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Bordt EA, Moya HA, Jo YC, Ravichandran CT, Bankowski IM, Ceasrine AM, McDougle CJ, Carlezon WA, Bilbo SD. Gonadal hormones impart male-biased behavioral vulnerabilities to immune activation via microglial mitochondrial function. Brain Behav Immun 2024; 115:680-695. [PMID: 37972878 PMCID: PMC10996880 DOI: 10.1016/j.bbi.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/16/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023] Open
Abstract
There is a strong male bias in the prevalence of many neurodevelopmental disorders such as autism spectrum disorder. However, the mechanisms underlying this sex bias remain elusive. Infection during the perinatal period is associated with an increased risk of neurodevelopmental disorder development. Here, we used a mouse model of early-life immune activation that reliably induces deficits in social behaviors only in males. We demonstrate that male-biased alterations in social behavior are dependent upon microglial immune signaling and are coupled to alterations in mitochondrial morphology, gene expression, and function specifically within microglia, the innate immune cells of the brain. Additionally, we show that this behavioral and microglial mitochondrial vulnerability to early-life immune activation is programmed by the male-typical perinatal gonadal hormone surge. These findings demonstrate that social behavior in males over the lifespan are regulated by microglia-specific mechanisms that are shaped by events that occur in early development.
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Affiliation(s)
- Evan A Bordt
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02129, USA
| | - Haley A Moya
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02129, USA
| | - Young Chan Jo
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02129, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
| | - Caitlin T Ravichandran
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02129, USA; McLean Hospital, Belmont, MA 02478, USA
| | - Izabella M Bankowski
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02129, USA
| | - Alexis M Ceasrine
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
| | - Christopher J McDougle
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02129, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | | | - Staci D Bilbo
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02129, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA.
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2
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Ellul P, Melki I, Antoun S, Lavialle L, Acquaviva E, Aeschlimann FA, Bader-Meunier B, Belot A, Dingulu G, Dumaine C, Faye A, Frémond ML, Meinzer U, Peyre H, Quartier P, Rosenzwajg M, Savioz I, Vinit C, Tchitchek N, Klatzmann D, Delorme R. Early systemic inflammation induces neurodevelopmental disorders: results from ARTEMIS, a French multicenter study of juvenile rheumatisms and systemic autoimmune and auto-inflammatory disorders and meta-analysis. Mol Psychiatry 2023; 28:1516-1526. [PMID: 36747095 DOI: 10.1038/s41380-023-01980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Prenatal immune-mediated events are known risk factors for neurodevelopmental disorders in the offspring (NDD). Although the brain continues to develop for years after birth and many postnatal factors alter the regular trajectory of neurodevelopment, little is known about the impact of postnatal immune factors. To fill this gap we set up ARTEMIS, a cohort of juvenile rheumatisms and systemic autoimmune and auto-inflammatory disorders (jRSAID), and assessed their neurodevelopment. We then complemented our results with a systematic review and meta-analysis. In ARTEMIS, we used unsupervised and supervised analysis to determine the influence of jRSAID age at onset (AO) and delay in introduction of disease-modifying therapy (DMT) on NDD (NCT04814862). For the meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane, and Web of Science up to April 2022 without any restrictions on language, or article type for studies investigating the co-occurence of jRSAID and NDD (PROSPERO- CRD42020150346). 195 patients were included in ARTEMIS. Classification tree isolated 3 groups of patients (i) A low-risk group (AO > 130 months (m)) with 5% of NDD (ii) A medium-risk group (AO < 130 m and DMT < 2 m) with 20% of NDD (iii) and a high-risk-group (AO < 130 m and DMT > 2 m) with almost half of NDD. For the meta-analysis, 18 studies encompassing a total of (i) 46,267 children with jRSAID; 213,930 children with NDD, and 6,213,778 children as controls were included. We found a positive association between jRSAID and NDD with an OR = 1.44 [95% CI 1.31; 1.57] p < 0.0001, [I2 = 66%, Tau2 = 0.0067, p < 0.01]. Several sensitivity analyses were performed without changing the results. Metaregression confirmed the importance of AO (p = 0.005). Our study supports the association between jRSAID and NDD. AO and DMT have pivotal roles in the risk of developing NDD. We plead for systematic screening of NDD in jRSAID to prevent the functional impact of NDD.
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Affiliation(s)
- Pierre Ellul
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France. .,Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France. .,Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.
| | - Isabelle Melki
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France.,Université Paris Cité, Inserm UMR 1163, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Stephanie Antoun
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Laura Lavialle
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Eric Acquaviva
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Florence A Aeschlimann
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Brigitte Bader-Meunier
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Bd Pinel, 68677, Lyon, Bron Cedex, France
| | - Glory Dingulu
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Cecile Dumaine
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Albert Faye
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Marie-Louise Frémond
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Université Paris Cité, Inserm UMR 1163, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Ulrich Meinzer
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Hugo Peyre
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Pierre Quartier
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Michelle Rosenzwajg
- Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France
| | - Isabelle Savioz
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Caroline Vinit
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Nicolas Tchitchek
- Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France
| | - David Klatzmann
- Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France
| | - Richard Delorme
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
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3
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Laukka D, Parkkola R, Hirvonen J, Ylikotila P, Vahlberg T, Salo E, Kivelev J, Rinne J, Rahi M. Brain white matter hyperintensities in Kawasaki disease: A case–control study. Front Neurosci 2022; 16:995480. [PMID: 36330348 PMCID: PMC9623056 DOI: 10.3389/fnins.2022.995480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cerebrovascular involvement of Kawasaki disease (KD) is poorly studied. White matter hyperintensities (WMH) indicate cerebral small vessel disease and increase the risk for stroke. Purpose To investigate whether childhood KD is associated with WMHs and other cerebrovascular findings later in adulthood. Materials and methods In this case-control study, patients diagnosed with KD (cases) at our tertiary hospital between 1978 and 1995 were invited to brain magnetic resonance (MRI) between 2016 and 2017. Migraine patients (controls) with available brain MRI were matched with cases (ratio 4:1) by age (±2 years) and sex. Two blinded neuroradiologists evaluated independently cerebrovascular findings from the brain MRI scans. Modified Scheltens' visual rating scale was used to evaluate WMH burden and the total WMH volume was measured using manual segmentation. Results Mean age [years, (SD)] at the time of brain MRI was 33.3 (3.8) and 32.8 (4.0) for cases (n = 40) and controls (n = 160), respectively (P = 0.53). Mean follow-up time for cases was 29.5 years (4.3). Total volume of WMHs (median) was 0.26 cm3 (IQR 0.34) for cases and 0.065 cm3 (IQR 0.075) for controls, P = 0.039. Cases had higher total WMH burden (P = 0.003), deep WMH burden (P = 0.003), and more periventricular WMHs (prevalence 7.5 vs. 0%, P = 0.008) than controls. Cases had greater risk of having total Scheltens' score ≥2 vs. < 2 (odds ratio, 6.88; 95% CI: 1.84–25.72, P = 0.0041) and ≥3 vs. < 3 (odds ratio, 22.71; 95% CI: 2.57–200.53, P = 0.0049). Diabetes type 1/type 2, hypertension, smoking status or hypercholesterolemia were not risk factors for WMH burden, p > 0.1. Myocarditis at the acute phase of KD increased the risk for periventricular WMHs (P < 0.05). Three cases (7.5%) and three controls (1.9%) had lacune of presumed vascular origin (P = 0.0096). Conclusion History of KD could be associated with an increased WMH burden. More studies are needed to confirm our results.
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Affiliation(s)
- Dan Laukka
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
- *Correspondence: Dan Laukka
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Pauli Ylikotila
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurocenter, Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Eeva Salo
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juri Kivelev
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Jaakko Rinne
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Melissa Rahi
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
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4
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He Y, Ji H, Xie JC, Zhou L. Coronary artery aneurysms caused by Kawasaki disease in an adult: A case report and literature review. World J Clin Cases 2022; 10:10266-10272. [PMID: 36246810 PMCID: PMC9561567 DOI: 10.12998/wjcc.v10.i28.10266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/13/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a self-limiting febrile illness and an acute vasculitis with an unknown origin. It predominantly affects children aged < 5 years. KD is the common cause of acquired heart disease in children. We here report a case of KD in an asymptomatic young female patient diagnosed with multiple coronary aneurysms with calcification.
CASE SUMMARY A 29-year-old female patient admitted to Hangzhou First People's Hospital with coronary artery abnormality identified for 1 wk. The patient was asymptomatic; however, chest computed tomography occasionally revealed strip-like dense shadows in the coronal sulcus. After coronary angiography and Doppler echocardiography, the final diagnosis was coronary artery aneurysms (CAAs) caused by KD. Although the patient was asymptomatic with no history of KD in childhood, the definitive diagnosis was CAAs caused by KD. The patient was administered anticoagulant, and surgical treatment was recommended.
CONCLUSION KD potentially causes CAAs in 25% of untreated cases, primarily occurring in the proximal portions of the coronary arteries.
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Affiliation(s)
- Ying He
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Hao Ji
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jian-Chang Xie
- Department of Cardiology, Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Liang Zhou
- Department of Cardiology, Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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5
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Daniels LB, Roberts S, Moreno E, Tremoulet AH, Gordon JB, Burns JC. Long-term health outcomes in young adults after Kawasaki disease. IJC HEART & VASCULATURE 2022; 40:101039. [PMID: 35573651 PMCID: PMC9096130 DOI: 10.1016/j.ijcha.2022.101039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
Background We compared the long-term health of adults with prior Kawasaki disease (KD) to controls and determined whether outcomes varied by coronary artery (CA) status. Methods We conducted a prospective cohort study of 258 KD subjects (mean 19 ± 9 years since KD) and 148 age-similar controls who completed extensive health questionnaires. KD subjects were divided into 2 groups, Cohort 1: 109 subjects followed since KD diagnosis at our institution; Cohort 2: 149 KD subjects diagnosed elsewhere. Results KD subjects and controls were of similar age at the time of questionnaire completion (p = 0.50). Overall, 128 subjects (including 60 in Cohort 1) reported normal CAs during and after KD. Compared to controls, KD subjects with normal CAs reported several medical conditions with increased prevalence including migraine headaches, shortness of breath, and leg pain with walking, among others. When limited to Cohort 1, KD subjects were significantly more likely to report chest pain (47% vs 16%, p < 0.001) or palpitations (23% vs 10%, p = 0.01) compared to controls. Prevalence of depression was similar (7% vs 5%, p = 0.73). Conclusions Despite always having normal CAs in the acute and subacute phases of KD, young adults with a history of KD with normal coronaries were more likely than controls to experience cardiovascular symptoms. These differences could be influenced by anxiety or depression, but report of depression was similar between groups. Whether these health differences reflect a heightened awareness of symptoms among KD subjects, or underlying vascular pathology (i.e. vasospasm, microvascular dysfunction, other) merits further study.
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6
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Jansson S, Malham M, Wewer V, Rask CU. Psychiatric comorbidity in childhood onset immune-mediated diseases-A systematic review and meta-analysis. Acta Paediatr 2022; 111:490-499. [PMID: 34986519 DOI: 10.1111/apa.16246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/08/2021] [Accepted: 01/04/2022] [Indexed: 12/01/2022]
Abstract
AIM To estimate psychiatric comorbidity in childhood onset immune-mediated inflammatory diseases (IMID). METHODS The PRISMA guidelines were followed, and the protocol was registered at Prospero (ID: CRD42021233890). Literature was searched in PubMed, PsycINFO and Embase. Original papers on prevalence rates of diagnosed psychiatric disorders and/or suicide in paediatric onset inflammatory bowel disease (pIBD), rheumatic diseases (RD) and autoimmune liver diseases were selected. Pooled prevalence rates of psychiatric disorders (grouped according to ICD-10 criteria) within the various IMID were calculated using random-effects meta-analysis. Risk of bias was evaluated by the Newcastle-Ottawa scale. RESULTS Twenty-three studies were included; 13 describing psychiatric disorders in pIBD and 10 in RD. Anxiety and mood disorders were mostly investigated with pooled prevalence rates in pIBD of 6% (95% confidence interval (CI): 4%-9%) and 4% (95%CI: 2%-8%), respectively, in register-based studies, and 33% (95%CI: 25%-41%) and 18% (95%CI: 12%-26%), respectively, in studies using psychiatric assessment. In RD, rates were 13% (95%CI: 12%-15%) for anxiety disorders and 20% (95%CI: 15%-26%) for mood disorders based on psychiatric assessment. CONCLUSION Anxiety and depression are commonly reported in childhood onset IMID. Physicians should be attentive to mental health problems in these patients as they seem overlooked.
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Affiliation(s)
- Sabine Jansson
- The Pediatric Department Copenhagen University Hospital Hvidovre Denmark
- Department of Child and Adolescent Psychiatry Aarhus University Hospital Aarhus Denmark
| | - Mikkel Malham
- The Pediatric Department Copenhagen University Hospital Hvidovre Denmark
- The Pediatric Department Holbaek Hospital Holbaek Denmark
| | - Vibeke Wewer
- The Pediatric Department Copenhagen University Hospital Hvidovre Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Hospital Aarhus Denmark
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7
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Chen DTL, Chang JPC, Cheng SW, Chang HC, Hsu JH, Chang HH, Chiu WC, Su KP. Kawasaki disease in childhood and psychiatric disorders: A population-based case-control prospective study in Taiwan. Brain Behav Immun 2022; 100:105-111. [PMID: 34848339 DOI: 10.1016/j.bbi.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a common childhood acute inflammatory disease and potentially triggers a chronic inflammation. Although some researches have investigated neurodevelopmental consequences following KD, the findings have been inconsistent. This is the first population-based study targeted on KD and common psychiatric disorders. OBJECTIVES We aimed to investigate the association between KD and psychiatric disorders and hypothesized that standard anti-inflammatory treatment by intravenous immunoglobulin (IVIG) may protect against development of psychiatric disorders. METHOD We retrieved data from Taiwan's National Health Insurance Research database (NHIRD). Patients (n = 282,513) with psychiatric disorders (the case group) during 1997-2013 were included, and the control group was matched with age, sex, income and urbanization (1:1). We calculated the prevalence of KD in both groups and estimated odd ratios (ORs) and 95% confidence intervals (CIs) in the subgroup analyses for KD in conditions of age, severity, and common psychiatric comorbidity. RESULTS Numbers of patients with KD were 460 in the cases and 380 in the controls (p = .006), and the crude OR of KD was 1.21 times greater (95% CI = 1.06-1.39, p = .006) in the case than the control groups. KD patients without IVIG treatment (n = 126) were higher in the cases than those in the controls (n = 54), with the OR of 2.33 (95% CI = 1.70-3.21, p < .0001). Subgroup analyses showed that KD survivors were at significant risk for autism spectrum disorders (ASD) (OR = 2.15, 95% CI = 1.27-3.65; p = .005) and attention deficit and hyperactivity disorders (ADHD) (OR = 1.19, 95% CI = 1.02-1.39; p = 0.03), and a trend of increased risk for anxiety disorders (OR = 1.36, 95%CI = 0.99-1.86; p = 0.05). CONCLUSIONS Patients with KD were more likely to have comorbid psychiatric disorders, including ASD and ADHD. Moreover, anti-inflammatory treatment with IVIG may have potential prophylactic effects against the development of psychiatric disorders.
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Affiliation(s)
- Daniel Tzu-Li Chen
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Jane Pei-Chen Chang
- Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedicine, College of Medicine, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Szu-Wei Cheng
- Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hui-Chih Chang
- Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hen-Hong Chang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Chinese Medicine Research Center, China Medical University, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Che Chiu
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan.
| | - Kuan-Pin Su
- Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedicine, College of Medicine, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
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8
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Mauro A, Di Mari C, Casini F, Giani T, Sandini M, Biondi L, Calcaterra V, Zuccotti GV, Bernardo L. Neurological manifestations of Kawasaki disease and multisystem inflammatory syndrome in children associated with COVID-19: A comparison of two different clinical entities. Front Pediatr 2022; 10:1088773. [PMID: 36683824 PMCID: PMC9849814 DOI: 10.3389/fped.2022.1088773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Kawasaki disease (KD) is one of the most frequent idiopathic vasculitis in children, affecting medium- and small-sized vessels. Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 has recently emerged as a new systemic hyperinflammatory condition affecting children some weeks after an acute COVID-19 infection. KD and MIS-C share different aspects and differ in many others: patients affected by MIS-C are usually older, with prominent gastrointestinal manifestations, diffuse adenopathy, extensive conjunctivitis, myocardial damage, leukopenia, and thrombocytopenia at the laboratory exams. Both conditions can present neurological complications. The aim of this manuscript is to provide a narrative review of neurological involvement in KD and MIS-C. A comprehensive review literature has been performed, and the main clinical features have been analyzed, contributing to neurological differential diagnosis.
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Affiliation(s)
- A Mauro
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - C Di Mari
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - F Casini
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - T Giani
- Department of Pediatrics, Anna Meyer Children's Hospital, Florence, Italy
| | - M Sandini
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - L Biondi
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - V Calcaterra
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy.,Department of Pediatrics, Anna Meyer Children's Hospital, Florence, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - G V Zuccotti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - L Bernardo
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
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Lin CH, Lai JN, Lee IC, Chou IC, Lin WD, Lin MC, Hong SY. Kawasaki Disease May Increase the Risk of Subsequent Cerebrovascular Disease. Stroke 2021; 53:1256-1262. [PMID: 34844424 DOI: 10.1161/strokeaha.120.032953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous epidemiological investigations examining the association between Kawasaki disease (KD) and cerebrovascular disease have had conflicting results. We analyzed the association between KD and cerebrovascular disease by conducting a population-based retrospective cohort study designed to investigate the hypothesis that KD could be a risk factor for subsequent cerebrovascular disease. METHODS From the National Health Insurance Research Database of Taiwan, the data of children (aged 0-18 years old) with KD (n=8467) were collected. Starting with the first year of study observation (referred to as the baseline year), data was collected for each child with KD, and 4 non-KD patients matched for sex, urbanization level of residence, and parental occupation were randomly selected to form the non-KD cohort (n=33 868) for our analysis. For the period from January 1, 2000, to December 31, 2012, we calculated the follow-up person-years for each patient, which is the time from the index date to the diagnosis of cerebrovascular disease, death, or the end of 2012. Furthermore, we compared the incidence, the incidence rate ratio, and the 95% CI of cerebrovascular disease between the KD and non-KD cohorts. RESULTS The overall cerebrovascular disease incidence rate was found to be 3.19-fold higher, which is significantly higher, in the KD cohort than in the non-KD cohort (14.73 versus 4.62 per 100 000 person-years), and the overall risk of cerebrovascular disease remained higher in the KD cohort (adjusted hazard ratio, 3.16 [95% CI, 1.46-6.85]). Furthermore, children aged <5 years showed a significantly higher risk of subsequent cerebrovascular disease in the KD cohort (adjusted hazard ratio, 3.14 [95% CI, 1.43-6.92]). CONCLUSIONS This nationwide retrospective cohort study shows that KD may increase the risk of subsequent cerebrovascular disease, especially in those with KD aged <5 years old.
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Affiliation(s)
- Chien-Heng Lin
- Division of Pediatric Pulmonology, China Medical University Children's Hospital, Taichung, Taiwan. (C.-H.L.).,Department of Biomedical Imaging and Radiological Science, College of Medicine, China Medical University, Taichung, Taiwan. (C.-H.L.)
| | - Jung-Nien Lai
- Department of Chinese Medicine, China Medical University Hospital, Taiwan. (J.-N.L.)
| | - Inn-Chi Lee
- Department of Pediatrics, Chung Shan Medical University Hospital and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (I.-C.L.)
| | - I-Ching Chou
- Division of Pediatric Neurology, China Medical University Children's Hospital, Taichung, Taiwan. (I.-C.C., S.-Y.H.).,Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan. (I.-C.C.)
| | - Wei-De Lin
- Department of Medical Research, China Medical University Hospital, Taiwan. (W.-D.L.)
| | - Mei-Chen Lin
- College of Medicine, China Medical University, Taichung, Taiwan. (M.-C.L.).,Management Office for Health Data, China Medical University Hospital, Taiwan. (M.-C.L.)
| | - Syuan-Yu Hong
- Division of Pediatric Neurology, China Medical University Children's Hospital, Taichung, Taiwan. (I.-C.C., S.-Y.H.).,Institute of Biomedicine, School of Medicine, China Medical University, Taichung, Taiwan. (S.-Y.H.).,Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan. (S.-Y.H.)
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Robinson C, Lao F, Chanchlani R, Gayowsky A, Darling E, Batthish M. Long-term hearing and neurodevelopmental outcomes following Kawasaki disease: A population-based cohort study. Brain Dev 2021; 43:735-744. [PMID: 33824025 DOI: 10.1016/j.braindev.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Kawasaki disease (KD) incidence is increasing in Ontario. Cardiovascular sequelae following KD are well-described. However, there are limited data on non-cardiovascular outcomes. OBJECTIVES To determine the risk of hearing loss, anxiety, developmental disorders, intellectual disabilities and attention-deficit/hyperactivity disorder (ADHD) among KD survivors vs. non-exposed children. METHODS We included all Ontario children (≤18 yr) surviving hospitalization with a KD diagnosis between 1995 and 2018, using population-based health administrative databases. We excluded children with prior KD diagnoses and non-residents. KD cases were matched with 100 non-exposed children by age, sex and year. Follow-up continued until death or March 2019. We calculated the prevalence, incidence and adjusted hazard ratios (aHR [95%CI]) of outcomes between 0-1 yr, 1-5 yr, 5-10 yr and >10 yr follow-up. RESULTS Among 4597 KD survivors, 364 (7.9%) were diagnosed with hearing loss, 1213 (26.4%) anxiety disorders, 398 (8.7%) developmental disorders, 51 (1.1%) intellectual disability and 21 (0.5%) ADHD, during median 11 year follow-up. Compared to 459,700 non-exposed children, KD survivors were not at increased risk of hearing loss after adjustment for potential confounders. KD survivors were at increased risk of anxiety disorders between 0-1 yr (aHR 1.75 [1.46-2.10]), 1-5 yr (aHR 1.13 [1.01-1.28]), 5-10 yr (aHR 1.14 [1.03-1.28]) and >10 yr (aHR 1.11 [1.02-1.22]); developmental disorders between 0-1 yr (aHR 1.49 [1.28-1.74]) and 1-5 yr (aHR 1.19 [1.02-1.40]); intellectual disabilities >10 yr (aHR 2.36 [1.36-4.10]); and ADHD >10 yr (aHR 2.01 [1.14-3.57]). CONCLUSIONS KD survivors are at increased risk of being diagnosed with anxiety disorders sooner, being diagnosed with developmental disorders between 0 and 5 yr and being diagnosed with intellectual disabilities or ADHD >10 yr after KD diagnosis. This may justify enhanced developmental and audiological surveillance of KD survivors.
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Affiliation(s)
- Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Francis Lao
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; ICES McMaster, Hamilton, Ontario, Canada
| | | | - Elizabeth Darling
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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11
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Lin CH, Lai JN, Lee IC, Chou IC, Lin WD, Lin MC, Hong SY. Association Between Kawasaki Disease and Childhood Epilepsy: A Nationwide Cohort Study in Taiwan. Front Neurol 2021; 12:627712. [PMID: 33889123 PMCID: PMC8055829 DOI: 10.3389/fneur.2021.627712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Kawasaki disease is a common vasculitis of childhood in East Asia. The complications following Kawasaki disease mostly included cardiovascular sequelae; non-cardiac complications have been reported but less studied. This study investigated potential epilepsy following Kawasaki disease in Taiwanese children. Objectives: Through National Health Insurance Research Database, we retrospectively analyzed the data of children aged <18 years with clinically diagnosed Kawasaki disease from January 1, 2000 to December 31, 2012 in Taiwan. These patients were followed up to estimate the incidence of epilepsy in the Kawasaki cohort in comparison with that in the non-Kawasaki cohort in Taiwan. Results: A total of 8,463 and 33,872 patients in the Kawasaki and non-Kawasaki cohorts were included in the study, respectively. Of the total eligible study subjects, 61.1% were boys and 38.9% were girls; most patients with newly diagnosed Kawasaki disease were aged <5 years [88.1%]. Patients with Kawasaki disease showed a higher incidence rate [47.98 vs. 27.45 every 100,000 person years] and significantly higher risk [adjusted hazard ratio = 1.66, 95% confidence interval = 1.13–2.44] of epilepsy than those without the disease. Additionally, female sex [adjusted hazard ratio = 2.30, 95% confidence interval = 1.31–4.04] and age <5 years [adjusted hazard ratio = 1.82, 95% confidence interval = 1.22–2.72] showed a significantly higher risk of epilepsy in the Kawasaki cohort. Conclusion: Results revealed a higher incidence rate and significant risk of epilepsy in Taiwanese children with Kawasaki disease than in those without the disease. Therefore, children diagnosed with Kawasaki disease are recommended follow-up as they have a high risk of epilepsy and seizure disorders.
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Affiliation(s)
- Chien-Heng Lin
- Division of Pediatrics Pulmonology, China Medical University, Children's Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Inn-Chi Lee
- Department of Pediatrics, School of Medicine, Chung Shan Medical University Hospital and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - I-Ching Chou
- Division of Pediatrics Neurology, China Medical University, Children's Hospital, Taichung, Taiwan.,College of Chinese Medicine, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Wei-De Lin
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Syuan-Yu Hong
- Division of Pediatrics Neurology, China Medical University, Children's Hospital, Taichung, Taiwan
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12
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Moretti A. Are TNF-α blockers effective and safe for Kawasaki disease in children? A Cochrane Review summary with commentary. Int J Rheum Dis 2020; 23:1252-1254. [PMID: 32761848 DOI: 10.1111/1756-185x.13884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
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13
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Huang PY, Huang YH, Guo MMH, Chang LS, Kuo HC. Kawasaki Disease and Allergic Diseases. Front Pediatr 2020; 8:614386. [PMID: 33490002 PMCID: PMC7817814 DOI: 10.3389/fped.2020.614386] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Kawasaki disease (KD) is an inflammatory disorder with an unknown etiology. It is the leading cause of acquired heart disease, which leads to coronary vasculitis among children. Studies of frequent manifestation of allergic diseases in children with KD have been the subject of mounting clinical interest. However, evidence supporting the association between KD and allergies has yet to be systematically reviewed. Methods: In this article, we reviewed current literature regarding the association between KD and allergic diseases. References for this review were identified through searches of PubMed, Cochrane, and Embase through the end of August 2020. Results: The results of the analyses of immune repertoire, clinical, and epidemiological studies have indicated some of the characteristics of infectious disease for KD. Although some allergic disorders, such as asthma, may be exacerbated by viral infections, allergies are typically caused by an allergen that triggers an immune response, with the potential involvement of type 2 inflammation and immune disturbances leading to tissue remodeling in genetically susceptible hosts. The effect of intravenous immunoglobulin is multi-faceted and results in a decrease in activating Fc gamma receptor IIA and an increase in anti-inflammatory eosinophils. The findings from this review demonstrate that children who have suffered from KD are more likely to have allergic rhinitis than the general population and their siblings, a condition that lasts until the age of 17. When followed up as teenagers and adults, children with KD are more likely to develop urticaria. Conclusions: This review supports that allergic diseases, such as allergic rhinitis, have been demonstrated to increase following KD. Therefore, the importance of allergic diseases in patients with KD should be emphasized in long-term care. Interventions that include strategies for managing allergies in children with KD would be beneficial.
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Affiliation(s)
- Po-Yu Huang
- Department of Traditional Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kawasaki Disease Center, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Mindy Ming-Huey Guo
- Department of Pediatrics, Kawasaki Disease Center, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kawasaki Disease Center, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kawasaki Disease Center, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan.,Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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