 1993-1997

What Lies Ahead for Young Hearts in the 21st Century - Is It Double Trouble of Acute Rheumatic Fever and Kawasaki Disease in Developing Countries?

Rheumatic heart disease (RHD), the principal long-term sequel of acute rheumatic fever (ARF), has been a major contributor to cardiac-related mortality in general population, especially in developing countries. With improvement in health and sanitation facilities across the globe, there has been almost a 50% reduction in mortality rate due to RHD over the last 25 years. However, recent estimates suggest that RHD still results in more than 300,000 deaths annually. In India alone, more than 100,000 deaths occur due to RHD every year (Watkins DA et al., N Engl J Med, 2017). Children and adolescents (aged below 15 years) constitute at least one-fourth of the total population in India. Besides, ARF is, for the most part, a pediatric disorder. The pediatric population, therefore, requires special consideration in developing countries to reduce the burden of RHD. In the developed world, Kawasaki disease (KD) has emerged as the most important cause of acquired heart disease in children. Mirroring global trends over the past two decades, India also has witnessed a surge in the number of cases of KD. Similarly, many regions across the globe classified as “high-risk” for ARF have witnessed an increasing trend in the incidence of KD. This translates to a double challenge faced by pediatric health care providers in improving cardiac outcomes of children affected with ARF or KD. We highlight this predicament by reviewing the incidence trends of ARF and KD over the last 50 years in ARF “high-risk” regions.

Kawasaki disease in children: Epidemiology, clinical symptoms and diagnostics of 231 cases in 10 years

The present study was a retrospective analysis of the dynamic changes and clinical characteristics of 231 cases of Kawasaki disease (KD) in pediatric patients admitted to the People's Hospital of Inner Mongolia between January 2003 and December 2012. A total of 37.23% of the cases occurred in the first 5 years, compared with 62.77% in the latter 5 years. The age distribution ranged from 3 months to 10 years, with a peak age of <1 year. The male-to-female ratio was 2.12:1, and the reoccurrence rate was 1.3%. Among the patient cohort, 7.8% were Mongolian children. The most common clinical symptom was fever (87.6%), while perianal skin peeling was the most rare (14.1%). With regard to the analyzed biomarkers, 90.4% of patients had abnormal platelet (PLT) counts; the next highest abnormality rates were associated with erythrocyte sedimentation rate (ESR) (74.46%) and white blood cell (WBC) counts (59.74%), followed by levels of C-reactive protein (CRP) (57.58%), creatinine kinase-MB (40.26%) and hemoglobin (Hb) (38.53%). In conclusion, the present study has found that approximately two-thirds of cases of KD over a 10-year period occurred in the latter 5 years. Changes in a number of experimental indicators, including PLT, ESR and WBC, could be used in the diagnosis of the condition and to reflect the success of the clinical treatment.

Single-nucleotide polymorphism rs2290692 in the 3'UTR of ITPKC associated with susceptibility to Kawasaki disease in a Han Chinese population

Kawasaki disease (KD) is characterized by acute systemic vasculitis and frequently is complicated by coronary artery lesions (CALs). The inositol 1,4,5-trisphosphate 3-kinase C (ITPKC) gene rs28493229 was recently found to be associated with the risk for KD in the Japanese population, suggesting that the ITPKC gene may contribute to KD susceptibility. This study investigated the association of ITPKC polymorphisms with KD in a Han Chinese population. Five ITPKC Single-nucleotide polymorphisms, including rs28493229, were genotyped in 223 unrelated patients who had KD and 318 non-KD control subjects. The allele, genotype, and haplotype frequencies were compared between the patients and the control subjects, between the patients with and those without CALs, and between patients resistant to intravenous immunoglobulin treatment and those responsive to such treatment. Multiple alleles were observed for rs28493229 and rs2290692. No significant differences in the frequencies of the C allele, the CC genotype, or the C carriers of rs28493229 were observed in the comparisons. Interestingly, significantly higher frequencies of the C allele (p < 0.001), the CC genotype (p = 0.001), and the C carriers (p = 0.003) were observed for rs2290692 among the patients than among the control subjects, and similar differences were observed between the patients with and those without CALs. The GC haplotype for rs28493229 and rs2290692 was more common among the patients than among the control subjects. The results indicate that the C allele of the ITPKC gene rs2290692 is linked to a significantly higher risk for KD in the studied population, which provides new evidence to support the importance of the ITPKC gene in the occurrence of KD. More notably, this finding suggests that there may be an unidentified ITPKC polymorphism in strong linkage disequilibrium to rs2290692, significantly affecting susceptibility to KD in the Han population.

Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003

BACKGROUND

Kawasaki syndrome (KS) causes significant morbidity among children in the United States and other countries and can result in a range of cardiac and noncardiac complications.

METHODS

To describe the occurrence of KS in the United States and risk factors for the development of coronary artery abnormalities (CAA), national KS surveillance data were analyzed for patients with KS onset during 1994-2003. The surveillance is a passive system, and information is collected on a standardized case report form.

RESULTS

During 1994 through 2003, 3115 patients who met the KS case definition were reported to the national KS surveillance system. The median age of KS patients was 32 months; the male-female ratio was 1.5:1. Nearly one-third (31.8%) of the cumulative number of KS cases occurred during January through March. During the study period, 362 (12.9%) of 2798 KS patients had CAA. The proportion of patients with CAA increased from 10.0% in 1994 to 17.8% in 2003. Age younger than 1 year and 9-17 years, male sex, Asian and Pacific Islander race and Hispanic ethnicity (a previously unidentified risk factor) were significantly associated with the development of CAA.

CONCLUSIONS

The increase in CAA was attributed to widespread use of the criteria of de Zorzi et al, resulting in increased recognition of coronary artery dilatations. The factors contributing to a higher risk of CAA, such as delayed treatment, particularly among Hispanics, need to be investigated.

The epidemiology of Kawasaki disease in an urban hospital: does African American race protect against coronary artery aneurysms?

The etiology and pathogenesis of Kawasaki disease (KD) is largely unknown. Certain demographic factors and laboratory findings are predictive of the development of coronary artery (CA) aneurysms. The objectives of this study were to determine the epidemiology of KD patients in an urban hospital and determine risk factors associated with their development of CA abnormalities. A longitudinal case series of KD patients admitted to Children's National Medical Center from 1990 to 2002 was examined. Age, sex, ethnic background, duration of fever prior to diagnosis, address, month diagnosed, and CA abnormalities (ectasia or aneurysms) on echocardiography were recorded. Median household income was obtained from the U.S. Census Bureau Web site. The Student t-test, logistic regression analyses, and the Kruskal-Wallis test were used, with significance assumed at p < 0.05. A total of 302 patients were evaluated. CA abnormalties were found in 27 patients (9%), with aneurysms identified in 13 patients (4%). Age was 2.9 +/- 2.4 years (range, 2 months to 14 years). A total of 51 patients (16%) were < or =1 year and 35 patients (12%) were > or =5 years. Ethnic distribution was 54% (164) African American, 24% (72) Caucasian, 9% (29) Asian/Pacific Islander, 8% (23) Hispanic, and 5% (14) Middle Eastern. Only 2/164 (1.2%) African Americans developed CA aneurysms. Neighborhood median income of the cohort was $45,400 +/- $21,200 ($52,200 +/-$25,800 for patients with aneurysms). A total of 28% of cases clustered between December and January. Cases doubled annually in 1999-2001 compared to 1990-1998 (39 vs 19). Multivariate logistic regression found age between 1 and 5 years [p = 0.045; odds ratio, 0.31; 95% confidence interval (CI), 0.10-0.97] and African American race (p = 0.014; odds ratio, 0.15; 95% CI, 0.03-0.68) to be independently protective against CA aneurysms. Duration of fever prior to diagnosis, considered in 210 patients, was different between patients with and without aneurysms (11 +/- 5.3 vs 6.5 +/- 3.8 days, respectively, p = 0.0007). Multivariate logistic regression found fever longer than 5 days to be the only predictive factor associated with the development of aneurysms and any abnormality. African Americans had a shorter duration of fever than the rest of the cohort (6.03 vs 7.31 days), (p = 0.0087). The epidemiology of KD at our hospital is similar to that at other centers except for the predominance of African Americans with a shorter duration of fever prior to diagnosis and a decreased incidence of CA aneurysms compared to other ethnicities. The protective nature of African American ethnicity against the development of CA aneurysms raises speculation about the role of genetics and its interaction with immunity in the pathogenesis of KD.

Epidemiology of the vasculitides

The past year has seen some notable publications in the field of vasculitis epidemiology. The appearance of reports from several different parts of the world has permitted comparisons to be made. In Europe, Wegener granulomatosis appears to be more common at high latitudes, whereas microscopic polyangiitis shows the reverse pattern. Kawasaki disease is most common in Japan. In China, the United States, and the United Kingdom, the incidence is lower, but the incidence appears to be increasing globally. Studies of infectious triggers continue to be disappointingly negative. Immunogenetic associations with cytokine polymorphisms are beginning to be reported.