1
|
Shaanxi Provincial Diagnosis and Treatment Center of Kawasaki Disease. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:867-876. [PMID: 34535199 PMCID: PMC8480171 DOI: 10.7499/j.issn.1008-8830.2107110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 12/19/2022]
Abstract
Kawasaki disease is an acute, self-limited vascuitis that mainly occurs in children under 5 years of age. Intravenous immunoglobulin (IVIG) has become an effective treatment regimen, which can effectively reduce the incidence of cardiovascular complications. However, there has been no consensus or clinical guidelines for the application of IVIG in children with Kawasaki disease till now. This consensus is developed based on the current research progress on the application of IVIG in children with Kawasaki disease in China and overseas, with reference to the diagnosis and treatment guidelines for Kawasaki disease in China and overseas, and the opinions of experts. This consensus provides recommendations on the clinical application strategy of IVIG in children with Kawasaki disease and the prevention and treatment of its adverse reactions. Citation.
Collapse
|
2
|
Pruc M, Smereka J, Dzieciatkowski T, Jaguszewski M, Filipiak KJ, Szarpak L. Kawasaki disease shock syndrome or toxic shock syndrome in children and the relationship with COVID-19. Med Hypotheses 2020; 144:109986. [PMID: 32562912 PMCID: PMC7289107 DOI: 10.1016/j.mehy.2020.109986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 01/30/2023]
Abstract
Most pediatric patients with COVID-19 are asymptomatic or show only mild symptoms. However, in the last two months, first in Europe and recently in the United States, a small number of children have developed a more severe inflammatory syndrome associated with COVID-19, which often leads to hospitalization and sometimes requires intensive care. A potential relationship was observed, especially between the occurrence of the Kawasaki disease and viral upper respiratory tract infections.
Collapse
Affiliation(s)
- Michal Pruc
- Faculty of Medicine, Lazarski Univeristy, Warsaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | | | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | | | - Lukasz Szarpak
- Faculty of Medicine, Lazarski Univeristy, Warsaw, Poland.
| |
Collapse
|
3
|
Platelets in Kawasaki disease: Is this only a numbers game or something beyond? Genes Dis 2019; 7:62-66. [PMID: 32181276 PMCID: PMC7063415 DOI: 10.1016/j.gendis.2019.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/30/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is a medium vessel vasculitis with predilection to cause coronary artery abnormalities. KD is now the most common cause of acquired heart disease in developed countries. Thrombocytosis is consistently found in patients with KD, usually in 2nd to 3rd week of illness. Thrombocytopenia has occasionally been reported in the acute phase of KD. An increase or decrease in platelet number in patients with KD was initially considered to be a benign phenomenon. However, recent literature on platelet biology in KD has suggested that platelets are not only increasing but are rather activated. This phenomenon has been found to increase the risk of thrombosis in these patients. Similarly a fall in platelet counts during acute stage of KD has also been found to be associated with increased severity of disease. In this review, we update on the current best understanding about pathogenic role of platelets in patients with KD.
Collapse
|
4
|
Grignani R, Rajgor DD, Leow YG, Heng CK, Quek SC. A novel model for predicting non-responsiveness to intravenous immunoglobulins in Kawasaki disease: The Singapore experience. J Paediatr Child Health 2019; 55:962-967. [PMID: 30520192 DOI: 10.1111/jpc.14329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
AIM We aimed to assess the utility of four published risk-scoring methods in predicting intravenous immunoglobulins (IVIG) non-responsiveness in Kawasaki disease (KD) patients from Singapore and develop a new predictive model. METHODS We reviewed the medical records of 215 KD children. The performance of existing scoring methods in identifying non-responsive cases based on sensitivities (SN) and specificities (SP) was evaluated in 122 Singaporean Chinese. From our dataset, a model involving six predictors was built. RESULTS The following respective SN (%) and SP (%) were obtained: Egami: 26%, 68%; Kobayashi: 21%, 62%; Sano: 13%, 86% and Fukunishi: 46%, 71%. These results indicated that the existing scoring methods performed poorly compared to those reported in their respective original publications, which ranged between 68 and 87%. The new predictive model was derived with an improved SN (80%) and SP (80%). CONCLUSIONS Currently available risk-scoring methods have less applicability in the Singaporean Chinese population. The proposed new risk-scoring predictive model derived based on data from Chinese cohort demonstrated much better SN and SP.
Collapse
Affiliation(s)
- Robert Grignani
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore.,Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Dimple D Rajgor
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao-Guang Leow
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chew-Kiat Heng
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Swee-Chye Quek
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
5
|
Downie ML, Manlhiot C, Collins TH, Chahal N, Yeung RS, McCrindle BW. Factors associated with development of coronary artery aneurysms after Kawasaki disease are similar for those treated promptly and those with delayed or no treatment. Int J Cardiol 2017; 236:157-161. [DOI: 10.1016/j.ijcard.2017.01.068] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/06/2017] [Indexed: 11/15/2022]
|
6
|
Kim HJ, Lee HE, Yu JW, Kil HR. Clinical outcome of patients with refractory Kawasaki disease based on treatment modalities. KOREAN JOURNAL OF PEDIATRICS 2016; 59:328-34. [PMID: 27610181 PMCID: PMC5014912 DOI: 10.3345/kjp.2016.59.8.328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/16/2016] [Accepted: 04/11/2016] [Indexed: 01/15/2023]
Abstract
Purpose Although a significant number of reports on new therapeutic options for refractory Kawasaki disease (KD) such as steroid, infliximab, or repeated intravenous immunoglobulin (IVIG) are available, their effectiveness in reducing the prevalence of coronary artery lesions (CAL) remains controversial. This study aimed to define the clinical characteristics of patients with refractory KD and to assess the effects of adjuvant therapy on patient outcomes. Methods We performed a retrospective study of 38 refractory KD patients from January 2012 to March 2015. We divided these patients into 2 groups: group 1 received more than 3 IVIG administration+ steroid therapy, (n=7, 18.4%), and group 2 patients were unresponsive to initial IVIG and required steroid therapy or second IVIG (n=31, 81.6%). We compared the clinical manifestations, laboratory results, and echocardiographic findings between the groups and examined the clinical utility of additional therapies in both groups. Results A significant difference was found in the total duration of fever between the groups (13.0±4.04 days in group 1 vs. 8.87±2.30 days in group 2; P=0.035). At the end of the follow-up, all cases in group 1 showed suppressed CAL. In group 2, coronary artery aneurysm occurred in 2 patients (6.4 %). All the patients treated with intravenous corticosteroids without additional IVIG developed CALs including coronary artery aneurysms. Conclusion No statistical difference was found in the development of CAL between the groups. Prospective, randomized, clinical studies are needed to elucidate the effects of adjunctive therapy in refractory KD patients.
Collapse
Affiliation(s)
- Hyun Jung Kim
- Department of Pediatrics, Eulji Universitiy School of Medicine, Daejeon, Korea
| | - Hyo Eun Lee
- Department of Pediatrics, Eulji Universitiy School of Medicine, Daejeon, Korea
| | - Jae Won Yu
- Department of Pediatrics, Chungnam University School of Medicine, Daejeon, Korea
| | - Hong Ryang Kil
- Department of Pediatrics, Chungnam University School of Medicine, Daejeon, Korea
| |
Collapse
|
7
|
Zhang X, Liang Y, Feng W, Su X, Zhu H. Epidemiologic survey of Kawasaki disease in Inner Mongolia, China, between 2001 and 2013. Exp Ther Med 2016; 12:1220-1224. [PMID: 27446347 DOI: 10.3892/etm.2016.3393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/05/2016] [Indexed: 12/21/2022] Open
Abstract
The epidemiologic features of Kawasaki disease (KD) in the Inner Mongolia Autonomous Region of China has not been previously determined, to the best of our knowledge. Therefore, the aim of the present study was to investigate the epidemiology of KD in Inner Mongolia. Clinical data from 518 patients treated for KD in Inner Mongolia between January 2001 and December 2013 were analyzed. The results indicated that the mean annual incidence rate was 3.55±2.96 per 100,000 children under the age of 5 years between 2001 and 2013. The age at diagnosis ranged between 49 days and 14 years, while the disease occurred more frequently in the spring and summer. In addition, the incidence of coronary artery lesion (CAL) was reported to be 40.2% in the present survey. KD patients in the Han Chinese ethnic group were more likely to be complicated by CAL, whereas patients with incidence of KD in July were less likely to be complicated by CAL. In conclusion, the incidence of KD was observed to be increasing in Inner Mongolia, while the ethnic group and month of onset may be associated with the incidence of CAL in KD patients.
Collapse
Affiliation(s)
- Xiaomei Zhang
- Department of Pediatrics, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia 010017, P.R. China
| | - Yanyan Liang
- Department of Pediatrics, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia 010017, P.R. China
| | - Wanyu Feng
- Department of Pediatrics, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia 010017, P.R. China
| | - Xuewen Su
- Department of Pediatrics, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia 010017, P.R. China
| | - Hua Zhu
- Department of Pediatrics, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia 010017, P.R. China
| |
Collapse
|
8
|
Park HM, Lee DW, Hyun MC, Lee SB. Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2013; 56:75-9. [PMID: 23482814 PMCID: PMC3589594 DOI: 10.3345/kjp.2013.56.2.75] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 09/11/2012] [Accepted: 10/24/2012] [Indexed: 12/12/2022]
Abstract
Purpose It has been reported that 10% to 20% of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment. In this study, we aimed to identify useful predictors of therapeutic failure in children with KD. Methods We examined 309 children diagnosed with KD at the Kyungpook National University Hospital and the Inje University Busan Paik Hospital between January 2005 and June 2011. We retrospectively reviewed their medical records and analyzed multiple parameters in responders and nonresponders to IVIG. Results Among the 309 children, 30 (9.7%) did not respond to IVIG. They had significantly higher proportion of neutrophils, and higher levels of aspartate aminotransferase, alanine aminotransferase (ALT), total bilirubin, and N-terminal fragment of B-type natriuretic peptide than did responders. IVIG-nonresponders had a significantly longer duration of hospitalization, and more frequently experienced coronary artery lesion, and sterile pyuria. No differences in the duration of fever at initial treatment or, clinical features were noted. Conclusion Two independent predictors (ALT≥84 IU/L, total bilirubin≥0.9 mg/dL) for nonresponse were confirmed through multivariate logistic regression analysis. Thus elevated ALT and total bilirubin levels might be useful in predicting nonresponse to IVIG therapy in children with KD.
Collapse
Affiliation(s)
- Hyo Min Park
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | | | | | | |
Collapse
|
9
|
MBL Deficiency as Risk of Infection and Autoimmunity. ANIMAL LECTINS: FORM, FUNCTION AND CLINICAL APPLICATIONS 2012:933-953. [PMCID: PMC7122001 DOI: 10.1007/978-3-7091-1065-2_42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
In pathogen recognition by C-type lectins, several levels of complexity can be distinguished; these might modulate the immune response in different ways. Firstly, the pathogen-associated molecular pattern repertoire expressed at the microbial surface determines the interactions with specific receptors (Fig. 42.1). Secondly, each immune cell type possesses a specific set of pathogen-recognition receptors. Thirdly, changes in the cell-surface distribution of C-type lectins regulate carbohydrate binding by modulating receptor affinity for different ligands. Crosstalk between these receptors results in a network of multimolecular complexes, adding a further level of complexity in pathogen recognition (Cambi and Figdor 2005; Thiel et al. 2006) (see 10.1007/978-3-7091-1065-2_23). MBL deficiency is genetically determined and predisposes to recurrent infections and chronic inflammatory diseases. MBL deficiency has been implicated in susceptibility and course of viral, bacterial, fungal, and protozoan infection. More than 10% of the general population may, depending on definition, be classified as MBL deficient, underlining the redundancy of the immune system. MBL-disease association studies have been a fruitful area of research, which implicates a role for MBL in infective, inflammatory and autoimmune disease processes. MBL deficiency predisposes both to infection by extra-cellular pathogens and to autoimmune disease.
Collapse
|
10
|
Alexopoulos A, Vekiou A, Lycopoulou L, Tavena A, Lagona E, Kakourou T. Kawasaki disease in Greek children: a retrospective study. J Eur Acad Dermatol Venereol 2012; 27:580-8. [DOI: 10.1111/j.1468-3083.2012.04488.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
11
|
Kayiran SM, Dindar A, Gurakan B. An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study. Clinics (Sao Paulo) 2010; 65:1261-5. [PMID: 21340213 PMCID: PMC3020335 DOI: 10.1590/s1807-59322010001200007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 08/28/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute, self-limiting vasculitis of unknown etiology. The incidence of KD is increasing world wide. However, the epidemiological data for KD in Turkey has not been well described. OBJECTIVE To describe the demographic, clinical, and laboratory features of children with KD who were diagnosed and managed in the American Hospital, Istanbul, Turkey. METHOD Patients with KD were retrospectively identified from the hospital discharge records between 2002 and 2010. Atypical cases of KD were excluded. A standardized form was used to collect demographic data, clinical information, echocardiography and laboratory results. RESULTS Thirty-five patients with KD, with a mean age of 2.5 + 1.9 years, were identified. Eighty-five point seven per cent of patients were under 5 years of age. A seasonal pattern favouring the winter months was noticed. In addition to fever and bilateral conjunctival injection, changes in the oral cavity and lips were the most commonly detected clinical signs in our cases. Coronary artery abnormalities were detected in nine patients. The majority of our patients had started treatment with intravenous immunoglobulin in the first 10 days of the onset of fever, and only one patient required systemic steroids for intravenous immunoglobulin-resistant KD. The coronary artery abnormalities resolved in all nine patients within 8 months. CONCLUSION This study is the most comprehensive series of children from Turkey with KD included in Medline. As adult-onset ischemic heart disease may be due to KD in childhood, further prospective clinical investigations are needed to understand the epidemiology, management and long-term follow-up of the disease.
Collapse
|
12
|
Acute cholestasis: atypical onset of Kawasaki disease. Dig Liver Dis 2008; 40:582-4. [PMID: 18055284 DOI: 10.1016/j.dld.2007.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 10/11/2007] [Accepted: 10/17/2007] [Indexed: 12/11/2022]
Abstract
Atypical onset of Kawasaki disease (KD) is a frequent problem leading to diagnostic mistake. Acute cholestasis and liver involvement occur occasionally as minor manifestation of KD. We report the case of a 6-year-old boy presenting fever, jaundice, abdominal pain, and ascites who subsequently developed typical KD clinical pattern just at the same time of echocardiographic coronary arteries anomalies. Abdominal radiological evaluation was normal and seroimmunologic markers resulted negative. Shortly after intravenous immunoglobulin and acetylsalicylic acid administration the clinical features disappeared. KD should be considered in differential diagnosis in children with cholestasis, abdominal pain and fever of unknown etiology.
Collapse
|
13
|
|
14
|
Usta Guc B, Cengiz N, Yildirim SV, Uslu Y. Cytomegalovirus infection in a patient with atypical Kawasaki disease. Rheumatol Int 2007; 28:387-9. [PMID: 17717671 PMCID: PMC7079931 DOI: 10.1007/s00296-007-0440-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 07/29/2007] [Indexed: 11/28/2022]
Abstract
Kawasaki disease (KD) is an acute, febrile, and multisystem vasculitis of early childhood with a striking predilection for the coronary arteries. The most significant complication is coronary artery abnormalities, including coronary aneurysms. The etiology of KD remains unknown. Many infectious agents including viruses have been postulated as possible causes of KD. But standard microbiologic techniques, molecular methods and serologic investigations have failed to identify an etiologic agent. We described a patient with atypical KD during cytomegalovirus infection.
Collapse
Affiliation(s)
- Belgin Usta Guc
- Department of Pediatrics, Faculty of Medicine, Adana Teaching and Medical Research Center, Baskent University, Adana, Turkey.
| | | | | | | |
Collapse
|
15
|
Abstract
The differential diagnosis of a fever and rash presenting in a pediatric patient is quite extensive. This article is not all-inclusive but is meant to aid in the diagnosis to differentiate serious, life-threatening eruptions from more benign common rashes.
Collapse
Affiliation(s)
- Cheryl Aber
- Miller School of Medicine, University of Miami, Department of Dermatology and Cutaneous Surgery, Cedar Medical Center, Miami, Florida 33125, USA.
| | | | | |
Collapse
|
16
|
Falcini F, Cimaz R. Chapter 11 Kawasaki Disease. HANDBOOK OF SYSTEMIC AUTOIMMUNE DISEASES 2007. [PMCID: PMC7148694 DOI: 10.1016/s1571-5078(07)06015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kawasaki disease (KD) is an acute febrile systemic vasculitis usually occurring in children younger than five years, and rarely reported in neonates and adults. This chapter discusses the epidemiology, etiology, pathogenesis, clinical manifestations, and treatments of KD. The etiology still remains unknown, although epidemiological and clinical features strongly suggest an infectious cause. Immunological abnormalities in the acute phase of the disease reflect activation of immune system and marked production of cytokines by activated cells. KD has some similarities to toxin-mediated diseases, both from a clinical and an immunological point of view. The role of one or more superantigens competent of stimulating large numbers of T cells produced by certain strains of Staphylococcus or Streptococcus is discussed in the chapter, in the context of the etiology of KD. Atypical cases are those with fever, acute surgical symptoms, or neurological manifestations as presenting signs. Medical history, physical examination, and laboratory tests including elevated white-blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and low hemoglobin, sodium and albumin levels may help to rule out illnesses mimicking KD. Oral or pulsed corticosteroids in children refractory to intravenous immunoglobulins (IVIG) are an alternative and safe treatment.
Collapse
|
17
|
Kim SA, Jung BS, Yoon JS, Han JW, Lee JS. Influence of vascular endothelial growth factor (VEGF) and endostatin on coronary artery lesions in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.12.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Seon A Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bum Suk Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Whan Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
18
|
Abstract
Vasculitis presents several diagnostic challenges. Firstly, patients could present with protean clinical manifestations with a wide spectrum ranging from isolated cutaneous vasculitis to multisystem involvement. Secondly, there are several medical conditions that could mimic the presentation of vasculitis. The range of differential diagnosis is therefore broad. Thirdly, vasculitis could occur as a primary disorder or be secondary to various medical conditions. It becomes important to differentiate them, as treatment of some forms of vasculitis such as those that are secondary to infection or drugs, is different from that of primary vasculitis. Fourthly, there are several different forms of vasculitis. Some are benign and self limiting, while others have the potential to threaten vital organ function and life. It follows that a rational approach is required during evaluation of patients with suspected vasculitis.
Collapse
Affiliation(s)
- E Suresh
- Rheumatology Department, Kettering General Hospital, Rothwell Road, Kettering NN16 8UZ, UK.
| |
Collapse
|
19
|
Abstract
AIM The diagnosis of Kawasaki disease (KD) in those outside the typical age range (6 months-4 years) is often delayed, potentially worsening prognosis. The features of KD in children<or=6 months and >or=5 years were compared with those presenting within the more typical age distribution. METHODS Korean children with complete diagnostic criteria for KD were grouped according to their age at presentation: Group A (<or=6 months), Group B (7 months-4 years) and Group C (>or=5 years). The clinical features, laboratory findings and outcome in each group were compared. RESULTS Of 136 children presenting to a single centre between 1999 and 2003, 10 children were in Group A, 114 in Group B and 12 in Group C. The mean total fever duration was 8 days in Group C and 6.2 days in Group A (P=0.03). All children in Group C had cervical lymphadenopathy, compared with 50% of Group A and 64% of Group B (P=0.01). Coronary artery lesions were commoner in older children (Group C, 42%) compared with Group B (17%, P=0.05). All children had an equivalent leukocytosis, but Group C had significantly higher neutrophil counts (P=0.001). Group A had significantly lower mean haemoglobin (P=0.003) and total protein (P=0.002) at presentation and a more marked thrombocytosis 1 week after intravenous immunoglobulin therapy (P<0.05). CONCLUSION The clinical and laboratory phenotype of KD varies with age. Older children may have a more marked inflammatory response and worse outcome. Younger children who are treated appropriately may not have a chance to higher risk of coronary artery lesions.
Collapse
Affiliation(s)
- Kyung-Yil Lee
- Department of Paediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
Mannan-binding lectin (MBL) is a plasma protein of the innate immune system with the ability to initiate antimicrobial and inflammatory actions. MBL deficiency is common. More than 10% of the general population may, depending on definition, be classified as MBL deficient, underlining the redundancy of the immune system. Ongoing research attempt to illuminate at which conditions MBL deficiency may lead to disease. With examples, this review illustrates the diversity of results obtained so far.
Collapse
Affiliation(s)
- S Thiel
- Department of Medical Microbiology and Immunology, University of Aarhus, DK8000 Denmark.
| | | | | |
Collapse
|
21
|
Burgner D, Harnden A. Kawasaki disease: what is the epidemiology telling us about the etiology? Int J Infect Dis 2005; 9:185-94. [PMID: 15936970 PMCID: PMC7110839 DOI: 10.1016/j.ijid.2005.03.002] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Revised: 03/14/2005] [Accepted: 03/22/2005] [Indexed: 12/15/2022] Open
Abstract
Kawasaki disease (KD) is an important and common inflammatory vasculitis of early childhood with a striking predilection for the coronary arteries. It is the predominant cause of paediatric acquired heart disease in developed countries. Despite 40 years of research, the aetiology of KD remains unknown and consequently there is no diagnostic test and treatment is non-specific and sub-optimal. The consensus is that KD is due to one or more widely distributed infectious agent(s), which evoke an abnormal immunological response in genetically susceptible individuals. The epidemiology of KD has been extensively investigated in many populations and provides much of the supporting evidence for the consensus regarding etiology. These epidemiological data are reviewed here, in the context of the etiopathogenesis. It is suggested that these data provide additional clues regarding the cause of KD and may account for some of the continuing controversies in the field.
Collapse
Affiliation(s)
- David Burgner
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, GPO Box D184, Perth WA 6840, Australia.
| | | |
Collapse
|