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Leon-Jimenez P, Lorenzo-Martin M, Tomatis-Souverbielle C, Akoghlanian S, Cripe L, Ramilo O, Mejias A. Pan-valvulitis in Children With Kawasaki Disease: A Case Report and Review of the Literature. Pediatr Infect Dis J 2024; 43:e100-e103. [PMID: 38063514 DOI: 10.1097/inf.0000000000004203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
We present a rare case of pan-valvular involvement in a 5-month-old female with Kawasaki disease shock syndrome despite early treatment with intravenous immunoglobulin and corticosteroids. She experienced a favorable outcome after the addition of infliximab, which was guided based on clinical, laboratory and echocardiogram findings, rather than recrudescence of fever, the most common indicator of intravenous immunoglobulin resistance.
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Affiliation(s)
| | | | - Cristiana Tomatis-Souverbielle
- From the Division of Infectious Diseases, Nationwide Children's Hospital
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine
| | | | - Linda Cripe
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Octavio Ramilo
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Asuncion Mejias
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
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2
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Zhang M, Wang C, Li Q, Wang H, Li X. Risk factors and an early predictive model for Kawasaki disease shock syndrome in Chinese children. Ital J Pediatr 2024; 50:22. [PMID: 38310292 PMCID: PMC10837898 DOI: 10.1186/s13052-024-01597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Kawasaki disease shock syndrome (KDSS), though rare, has increased risk for cardiovascular complications. Early diagnosis is crucial to improve the prognosis of KDSS patients. Our study aimed to identify risk factors and construct a predictive model for KDSS. METHODS This case-control study was conducted from June, 2015 to July, 2023 in two children's hospitals in China. Children initially diagnosed with KDSS and children with Kawasaki disease (KD) without shock were matched at a ratio of 1:4 by using the propensity score method. Laboratory results obtained prior to shock syndrome and treatment with intravenous immunoglobulin were recorded to predict the onset of KDSS. Univariable logistic regression and forward stepwise logistic regression were used to select significant and independent risk factors associated with KDSS. RESULTS After matching by age and gender, 73 KDSS and 292 KD patients without shock formed the development dataset; 40 KDSS and 160 KD patients without shock formed the validation dataset. Interleukin-10 (IL-10) > reference value, platelet counts (PLT) < 260 × 109/L, C-reactive protein (CRP) > 80 mg/ml, procalcitonin (PCT) > 1ng/ml, and albumin (Alb) < 35 g/L were independent risk factors for KDSS. The nomogram model including the above five indicators had area under the curves (AUCs) of 0.91(95% CI: 0.87-0.94) and 0.90 (95% CI: 0.71-0.86) in the development and validation datasets, with a specificity and sensitivity of 80% and 86%, 66% and 77%, respectively. Calibration curves showed good predictive accuracy of the nomogram. Decision curve analyses revealed the predictive model has application value. CONCLUSIONS This study identified IL-10, PLT, CRP, PCT and Alb as risk factors for KDSS. The nomogram model can effectively predict the occurrence of KDSS in Chinese children. It will facilitate pediatricians in early diagnosis, which is essential to the prevention of cardiovascular complications.
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Affiliation(s)
- Mingming Zhang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
| | - Congying Wang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
- Department of Cardiology, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Qirui Li
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Hongmao Wang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
| | - Xiaohui Li
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China.
- Department of Cardiology, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
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3
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Robinson LA, Dale M, Gorelik M. Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: A Spectrum of Postinfectious Hyperinflammatory Disease. Rheum Dis Clin North Am 2023; 49:661-678. [PMID: 37331739 DOI: 10.1016/j.rdc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Kawasaki disease and multisystem inflammatory syndrome in children are hyperinflammatory conditions that share similar emerging pathophysiology hypotheses, clinical features, treatment strategies, and outcomes. Although both conditions have key differences, growing evidence suggests that both conditions might be closely related on a larger spectrum of postinfectious autoimmune responses.
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Affiliation(s)
- Lauren Ambler Robinson
- Department of Medicine, Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA; Department of Pediatric Rheumatology, 535 East 70th Street, New York, NY 10021, USA
| | - Marissa Dale
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Morgan Stanley Children's Hospital, 3959 Broadway Central 5th Floor, New York, NY 10032, USA
| | - Mark Gorelik
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Medical Center, College of Physicians and Surgeons Building, P&S 10-451, 630 West 168th Street, New York NY 10032, USA.
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4
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Galeotti C, Bajolle F, Belot A, Biscardi S, Bosdure E, Bourrat E, Cimaz R, Darbon R, Dusser P, Fain O, Hentgen V, Lambert V, Lefevre-Utile A, Marsaud C, Meinzer U, Morin L, Piram M, Richer O, Stephan JL, Urbina D, Kone-Paut I. French national diagnostic and care protocol for Kawasaki disease. Rev Med Interne 2023:S0248-8663(23)00647-1. [PMID: 37349225 DOI: 10.1016/j.revmed.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
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Affiliation(s)
- C Galeotti
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - F Bajolle
- M3C-Necker-Enfants-Malades, hôpital Necker-Enfants-Malades, université de Paris Cité, Paris, France
| | - A Belot
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - S Biscardi
- Service des urgences pédiatriques, centre hospitalier intercommunal de Créteil, Créteil, France
| | - E Bosdure
- Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 13385 Marseille cedex 5, France
| | - E Bourrat
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - R Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Department of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - R Darbon
- Association France vascularites, Blaisy-Bas, France
| | - P Dusser
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - O Fain
- Service de médecine interne, hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - V Hentgen
- Service de pédiatrie, centre de référence des maladies auto-inflammatoires et de l'amylose (CEREMAIA), centre hospitalier de Versailles, Le Chesnay, France
| | - V Lambert
- Service de radiologie pédiatrique, Institut mutualiste Montsouris, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - A Lefevre-Utile
- Service de pédiatrie générale et des urgences pédiatriques, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - C Marsaud
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - U Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Morin
- Service de réanimation pédiatrique et néonatale, DMU 3 santé de l'enfant et adolescent, hôpital Bicêtre, université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - M Piram
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, Quebec, Canada
| | - O Richer
- Service des urgences pédiatriques, hôpital universitaire de Pellegrin, Bordeaux, France
| | - J-L Stephan
- Service de pédiatrie, CHU Saint-Étienne, Saint-Étienne, France
| | - D Urbina
- Service d'accueil des urgences pédiatriques, hôpital Nord, AP-HM, 13005 Marseille, France
| | - I Kone-Paut
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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Conte C, Sogni F, Rigante D, Esposito S. An Update on Reports of Atypical Presentations of Kawasaki Disease and the Recognition of IVIG Non-Responder Children. Diagnostics (Basel) 2023; 13:diagnostics13081441. [PMID: 37189542 DOI: 10.3390/diagnostics13081441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Kawasaki disease (KD) is an acute vasculitis with an intrinsic risk of severe involvement of coronary arteries. The worldwide spread of KD and the importance of early diagnosis for preventing cardiovascular complications have ascertained the need for updating guidelines for prompt disease recognition and treatment efficacy assessment. All KD patients who comply with the definition of classic or atypical disease should be treated with intravenous immunoglobulin (IVIG) soon after diagnosis. The objective of our narrative review was to analyze the medical literature about case reports with atypical KD in relation to diagnosis and potential identification of predictors of non-responsiveness to IVIG. Our analysis has shown that the seminal challenge in KD management is the timeliness of diagnosis, although both extreme variability and transience of clinical manifestations make this goal difficult. A non-negligible percentage of patients, especially in the first 6 months of life, might have atypical manifestations of KD, whose painstaking differential diagnosis may be tricky. Many attempts to develop universal scoring systems and detect children at higher risk of IVIG resistance have been rather unsuccessful. Additionally, KD may show different evolutions according to unraveled demographic, genetic, or epigenetic factors. Further research is needed to elucidate all open questions about KD and clarify the long-term outcome of its potential complications.
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Affiliation(s)
- Cristiano Conte
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy
| | - Francesco Sogni
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy
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COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry. Pediatr Cardiol 2023:10.1007/s00246-023-03109-w. [PMID: 36786810 PMCID: PMC9926414 DOI: 10.1007/s00246-023-03109-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [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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7
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Zhang HY, Xiao M, Zhou D, Yan F, Zhang Y. Platelet and ferritin as early predictive factors for the development of macrophage activation syndrome in children with Kawasaki disease: A retrospective case-control study. Front Pediatr 2023; 11:1088525. [PMID: 36873655 PMCID: PMC9977190 DOI: 10.3389/fped.2023.1088525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To investigate the early predictive factors for Kawasaki disease complicated with macrophage activation syndrome (KD-MAS). METHODS We performed a retrospective case-control study in children with KD from August 2017 to August 2022, involving 28 cases with KD-MAS and 112 cases not developing KD-MAS. Based on the univariate analysis, binary logistic regression was used to identify the early predictive factors for KD-MAS development, and the receiver operating characteristic curve (ROC) analysis was carried out to obtain the optimal cut-off value. RESULTS Two predictive factors were associated with the development of KD-MAS, which were PLT (OR = 1.013, 95%CI, 1.001-1.026), and serum ferritin (OR = 0.991, 95%CI, 0.982-0.999). The cut-off value of PLT was 110 × 109/L, and the cut-off value of serum ferritin was 548.4 ng/ml. CONCLUSION Children with KD who had a PLT count under 110 × 109/L, and a serum ferritin level over 548.4 ng/ml are more likely to develop KD-MAS.
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Affiliation(s)
- Hua-Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Min Xiao
- Department of Rheumatology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Dan Zhou
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Fan Yan
- Department of Critical Care Medicine, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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8
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Yi C, She X, Chen J. Kawasaki disease complicated with shock syndrome, macrophage activation syndrome, and acute abdomen in children: Two case reports. Front Pediatr 2023; 11:1152242. [PMID: 37152308 PMCID: PMC10160470 DOI: 10.3389/fped.2023.1152242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis that can involve multiple organs. Few reports have been published about KD patients presenting with multiple complications such as acute abdomen, KD shock syndrome (KDSS), and macrophage activation syndrome (MAS). Case Description We present the cases of two males (9 and 12 years old) diagnosed with KD accompanied by rare manifestations. Case 1 is a 9-year-old male treated for acute appendicitis, KDSS, and MAS. Case 2 is a 12-year-old male who presented with KDSS, MAS, and an ileal perforation. They were treated with intravenous immunoglobulin, aspirin, high-dose corticosteroids, vasoactive drugs, and symptomatic treatment, with good outcomes. Conclusions Clinicians should be aware of the possibility of KD in the presence of fever and unusual manifestations, such as severe inflammatory indicators and acute abdomen that is nonresponsive to antibiotic therapy. Meanwhile, KD-related unusual complications should be recognized, such as KDSS and MAS.
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Affiliation(s)
| | | | - Jia Chen
- Correspondence: Jia Chen Xiang She
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Biesbroek G, Kapitein B, Kuipers IM, Gruppen MP, van Stijn D, Peros TE, van Veenendaal M, Jansen MHA, van der Zee CW, van der Kuip M, von Asmuth EGJ, Mooij MG, den Boer MEJ, Landman GW, van Houten MA, Schonenberg-Meinema D, Tutu van Furth AM, Boele van Hensbroek M, Scherpbier H, van Meijgaarden KE, Ottenhoff THM, Joosten SA, Ketharanathan N, Blink M, Brackel CLH, Zaaijer HL, Hombrink P, van den Berg JM, Buddingh EP, Kuijpers TW. Inflammatory responses in SARS-CoV-2 associated Multisystem Inflammatory Syndrome and Kawasaki Disease in children: An observational study. PLoS One 2022; 17:e0266336. [PMID: 36449533 PMCID: PMC9710748 DOI: 10.1371/journal.pone.0266336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/19/2022] [Indexed: 12/05/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe inflammatory disease in children related to SARS-CoV-2 with multisystem involvement including marked cardiac dysfunction and clinical symptoms that can resemble Kawasaki Disease (KD). We hypothesized that MIS-C and KD might have commonalities as well as unique inflammatory responses and studied these responses in both diseases. In total, fourteen children with MIS-C (n=8) and KD (n=6) were included in the period of March-June 2020. Clinical and routine blood parameters, cardiac follow-up, SARS-CoV-2-specific antibodies and CD4+ T-cell responses, and cytokine-profiles were determined in both groups. In contrast to KD patients, all MIS-C patients had positive Spike protein-specific CD3+CD4+ T-cell responses. MIS-C and KD patients displayed marked hyper-inflammation with high expression of serum cytokines, including the drug-targetable interleukin (IL)-6 and IFN-γ associated chemokines CXCL9, 10 and 11, which decreased at follow-up. No statistical differences were observed between groups. Clinical outcomes were all favourable without cardiac sequelae at 6 months follow-up. In conclusion, MIS-C and KD-patients both displayed cytokine-associated hyper-inflammation with several high levels of drug-targetable cytokines.
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Affiliation(s)
- G. Biesbroek
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - B. Kapitein
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - I. M. Kuipers
- Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M. P. Gruppen
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - D. van Stijn
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - T. E. Peros
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M. van Veenendaal
- Department of Pediatric Immunology and Infectious Disease, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. H. A. Jansen
- Department of Pediatric Immunology and Infectious Disease, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - M. van der Kuip
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - E. G. J. von Asmuth
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - M. G. Mooij
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - M. E. J. den Boer
- Department of Pediatrics, Medical Spectrum Twente, Enschede, The Netherlands
| | - G. W. Landman
- Department of Internal medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - M. A. van Houten
- Department of Pediatrics, Spaarne Hospital, Haarlem, The Netherlands
| | - D. Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - A. M. Tutu van Furth
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M. Boele van Hensbroek
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - H. Scherpbier
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - K. E. van Meijgaarden
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - T. H. M. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - S. A. Joosten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - N. Ketharanathan
- Department of Pediatric Surgery and Intensive Care, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - M. Blink
- Pediatric Intensive Care Unit, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - C. L. H. Brackel
- Department of Pediatrics, Hilversum, The Netherlands
- Department of Pediatric Pulmonology, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - H. L. Zaaijer
- Department of Virology, Sanquin Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - P. Hombrink
- Department of Blood Cell Research, Sanquin Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - J. M. van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - E. P. Buddingh
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - T. W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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10
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Sadat Larijani M, Ashrafian F, Bagheri Amiri F, Banifazl M, Bavand A, Karami A, Asgari Shokooh F, Ramezani A. Characterization of long COVID-19 manifestations and its associated factors: A prospective cohort study from Iran. Microb Pathog 2022; 169:105618. [PMID: 35690233 PMCID: PMC9176176 DOI: 10.1016/j.micpath.2022.105618] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 11/02/2022]
Abstract
The prevalence and variety complaints of COVID-19 cases in a long term have been investigated in recent studies. The symptoms over the time are various and unpredictable which may persist several weeks after full recovery. The importance of long-COVID-19 manifestations includes its effect on the recovered cases which requires a rational management based on an accurate guideline to handle post-acute COVID-19 state. The aim of this study was to evaluate the incidence of post-acute COVID-19 syndrome and to identify the associated risk factors as well as to compare new and persistent symptoms at different post-acute phases. Totally 254 individuals from Pasteur Institute of Iran (or/and their relatives) were investigated who had a previously confirmed COVID-19 PCR test. The long-term manifestations of the virus were categorized through a time window as acute, ongoing, post-COVID and persistent phases and the individuals were assessed by the face-to-face or the phone call interview according to their complaints. The data were then statistically analyzed to determine the frequency of the symptoms and also the associated factors in which a p value < 0.05 was considered significant. Except a small asymptotic group of five, 249 cases progressed the symptoms to acute phase among which 64.1% reported at least one symptom in post-acute phase. Neurological sequelae were found as the most frequent symptom (91.6%). Furthermore, there was a significant association between the underlying diseases, age and acute phase symptoms to the post-acute phase syndrome susceptibility (p < 0.05). In conclusion, the increasing number of the reports and studies on long COVID-19 which can hugely affect the life quality should be more investigated and explored in terms of the pathophysiology to achieve appropriate treatments in time. The clusters of symptoms, specially a combination of neurological signs, presenting over months after the recovery impose a huge difficulty to the recovered population.
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Affiliation(s)
| | | | - Fahimeh Bagheri Amiri
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.
| | - Mohammad Banifazl
- Iranian Society for Support of Patients with Infectious Disease, Tehran, Iran.
| | - Anahita Bavand
- Clinical Research Dept., Pasteur Institute of Iran, Tehran, Iran.
| | - Afsaneh Karami
- Department of Infectious Disease, Zanjan University of Medical Sciences, Zanjan, Iran.
| | | | - Amitis Ramezani
- Clinical Research Dept., Pasteur Institute of Iran, Tehran, Iran.
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Sartori LF, Balamuth F. Multisystem Inflammatory Syndrome in Children: Examining Emerging Data and Identifying Key Knowledge Gaps. Pediatr Emerg Care 2022; 38:83-91. [PMID: 35100745 PMCID: PMC8855966 DOI: 10.1097/pec.0000000000002633] [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] [Indexed: 02/03/2023]
Abstract
ABSTRACT Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of abnormal immune response after severe acute respiratory syndrome coronavirus 2 infection that can result in organ dysfunction including severe cardiovascular compromise in children. Increased evidence supports a clinical and laboratory profile in MIS-C distinct from Kawasaki disease, with MIS-C typically occurring in older children and with more prominent gastrointestinal and neurologic symptoms, as well as increased inflammation, lymphopenia, and cardiac injury on laboratory testing. However, high-level evidence regarding best practices for treatment and long-term outcomes in MIS-C is limited.
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Affiliation(s)
- Laura F Sartori
- From the Assistant Professor and Associate Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; and Division of Pediatric Emergency Medicine and Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA
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Zhang H, Zheng Q, Li F. Comparison of Clinical Features and Inflammatory Markers between Kawasaki Disease Shock Syndrome and Kawasaki Disease without Shock: A Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1486089. [PMID: 34966519 PMCID: PMC8712158 DOI: 10.1155/2021/1486089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
Since the shock is not a common symptom of KD, it is often misdiagnosed at the beginning of the pathogenesis of KDSS. The language searched was only Chinese and English. Data from the articles were screened and extracted for meta-analysis using Stata16.0 software. A total of 9 cohort studies, including 1231 patients, were included in this meta-analysis. The results of meta-analysis showed that the age of the children in the KDSS group was higher than that in the KD group without shock, and the difference was statistically significant (SMD = 1.15, 95% CI (0.52, 1.78), P < 0.05); the CRP content in the KDSS group was higher than that in the KD group without shock, and the difference was statistically significant (SMD = 1.99, 95% CI (0.72, 3.26), P < 0.05); the albumin content in the KDSS group was lower than that in the KD group without shock, and the difference was statistically significant (SMD = -1.26, 95% CI (-1.85,-0.67), P < 0.05); the AST content in the KDSS group was higher than that in the KD group without shock, and the difference was statistically significant (WMD = 25.95, 95% CI (15.14, 36.75), P < 0.05); the difference had statistical significance (RR = 3.50, 95% CI (2.30, 5.32), P < 0.05); meta-analysis results of type of KD, fever duration, WBC count, ESR, ALT, and other outcome measures showed that there was no significant difference between KDSS and KD without shock (P > 0.05). Compared with KD without shock, children with KDSS are older and have a higher incidence of coronary artery disease, serum CRP, and AST, but albumin is lower than KD without shock. According to these characteristics, it may be helpful for the early identification of KDSS.
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Affiliation(s)
- Hui Zhang
- Department of Pediatrics, The Central Hospital of Jiangjin, Jiangjin, Chongqing, China
- Department of Pediatrics, Chongqing University Jiangjin Hospital, Jiangjin, Chongqing, China
| | - Qin Zheng
- Department of Pediatrics, The Central Hospital of Jiangjin, Jiangjin, Chongqing, China
- Department of Pediatrics, Chongqing University Jiangjin Hospital, Jiangjin, Chongqing, China
| | - Feng Li
- Department of Pediatrics, The Central Hospital of Jiangjin, Jiangjin, Chongqing, China
- Department of Pediatrics, Chongqing University Jiangjin Hospital, Jiangjin, Chongqing, China
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13
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Tsujioka Y, Handa A, Nishimura G, Miura M, Yokoyama K, Sato K, Handa H, Jinzaki M, Nosaka S, Kono T. Multisystem Imaging Manifestations of Kawasaki Disease. Radiographics 2021; 42:268-288. [PMID: 34826255 DOI: 10.1148/rg.210070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Kawasaki disease (KD) is a common pediatric vasculitis syndrome involving medium- and small-sized arteries that is especially prevalent in early childhood (ie, age 6 months to 5 years). The diagnosis of KD is made on the basis of clinical features, such as fever, characteristic mucocutaneous changes, and nonsuppurative cervical lymphadenopathy. However, early diagnosis is often challenging because many children with KD present with atypical symptoms. The most serious complication of KD is coronary artery aneurysm caused by coronary arteritis. Prompt intravenous immunoglobulin therapy reduces the risk of cardiac morbidity. In addition, the systemic extension of KD-related vasculitis during the acute phase causes a variety of multisystem manifestations, including encephalopathy, stroke, retropharyngeal edema, pericarditis, myocarditis, KD shock syndrome, pulmonary lesions, intestinal pseudo-obstruction, gallbladder hydrops, arthritis, and myositis. These complications tend to be more common in affected children with atypical presentation. Radiologists can play an important role in the timely identification of diverse KD-associated morbidities and thus may contribute to the early diagnosis of atypical KD. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Yuko Tsujioka
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Atsuhiko Handa
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Gen Nishimura
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Masaru Miura
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Koji Yokoyama
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Kozo Sato
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Hideo Handa
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Masahiro Jinzaki
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Shunsuke Nosaka
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
| | - Tatsuo Kono
- From the Departments of Radiology (Y.T., T.K.) and Cardiology (M.M.), Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., M.J.); Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.H.); Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (A.H.); Center for Intractable Diseases, Saitama University Hospital, Saitama, Japan (G.N.); Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan (K.Y.); Department of Radiology, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan (K.S.); Department of Neurology, Chiba University School of Medicine, Chiba, Japan (H.H.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (S.N.)
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Cherqaoui B, Koné-Paut I, Yager H, Bourgeois FL, Piram M. Delineating phenotypes of Kawasaki disease and SARS-CoV-2-related inflammatory multisystem syndrome: a French study and literature review. Rheumatology (Oxford) 2021; 60:4530-4537. [PMID: 33493353 PMCID: PMC7928644 DOI: 10.1093/rheumatology/keab026] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023] Open
Abstract
Objective To better define the clinical distinctions between the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related paediatric inflammatory multisystem syndrome (PIMS) and Kawasaki disease (KD). Methods We compared three groups of patients: group 1, cases from our national historic KD database (KD-HIS), before the SARS-CoV-2 pandemic; group 2, patients with KD admitted to an intensive care unit (KD-ICU) from both our original cohort and the literature, before the SARS-CoV-2 pandemic; and group 3, patients with PIMS from the literature. Results KD-HIS included 425 patients [male:female ratio 1.3, mean age 2.8 years (s.d. 2.4)], KD-ICU 176 patients [male:female ratio 1.3, mean age 3.5 years (s.d. 3.1)] and PIMS 404 patients [male:female ratio 1.4, mean age 8.8 years (s.d. 3.7)]. As compared with KD-HIS patients, KD-ICU and PIMS patients had a higher proportion of cardiac failure, digestive and neurological signs. KD-ICU and PIMS patients also had a lower frequency of typical KD-mucocutaneous signs, lower platelet count, higher CRP and lower sodium level. As compared with KD-HIS and KD-ICU patients, PIMS patients were older and more frequently had myocarditis; they also had fewer coronary abnormalities and lower sodium levels. Unresponsiveness to IVIG was more frequent in KD-ICU than KD-HIS and PIMS patients. Conclusion On clinical grounds, KD-HIS, KD-ICU and PIMS might belong to a common spectrum of non-specific pathogen-triggered hyperinflammatory states. The causes of increasing inflammation severity within the three entities and the different effects on the heart remain to be determined.
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Affiliation(s)
- Bilade Cherqaoui
- Paediatric Rheumatology, APHP.,CEREMAIA, French Reference Centre for Auto-Inflammatory Diseases and Inflammatory Amyloidosis, CHU Bicêtre, Le Kremlin-Bicêtre.,University of Paris-Saclay, INSERM, UMR 1173, Infection and Inflammation, Montigny-Le-Bretonneux
| | - Isabelle Koné-Paut
- Paediatric Rheumatology, APHP.,CEREMAIA, French Reference Centre for Auto-Inflammatory Diseases and Inflammatory Amyloidosis, CHU Bicêtre, Le Kremlin-Bicêtre.,University of Paris-Saclay
| | | | | | - Maryam Piram
- CEREMAIA, French Reference Centre for Auto-Inflammatory Diseases and Inflammatory Amyloidosis, CHU Bicêtre, Le Kremlin-Bicêtre.,University of Paris-Saclay.,Paediatric Dermatology, CHU Sainte Justine Research Centre, University of Montreal, Montreal, Canada
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15
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Kawasaki Disease Shock Syndrome vs Classical Kawasaki Disease: A Meta-analysis and Comparison With SARS-CoV-2 Multisystem Inflammatory Syndrome. Can J Cardiol 2021; 37:1619-1628. [PMID: 34090979 PMCID: PMC8180353 DOI: 10.1016/j.cjca.2021.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The emergence of increasing reports worldwide of a severe inflammatory process and shock in pediatric patients resembling Kawasaki disease (KD)-and, more specifically, Kawasaki disease shock syndrome (KDSS)-prompted us to explore KDSS in a preamble of a systematic comparison between the 2 conditions. METHODS We completed a systematic review of KDSS and performed a meta-analysis comparison between reported KDSS cases and KD controls. RESULTS A total of 10 case-control series were included in the meta-analysis. Patients with KDSS were older (38.4 ± 30.6 vs 21.9 ± 19.5 months; P < 0.001) compared with standard KD with equal sex distribution and completeness of clinical diagnostic criteria. KDSS present higher C-reactive protein (59.4 ± 29.2 mg/dL vs 20.8 ± 14.8 mg/dL; P < 0.001), lower albumin (2.7 ± 0.5 g/dL vs 3.3 ± 0.5 g/dL; P < 0.01), and lower platelets (255 ± 149 109/L vs 394 ± 132 109/L; P < 0.001) but only borderline higher white blood cells (P = 0.06). Differences in alanine transaminase, aspartate aminotransferase, and erythrocyte sedimentation rate were nonsignificant. The odds of intravenous immunoglobulin resistance (44.4% vs 9.6%; (P < 0.001) and the hospital length of stay (10.9 ± 5.8 vs 5.0 ± 3.0 days; P < 0.001) were higher in KDSS, as were the odds of coronary-artery abnormalities (33.9% vs 8.6%; P < 0.001). CONCLUSIONS This first meta-analysis on KDSS vs KD represents a basis for future works on KDSS and opens the opportunity for future multicentre studies in the search of causal relationships between presenting elements and the eventual complications of KDSS. The similarities between SARS-CoV-2 multisystem inflammatory syndrome in children and KDSS open new horizons to the understanding of the etiology and pathophysiology related to KDSS.
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Complement 3 and the Prognostic Nutritional Index Distinguish Kawasaki Disease from Other Fever Illness with a Nomogram. CHILDREN-BASEL 2021; 8:children8090825. [PMID: 34572257 PMCID: PMC8466424 DOI: 10.3390/children8090825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022]
Abstract
Objective: This study aimed to establish a model to distinguish Kawasaki disease (KD) from other fever illness using the prognostic nutritional index (PNI) and immunological factors. Method: We enrolled a total of 692 patients (including 198 with KD and 494 children with febrile diseases). Of those, 415 patients were selected to be the training group and 277 patients to be the validation group. Laboratory data, including the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the prognostic nutritional index (PNI), and immunological factors, were retrospectively collected for an analysis after admission. We used univariate and multivariate logistic regressions and nomograms for the analysis. Result: Patients with KD showed significantly higher C3 and a lower PNI. After a multivariate logistic regression, the total leukocyte count, PNI, C3, and NLR showed a significance (p < 0.05) and then performed well with the nomogram model. The areas under the ROC in the training group and the validation group were 0.858 and 0.825, respectively. The calibration curves of the two groups for the probability of KD showed a near agreement to the actual probability. Conclusions: Compared with children with febrile diseases, patients with KD showed increased C3 and a decreased nutritional index of the PNI. The nomogram established with these factors could effectively identify KD from febrile illness in children.
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Godfred-Cato S, Tsang CA, Giovanni J, Abrams J, Oster ME, Lee EH, Lash MK, Le Marchand C, Liu CY, Newhouse CN, Richardson G, Murray MT, Lim S, Haupt TE, Hartley A, Sosa LE, Ngamsnga K, Garcia A, Datta D, Belay ED. Multisystem Inflammatory Syndrome in Infants <12 months of Age, United States, May 2020-January 2021. Pediatr Infect Dis J 2021; 40:601-605. [PMID: 33872279 PMCID: PMC8408805 DOI: 10.1097/inf.0000000000003149] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been identified in infants <12 months old. Clinical characteristics and follow-up data of MIS-C in infants have not been well described. We sought to describe the clinical course, laboratory findings, therapeutics and outcomes among infants diagnosed with MIS-C. METHODS Infants of age <12 months with MIS-C were identified by reports to the CDC's MIS-C national surveillance system. Data were obtained on clinical signs and symptoms, complications, treatment, laboratory and imaging findings, and diagnostic SARS-CoV-2 testing. Jurisdictions that reported 2 or more infants were approached to participate in evaluation of outcomes of MIS-C. RESULTS Eighty-five infants with MIS-C were identified and 83 (97.6%) tested positive for SARS-CoV-2 infection; median age was 7.7 months. Rash (62.4%), diarrhea (55.3%) and vomiting (55.3%) were the most common signs and symptoms reported. Other clinical findings included hypotension (21.2%), pneumonia (21.2%) and coronary artery dilatation or aneurysm (13.9%). Laboratory abnormalities included elevated C-reactive protein, ferritin, d-dimer and fibrinogen. Twenty-three infants had follow-up data; 3 of the 14 patients who received a follow-up echocardiogram had cardiac abnormalities during or after hospitalization. Nine infants had elevated inflammatory markers up to 98 days postdischarge. One infant (1.2%) died after experiencing multisystem organ failure secondary to MIS-C. CONCLUSIONS Infants appear to have a milder course of MIS-C than older children with resolution of their illness after hospital discharge. The full clinical picture of MIS-C across the pediatric age spectrum is evolving.
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Affiliation(s)
| | | | | | | | | | - Ellen H. Lee
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Maura K. Lash
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | | | | | | | | | | | - Sarah Lim
- Minnesota Department of Health, St. Paul, Minnesota
| | | | | | - Lynn E. Sosa
- Connecticut Department of Public Health, Hartford, Connecticut
| | | | - Ali Garcia
- Nevada Department of Health and Human Services, Reno, Nevada
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19
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Abstract
Immune-related manifestations are increasingly recognized conditions in patients with COVID-19, with around 3,000 cases reported worldwide comprising more than 70 different systemic and organ-specific disorders. Although the inflammation caused by SARS-CoV-2 infection is predominantly centred on the respiratory system, some patients can develop an abnormal inflammatory reaction involving extrapulmonary tissues. The signs and symptoms associated with this excessive immune response are very diverse and can resemble some autoimmune or inflammatory diseases, with the clinical phenotype that is seemingly influenced by epidemiological factors such as age, sex or ethnicity. The severity of the manifestations is also very varied, ranging from benign and self-limiting features to life-threatening systemic syndromes. Little is known about the pathogenesis of these manifestations, and some tend to emerge within the first 2 weeks of SARS-CoV-2 infection, whereas others tend to appear in a late post-infectious stage or even in asymptomatic patients. As the body of evidence comprises predominantly case series and uncontrolled studies, diagnostic and therapeutic decision-making is unsurprisingly often based on the scarcely reported experience and expert opinion. Additional studies are required to learn about the mechanisms involved in the development of these manifestations and apply that knowledge to achieve early diagnosis and the most suitable therapy.
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Power A, Runeckles K, Manlhiot C, Dragulescu A, Guerguerian AM, McCrindle BW. Kawasaki Disease Shock Syndrome Versus Septic Shock: Early Differentiating Features Despite Overlapping Clinical Profiles. J Pediatr 2021; 231:162-167. [PMID: 33290811 DOI: 10.1016/j.jpeds.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare the clinical features and resuscitative measures of children with Kawasaki disease shock syndrome vs septic shock. STUDY DESIGN In this retrospective case-control study, children with Kawasaki disease shock syndrome admitted to the intensive care unit from 2007 to 2017 were identified and compared with age-matched controls with septic shock. We studied 9 children with Kawasaki disease shock syndrome and 18 children with septic shock. Clinical characteristics were abstracted and between-group differences were compared. RESULTS Compared with septic shock controls, children with Kawasaki disease shock syndrome were less likely to have an underlying comorbid illness (1/9 [11%] vs 11/18 [61%]; P = .02) and were more likely to have at least 1 of the 5 classic diagnostic signs of Kawasaki disease at presentation (9/9 [100%] vs 0/18 [0%]; P < .001), a longer duration of illness before admission (9 days [IQR, 7-14 days] vs 3 days [IQR, 1-5 days]; P = .004), and a lower platelet count at presentation (140 [IQR 73, 167]) vs 258 [IQR, 137-334]; P = .02). Among patients who underwent echocardiography, abnormalities such as ventricular dysfunction, valvulitis, and coronary artery dilation were more common in the Kawasaki disease shock syndrome cohort (5/9 [56%] vs 0/7 [0%]; P = .03). There were no differences in volume of fluid resuscitation, vasoactive-inotropic scores, duration of inotropic therapy, or biochemical markers of illness severity (other than platelet count) between the matched groups. CONCLUSIONS A longer duration of illness before admission, lack of any significant underlying medical comorbidities, a lower platelet count, echocardiographic abnormalities, and the presence of classic diagnostic signs of Kawasaki disease at presentation may be useful early features to differentiate Kawasaki disease shock syndrome from septic shock.
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Affiliation(s)
- Alyssa Power
- Department of Pediatrics, Labatt Family Heart Center, University of Toronto, Toronto, Ontario, Canada.
| | - Kyle Runeckles
- Department of Pediatrics, Labatt Family Heart Center, University of Toronto, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, Labatt Family Heart Center, University of Toronto, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Department of Pediatrics, Labatt Family Heart Center, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Department of Pediatrics, Labatt Family Heart Center, University of Toronto, Toronto, Ontario, Canada
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21
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Suzuki J, Abe K, Matsui T, Honda T, Yasukawa K, Takanashi JI, Hamada H. Kawasaki Disease Shock Syndrome in Japan and Comparison With Multisystem Inflammatory Syndrome in Children in European countries. Front Pediatr 2021; 9:625456. [PMID: 33816399 PMCID: PMC8017212 DOI: 10.3389/fped.2021.625456] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/25/2021] [Indexed: 02/01/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe Kawasaki-like illness that was first linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in European countries in the spring of 2020 and has been suggested to have overlap with Kawasaki disease shock syndrome (KDSS). There are few reports of MIS-C from Asia. This observational study aimed to identify the clinical features in children presenting with KDSS in Japan over a 5-year period and to summarize similarities and differences between KDSS and MIS-C. We retrospectively collected data on patient characteristics, clinical signs and symptoms, treatment, and prognosis including coronary artery abnormalities (CAAs), which were compared with data of patients with KDSS worldwide and patients with MIS-C from a review. KDSS was identified in 6 (1.1%) of 552 patients with Kawasaki disease (KD) treated at a single institution in Japan between 2015 and 2020 (1 in 2020). In patients with KDSS in Japan or worldwide vs. patients with MIS-C, KDSS was more likely to have a diagnosis of complete KD (100, 70 vs. 6.3%), a higher incidence of CAAs (50, 65 vs. 11%), and a greater requirement for vasoactive agonists (67, 67 vs. 43%) because of circulatory shock (100, 50 vs. 26%). Both KDSS and MIS-C had good prognosis (mortality 0, 6.7 vs. 1.7%). Although KDSS in Japan and MIS-C show some overlap in clinical symptoms, they are unlikely to be the same disease entity. KDSS is more likely to have a cardiovascular phenotype with CAAs and requires treatment with cardiovascular agents.
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Affiliation(s)
- Junko Suzuki
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Kota Abe
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Takuya Matsui
- Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Takafumi Honda
- Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Kumi Yasukawa
- Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Jun-ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
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22
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Navarro Castellanos I, Dahdah N. Letter by Navarro Castellanos and Dahdah Regarding Article, "Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic". Circulation 2021; 143:e759-e760. [PMID: 33683948 DOI: 10.1161/circulationaha.120.049239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nagib Dahdah
- Pediatric Cardiology Department, CHU-Saint Justine, Université de Montréal, Quebec, Canada
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23
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Rassas A, Guizani R, Werdani A, Jammeli N, Mahjoub B. Kawasaki disease shock syndrome complicated by coronary aneurysms: a case report. Pan Afr Med J 2021; 38:52. [PMID: 33854681 PMCID: PMC8017355 DOI: 10.11604/pamj.2021.38.52.27599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
Kawasaki disease is a generalized systemic vasculitis, which primarily affects medium-sized arteries. Kawasaki disease shock syndrome is a rare but severe presentation of this disease. This report describes a case of delayed diagnosis of Kawasaki disease shock syndrome in a 13-year-old boy who presented with cervical adenophlegmon, persistent fever, injected conjunctiva, rash, and hypotension. Echocardiography revealed the presence of bilateral coronary aneurysms. Early recognition of Kawasaki disease shock syndrome can be difficult; however, delay in diagnosis and treatment can increase the risk of coronary artery disease.
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Affiliation(s)
- Ahmed Rassas
- Department of Pediatrics, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Rihab Guizani
- Department of Ear Nose and Throat (ENT), Taher Sfar University Hospital, Mahdia, Tunisia
| | - Amina Werdani
- Department of Pediatrics, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Nesrine Jammeli
- Department of Pediatrics, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Bahri Mahjoub
- Department of Pediatrics, Taher Sfar University Hospital, Mahdia, Tunisia
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24
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Park WY, Lee SY, Kim GB, Song MK, Kwon HW, Bae EJ, Choi EH, Park JD. Clinical aspects for differential diagnosis of Kawasaki disease shock syndrome: a case control study. BMC Pediatr 2021; 21:25. [PMID: 33413220 PMCID: PMC7790725 DOI: 10.1186/s12887-020-02488-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Because of the absence of a specific diagnostic test and pathognomonic clinical features, physicians must rely on the presence of specific clinical criteria and laboratory data that support the diagnosis of KD. To help clinicians distinguish KD, KDSS, septic shock, and TSS earlier, we suggest differential diagnosis and treatment guideline. Methods Medical records of immunocompetent patients who were admitted to the pediatric department with a diagnosis of KDSS, septic shock or TSS (SS group) were retrospectively reviewed. In addition, KD patients were selected by seasonal matching to each case of KDSS patient by date of admission (± 2 weeks). Results There were 13 patients with KDSS, 35 patients with SS group, and 91 patients with KD. In comparison between KDSS and septic shock group, KDSS group had significantly higher rate of coronary aneurysm incidence, and higher left ventricle dysfunction rate. In comparison between KDSS and TSS, patients with KDSS had a significantly higher erythrocyte sedimentation rate (ESR) and significantly lower creatinine. Receiver operation characteristic curve revealed that the optimal ESR cut off value for determining the KDSS was 56.0 (sensitivity 75.0%, specificity of 100.0%) and the optimal creatinine cut off value for determining the TSS was 0.695 (sensitivity 76.9%, specificity 84.6%). Conclusions Clinical symptoms, laboratory finding, echocardiography, and culture studies can be used to differentiate KD, KDSS, septic shock and TSS. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-020-02488-w.
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Affiliation(s)
- Woo Young Park
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
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25
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Multisystem inflammatory syndrome in children related to COVID-19: a systematic review. Eur J Pediatr 2021; 180:2019-2034. [PMID: 33599835 PMCID: PMC7890544 DOI: 10.1007/s00431-021-03993-5] [Citation(s) in RCA: 230] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/19/2022]
Abstract
An association between a novel pediatric hyperinflammatory condition and SARS-CoV-2 was recently published and termed pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome (in children) (MIS(-C)). We performed a systematic review and describe the epidemiological, clinical, and prognostic characteristics of 953 PIMS-TS/MIS(-C) cases in 68 records. Additionally, we studied the sensitivity of different case definitions that are currently applied. PIMS-TS/MIS(-C) presents at a median age of 8 years. Epidemiological enrichment for males (58.9%) and ethnic minorities (37.0% Black) is present. Apart from obesity (25.3%), comorbidities are rare. PIMS-TS/MIS(-C) is characterized by fever (99.4%), gastrointestinal (85.6%) and cardiocirculatory manifestations (79.3%), and increased inflammatory biomarkers. Nevertheless, 50.3% present respiratory symptoms as well. Over half of patients (56.3%) present with shock. The majority of the patients (73.3%) need intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%. Despite severe disease, mortality is rather low (1.9%). Of the currently used case definitions, the WHO definition is preferred, as it is more precise, while encompassing most cases.Conclusion: PIMS-TS/MIS(-C) is a severe, heterogeneous disease with epidemiological enrichment for males, adolescents, and racial and ethnic minorities. However, mortality rate is low and short-term outcome favorable. Long-term follow-up of chronic complications and additional clinical research to elucidate the underlying pathogenesis is crucial. What is Known: • A novel pediatric inflammatory syndrome with multisystem involvement has been described in association with SARS-CoV-2. • To date, the scattered reporting of cases and use of different case definitions provides insufficient insight in the full clinical spectrum, epidemiological and immunological features, and prognosis. What is New: • This systematic review illustrates the heterogeneous spectrum of PIMS-TS/MIS(-C) and its epidemiological enrichment for males, adolescents, and racial and ethnic minorities. • Despite its severe presentation, overall short-term outcome is good. • The WHO MIS definition is preferred, as it is more precise, while encompassing most cases.
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26
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Yeung RS, Ferguson PJ. Is multisystem inflammatory syndrome in children on the Kawasaki syndrome spectrum? J Clin Invest 2020; 130:5681-5684. [PMID: 32730226 DOI: 10.1172/jci141718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
An alarming increase in children presenting with fever, hyperinflammation, and multiorgan dysfunction frequently requiring intensive care has been observed after severe acute respiratory syndrome coronavirus 2 infection. The illness resembles Kawasaki disease (KD), with coronary dilatation and aneurysm occurring in some. However, the cardiovascular manifestations were typically on the severe end of the KD spectrum, with cardiogenic shock a common presentation together with other features. This led to defining a unique syndrome named multisystem inflammatory syndrome in children (MIS-C). In this issue of the JCI, Lee and Day-Lewis et al. and Diorio et al. explored the clinical profiles associated with coronavirus disease 2019 in children. We posit that while splitting MIS-C into a separate disease may aid clinical management decisions, lumping it into the KD pot may better serve to understand pathobiology.
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Affiliation(s)
- Rae Sm Yeung
- Department of Paediatrics, Immunology and Medical Science, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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27
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Current Approach to the Evaluation and Management of Incomplete Kawasaki Disease in the Emergency Department. Pediatr Emerg Care 2020; 36:537-541. [PMID: 33122594 DOI: 10.1097/pec.0000000000002259] [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] [Indexed: 11/26/2022]
Abstract
Kawasaki disease (KD) is one of the most common vasculitides of childhood and frequently presents to the emergency department. Although the diagnosis of KD is based on clinical criteria, children who do not fulfill the criteria but have sufficient supportive features of KD are diagnosed as having incomplete KD and warrant the same course of therapy as children with classic KD. The diagnosis of incomplete KD is challenging and requires a high index of suspicion. The purpose of this article is to review presenting features of incomplete KD and the diagnostic approach and management of children in the emergency department.
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28
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Sugiura Y, Okumura T, Kondo T, Murohara T. Adolescent Kawasaki disease shock syndrome with inflammatory cell infiltration into the myocardium: a case report. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 33204972 PMCID: PMC7649480 DOI: 10.1093/ehjcr/ytaa304] [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: 03/30/2020] [Revised: 05/18/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is a self-limiting form of systemic vasculitis. KD usually occurs in infants and young children and is rarely seen in adolescents. On rare occasions, KD is accompanied with reduced organ perfusion due to systolic hypotension, a condition known as Kawasaki disease shock syndrome (KDSS). The multifactorial causes of KDSS may include intensive vasculitis with capillary leak, myocardial dysfunction, and release of proinflammatory cytokines. However, the mechanisms underlying the pathophysiology of KDSS have not been fully elucidated. CASE SUMMARY A febrile 17-year-old male with cervical lymphadenopathy developed extreme shock with rapid cardiac dysfunction and reduced organ perfusion. Electrocardiogram revealed ST elevation in the precordial leads and increased serum levels of cardiac enzyme levels. Endomyocardial biopsy at the acute phase revealed CD3+, CD4+ or CD8+, and CD20- lymphocytes and CD68+ macrophages within infiltrates in the myocardium with mild interstitial fibrosis. He was treated with intravenous immunoglobulin (IVIG) and followed by glucocorticoids with mechanical circulatory support. His cardiac function recovered rapidly with no apparent adverse effects. DISCUSSION Our results suggest that KDSS may be a form of myocarditis, a condition in which inflammatory cells infiltrate the myocardium. Early immunosuppressive therapy, including IVIG and glucocorticoid therapy, may limit the severity of disease and improve the prognosis. As shown by this case, an accurate diagnosis of KD and KDSS will lead to early intervention and improved prognosis even among those in an older cohort.
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Affiliation(s)
- Yuki Sugiura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan
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29
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Spencer R, Closson RC, Gorelik M, Boneparth AD, Hough RF, Acker KP, Krishnan U. COVID-19 Inflammatory Syndrome With Clinical Features Resembling Kawasaki Disease. Pediatrics 2020; 146:peds.2020-1845. [PMID: 32843441 DOI: 10.1542/peds.2020-1845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 11/24/2022] Open
Abstract
We describe 2 patients with coronavirus disease who had multiple clinical features suggestive of Kawasaki disease (KD). Both patients presented with fever lasting >5 days and were found to have rash, conjunctival injection, and swollen lips. One patient also had extremity swelling, whereas the other developed desquamation of the fingers. In both cases, laboratory results were similar to those seen in KD. These patients had highly unusual but similar features, and both appeared to respond favorably to treatment. It remains unclear whether these patients had true KD or manifestations of coronavirus disease that resembled KD.
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Affiliation(s)
| | | | | | | | - Rebecca F Hough
- Pediatric Critical Care Medicine, Department of Pediatrics, Columbia University Irving Medical Center and Morgan Stanley Children's Hospital, New York, New York; and
| | - Karen P Acker
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, New York
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30
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Liu XP, Huang YS, Kuo HC, Xia HB, Yi-Sun, Huang WD, Lang XL, Liu CY, Liu X. A novel nomogram model for differentiating Kawasaki disease from sepsis. Sci Rep 2020; 10:13745. [PMID: 32792679 PMCID: PMC7427092 DOI: 10.1038/s41598-020-70717-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Kawasaki disease (KD) is a form of systemic vasculitis that occurs in children under the age of 5 years old. Due to prolonged fever and elevated inflammatory markers that are found in both KD and sepsis, the treatment approach differs for each. We enrolled a total of 420 children (227 KD and 193 sepsis) in this study. Logistic regression and a nomogram model were used to analyze the laboratory markers. We randomly selected 247 children as the training modeling group and 173 as the validation group. After completing a logistic regression analysis, white blood cell (WBC), anemia, procalcitonin (PCT), C-reactive protein (CRP), albumin, and alanine transaminase (ALT) demonstrated a significant difference in differentiating KD from sepsis. The patients were scored according to the nomogram, and patients with scores greater than 175 were placed in the high-risk KD group. The area under the curve of the receiver operating characteristic curve (ROC curve) of the modeling group was 0.873, sensitivity was 0.893, and specificity was 0.746, and the ROC curve in the validation group was 0.831, sensitivity was 0.709, and specificity was 0.795. A novel nomogram prediction model may help clinicians differentiate KD from sepsis with high accuracy.
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Affiliation(s)
- Xiao-Ping Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Yi-Shuang Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, #123, Dapei Rd., Niaosong, Kaohsiung, 83301, Taiwan
| | - Han-Bing Xia
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Yi-Sun
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Wei-Dong Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Xin-Ling Lang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Chun-Yi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China.
| | - Xi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China.
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31
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Singh‐Grewal D, Lucas R, Macartney K, Cheng AC, Wood N, Ostring G, Britton P, Crawford N, Burgner D. Update on the COVID-19-associated inflammatory syndrome in children and adolescents; paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2. J Paediatr Child Health 2020; 56:1173-1177. [PMID: 32735721 PMCID: PMC7436879 DOI: 10.1111/jpc.15049] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/12/2023]
Abstract
We provide an update on the state of play with regards a newly described inflammatory condition which has arisen during the current SARS-CoV-2 pandemic. The condition has been named paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 or multisystem inflammatory syndrome in children. This condition has shown significant similarities to Kawasaki disease and toxic shock syndrome.
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Affiliation(s)
- Davinder Singh‐Grewal
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia,School of Maternal and Child HealthUniversity of New South WalesSydneyNew South WalesAustralia,Department of PaediatricsJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
| | - Ryan Lucas
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia
| | - Kristine Macartney
- Children's Hospital Westmead Clinical School, The University of SydneySydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceWestmeadNew South WalesAustralia
| | - Allen C Cheng
- Department of Infectious DiseasesAlfred HealthMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Nicholas Wood
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia
| | - Genevieve Ostring
- Paediatric RheumatologyStarship Children's HospitalAucklandNew Zealand,University of AucklandPaediatrics Child and Youth HealthAucklandNew Zealand
| | - Philip Britton
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia
| | - Nigel Crawford
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Immunisation ServiceRoyal Children's HospitalMelbourneVictoriaAustralia,University of MelbourneMelbourneVictoriaAustralia
| | - David Burgner
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Infectious Diseases UniversityRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
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32
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Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, Barranco MA, Maxted AM, Rosenberg ES, Easton D, Udo T, Kumar J, Pulver W, Smith L, Hutton B, Blog D, Zucker H. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med 2020; 383:347-358. [PMID: 32598830 PMCID: PMC7346766 DOI: 10.1056/nejmoa2021756] [Citation(s) in RCA: 930] [Impact Index Per Article: 232.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome. METHODS Hospitals in New York State reported cases of Kawasaki's disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020. RESULTS As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days. CONCLUSIONS The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.
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Affiliation(s)
- Elizabeth M Dufort
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Emilia H Koumans
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Eric J Chow
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Elizabeth M Rosenthal
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Alison Muse
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Jemma Rowlands
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Meredith A Barranco
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Angela M Maxted
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Eli S Rosenberg
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Delia Easton
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Tomoko Udo
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Jessica Kumar
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Wendy Pulver
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Lou Smith
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Brad Hutton
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Debra Blog
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
| | - Howard Zucker
- From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.)
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Affiliation(s)
- Mary Beth F Son
- Rheumatology Program, Division of Immunology, Boston Children's Hospital, Boston, MA 02115, USA
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Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, Auriau J, Grimaud M, Oualha M, Beghetti M, Wacker J, Ovaert C, Hascoet S, Selegny M, Malekzadeh-Milani S, Maltret A, Bosser G, Giroux N, Bonnemains L, Bordet J, Di Filippo S, Mauran P, Falcon-Eicher S, Thambo JB, Lefort B, Moceri P, Houyel L, Renolleau S, Bonnet D. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation 2020; 142:429-436. [PMID: 32418446 DOI: 10.1161/circulationaha.120.048360] [Citation(s) in RCA: 832] [Impact Index Per Article: 208.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention. METHODS Over a 2-month period, contemporary with the SARS-CoV-2 pandemic in France and Switzerland, we retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction, and severe inflammatory state. RESULTS Thirty-five children were identified and included in the study. Median age at admission was 10 years (range, 2-16 years). Comorbidities were present in 28%, including asthma and overweight. Gastrointestinal symptoms were prominent. Left ventricular ejection fraction was <30% in one-third; 80% required inotropic support with 28% treated with extracorporeal membrane oxygenation. Inflammation markers were suggestive of cytokine storm (interleukin-6 median, 135 pg/mL) and macrophage activation (D-dimer median, 5284 ng/mL). Mean BNP (B-type natriuretic peptide) was elevated (5743 pg/mL). Thirty-one of 35 patients (88%) tested positive for SARS-CoV-2 infection by polymerase chain reaction of nasopharyngeal swab or serology. All patients received intravenous immunoglobulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in the 25 of 35 of those discharged from the intensive care unit. No patient died, and all patients treated with extracorporeal membrane oxygenation were successfully weaned. CONCLUSIONS Children may experience an acute cardiac decompensation caused by severe inflammatory state after SARS-CoV-2 infection (multisystem inflammatory syndrome in children). Treatment with immunoglobulin appears to be associated with recovery of left ventricular systolic function.
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Affiliation(s)
- Zahra Belhadjer
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
- Université de Paris, France (Z.B., L.H., S.R., D.B.)
| | - Mathilde Méot
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Fanny Bajolle
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Diala Khraiche
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Antoine Legendre
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Samya Abakka
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Johanne Auriau
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Marion Grimaud
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Mehdi Oualha
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Maurice Beghetti
- Pediatric Cardiology Unit, University Hospital, Geneva, Switzerland (M.B., J.W.)
| | - Julie Wacker
- Pediatric Cardiology Unit, University Hospital, Geneva, Switzerland (M.B., J.W.)
| | - Caroline Ovaert
- Paediatric and Congenital Cardiology Department, M3C Regional CHD Center, La Timone University Hospital, Marseille, France (C.O.)
- INSERM UMR 1251, Marseille Medical Genetics, University of Aix-Marseille, Marseille, France (C.O.)
| | - Sebastien Hascoet
- M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Groupe Hospitalier Saint-Joseph, Paris Sud University, Plessis-Robinson, France (S.H.)
| | - Maëlle Selegny
- Pediatric-Cardiology, Amiens-Picardie University Hospital, Amiens, France (M.S.)
| | - Sophie Malekzadeh-Milani
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Alice Maltret
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
| | - Gilles Bosser
- CHRU de Nancy, Service de cardiologie congénitale et pédiatrique, Vandoeuvre-lès-Nancy, France (G.B., N..G.)
| | - Nathan Giroux
- CHRU de Nancy, Service de cardiologie congénitale et pédiatrique, Vandoeuvre-lès-Nancy, France (G.B., N..G.)
| | - Laurent Bonnemains
- Department of Cardiac Surgery, University of Strasbourg, France (L.B., J.B.)
| | - Jeanne Bordet
- Department of Cardiac Surgery, University of Strasbourg, France (L.B., J.B.)
| | - Sylvie Di Filippo
- Pediatric Cardiology and Congenital Heart Disease Department, Cardiovascular Louis-Pradel Hospital, Hospices Civils de Lyon, France (S.D.F.)
| | - Pierre Mauran
- Department of Paediatric and Congenital Cardiology, Center de compétence M3C, American Memorial Hospital, CHU de Reims, France (P. Mauran)
| | | | - Jean-Benoît Thambo
- CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, France (J.-B.T.)
| | - Bruno Lefort
- Unité de Cardiologie Pédiatrique, Hôpital des Enfants Gatien de Clocheville, INSERM UMR 1069 et Université François Rabelais, Tours, France (B.L.)
| | - Pamela Moceri
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, France (P. Moceri)
| | - Lucile Houyel
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
- Université de Paris, France (Z.B., L.H., S.R., D.B.)
| | - Sylvain Renolleau
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
- Université de Paris, France (Z.B., L.H., S.R., D.B.)
| | - Damien Bonnet
- M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.)
- Université de Paris, France (Z.B., L.H., S.R., D.B.)
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Staats K, Tremoulet AH, Harvey H, Burns JC, Donofrio-Odmann JJ. A Four-Year-Old with History of Kawasaki Disease Presenting in Acute Shock. PREHOSP EMERG CARE 2020; 25:281-288. [PMID: 32250719 DOI: 10.1080/10903127.2020.1745339] [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: 10/24/2022]
Abstract
We present a case in which emergency medical services (EMS) intervened on a critically ill child with known giant coronary aneurysms as sequela to her severe complicated Kawasaki disease. This patient's severe shock ultimately ended in cardiac arrest and death. We discuss the keys to recognition, and critical importance to early intervention of pediatric shock in prehospital care. We also detail the cardiac ramifications of Kawasaki disease, steps for prompt identification of high risk complaints in these patients, and opportunities for treatment.
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Liang YC, Chang CH, Lin MT, Kao FY, Huang SK, Wu MH. Shock and unresponsiveness to repeated courses of intravenous immunoglobulin in Kawasaki disease: a nationwide database study. Pediatr Res 2020; 87:961-966. [PMID: 31711068 DOI: 10.1038/s41390-019-0668-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to investigate the clinical implications of unresponsiveness to single or repeated courses intravenous immunoglobulin (IVIG) and Kawasaki disease (KD) shock syndrome in patients with KD in an era of a single brand of IVIG. METHODS Data were collected from National Health Insurance database 2010-2013. Characteristics of the KD patients were analyzed, including age, gender, shock, and associated coronary aneurysms. RESULTS There were 3043 KD patients (male: 1872) identified. Among them, 46 (1.51%) had KDSS, 261 patients (8.5%) had IVIG unresponsiveness, and 225 patients (7.4%) developed coronary aneurysms. Moreover, 51 patients did not respond to the second course IVIG therapy, i.e., re-IVIG unresponsiveness. KDSS was associated with the occurrence of IVIG unresponsiveness (P < 10-4) and re-IVIG unresponsiveness (P = 0.02). In addition to male gender and KD shock syndrome, IVIG unresponsiveness (OR: 2.18, 95% CI: 1.48-3.22, P = 0.001) and re-IVIG unresponsiveness (OR: 2.87, 95% CI: 1.40-5.89, P = 0.004) were both independent risk factors for coronary aneurysms. CONCLUSIONS In a nationwide KD cohort, both IVIG unresponsiveness and re-IVIG unresponsiveness increase the risk of coronary aneurysms. Such observation addresses the importance of refining the treatment for IVIG unresponsiveness, at least in those with KD shock syndrome.
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Affiliation(s)
- Yun-Chieh Liang
- Clinical Trial Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Feng-Yu Kao
- Taiwan Bureau of National Health Insurance, Taipei, Taiwan
| | - San-Kuei Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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de Graeff N, Groot N, Ozen S, Eleftheriou D, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, McCann L, Pilkington C, Ravelli A, van Royen-Kerkhof A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Brogan P, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative. Rheumatology (Oxford) 2020; 58:672-682. [PMID: 30535127 DOI: 10.1093/rheumatology/key344] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The European Single Hub and Access point for paediatric Rheumatology in Europe initiative aimed to optimize care for children with rheumatic diseases. Kawasaki disease (KD) is the most common cause of acquired heart disease in children and an important cause of long-term cardiac disease into adulthood. Prompt diagnosis and treatment of KD is difficult due to the heterogeneity of the disease but is crucial for improving outcome. To date, there are no European internationally agreed, evidence-based guidelines concerning the diagnosis and treatment of KD in children. Accordingly, treatment regimens differ widely. The aim of this study is to provide consensus-based, European-wide evidence-informed recommendations for diagnosis and treatment of children with KD. METHODS Recommendations were developed using the EULAR's standard operating procedures. An extensive systematic literature search was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of international experts via online surveys and subsequently discussed in three consensus meetings, using nominal group technique. Recommendations were accepted when ⩾80% agreed. RESULTS In total, 17 recommendations for diagnosis and 14 for treatment of KD in children were accepted. Diagnostic recommendations included laboratory and imaging workup for complete as well as incomplete KD. Treatment recommendations included the importance of early treatment in both complete and incomplete KD, use of intravenous immunoglobulin, aspirin, corticosteroids for high-risk cases, and other treatment options for those with resistant disease. CONCLUSION The Single Hub and Access point for paediatric Rheumatology in Europe initiative provides international evidence-based recommendations for diagnosing and treating KD in children, facilitating improvement and uniformity of care.
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Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Despina Eleftheriou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Brigitte Bader-Meunier
- Department of Paediatric Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pavla Dolezalova
- First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Brian M Feldman
- Department of Paediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre Hospital, APHP, University of Paris SUD, Paris, France
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Gaslini Children's Hospital, Genoa, Italy
| | - Annet van Royen-Kerkhof
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Yosef Uziel
- Meir Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paul Brogan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Chang LS, Kuo HC. The role of corticosteroids in the treatment of Kawasaki disease. Expert Rev Anti Infect Ther 2020; 18:155-164. [DOI: 10.1080/14787210.2020.1713752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ling-Sai Chang
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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Derespina KR, Kaushik S, Medar SS. Pediatric Shock: An Uncommon and Underrecognized Etiology. J Pediatr Intensive Care 2020; 9:210-212. [PMID: 32685250 DOI: 10.1055/s-0039-1700964] [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] [Received: 10/18/2019] [Accepted: 11/27/2019] [Indexed: 01/23/2023] Open
Abstract
Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a well-known disease entity. Kawasaki shock syndrome (KSS), on the other hand, is less well recognized and has been reported in small single-center international studies and case reports. We report a case in the United States of an 11-year-old male with multiorgan failure and shock, presumed to be secondary to toxic shock but later diagnosed with KSS, an underrecognized entity in the US and review the literature. KSS should be considered in a critically ill child with unexplained shock.
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Affiliation(s)
- Kim R Derespina
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, United States
| | - Shubhi Kaushik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, United States
| | - Shivanand S Medar
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, United States
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Hoshino S, Shimizu C, Jain S, He F, Tremoulet AH, Burns JC. Biomarkers of Inflammation and Fibrosis in Kawasaki Disease Patients Years After Initial Presentation With Low Ejection Fraction. J Am Heart Assoc 2020; 9:e014569. [PMID: 31880981 PMCID: PMC6988139 DOI: 10.1161/jaha.119.014569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/15/2019] [Indexed: 01/03/2023]
Abstract
Background Coronary artery aneurysms and myocarditis are well-recognized complications of Kawasaki disease (KD) but no systematic evaluation of the consequences of myocarditis has been performed in the subset presenting with low ejection fraction (EF). We postulated that more severe myocardial inflammation as evidenced by low EF during the acute phase could lead to late myocardial fibrosis. Methods and Results We measured the carboxyterminal propeptide of procollagen type I (PIPC), soluble suppressor of tumorigenicity 2, galectin-3 (Gal-3), growth-differentiation factor-15, and calprotectin by ELISA in late convalescent blood samples from 16 KD patients who had an EF ≤55% on their initial echocardiogram. Results were compared with samples from sex- and age-matched KD patients with initial EF >60%. In the univariate analysis, the median Gal-3 and PIPC levels in the low EF group were significantly higher than those in the normal EF group (Gal-3: low EF 6.216 versus normal EF 4.976 mg/dL P=0.038, PIPC: low EF 427.4 versus normal EF 265.2 mg/dL, P=0.01). In a multivariable analysis, there were significant differences for Gal-3 and PIPC levels between the low and normal EF groups, adjusting for age, sex, and worst z score. Conclusions Convalescent KD patients with a history of low EF during the acute illness had significantly elevated levels of Gal-3 and PIPC when compared with matched-control KD patients with normal EF. These findings raise concern for myocardial fibrosis as a potential late sequela of the more severe myocarditis experienced by a subset of KD patients during the acute phase.
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Affiliation(s)
- Shinsuke Hoshino
- Department of PediatricsUniversity of California San Diego School of MedicineLa JollaCA
| | - Chisato Shimizu
- Department of PediatricsUniversity of California San Diego School of MedicineLa JollaCA
| | - Sonia Jain
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCA
| | - Feng He
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCA
| | - Adriana H. Tremoulet
- Department of PediatricsUniversity of California San Diego School of MedicineLa JollaCA
- Rady Children's Hospital San DiegoSan DiegoCA
| | - Jane C. Burns
- Department of PediatricsUniversity of California San Diego School of MedicineLa JollaCA
- Rady Children's Hospital San DiegoSan DiegoCA
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Pilania RK, Jindal AK, Bhattarai D, Naganur SH, Singh S. Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis. Front Pediatr 2020; 8:526969. [PMID: 33072669 PMCID: PMC7542237 DOI: 10.3389/fped.2020.526969] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is now a common cause of acquired heart disease in children. Coronary artery involvement is the most serious complication in children with KD. Several non-coronary complications have now been identified in this condition but these are often overlooked. Myocarditis is an integral component of KD and may be more common than coronary artery abnormalities. Pericardial involvement and valvular abnormalities have also been observed in patients with KD. KD shock syndrome is now being increasingly recognized and may be difficult to differentiate clinically from toxic shock syndrome. Endothelial dysfunction has been reported both during acute stage and also on follow-up. This may be a potentially modifiable cardiovascular risk factor.
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Affiliation(s)
- Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmagat Bhattarai
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Hanumantacharya Naganur
- Department of Cardiology, Advances Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
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Liu XP, Huang YS, Xia HB, Sun Y, Lang XL, Li QZ, Liu CY, Kuo HC, Huang WD, Liu X. A Nomogram Model Identifies Eosinophilic Frequencies to Powerfully Discriminate Kawasaki Disease From Febrile Infections. Front Pediatr 2020; 8:559389. [PMID: 33363059 PMCID: PMC7759494 DOI: 10.3389/fped.2020.559389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Kawasaki disease (KD) is a form of systemic vasculitis that occurs primarily in children under the age of 5 years old. No single laboratory data can currently distinguish KD from other febrile infection diseases. The purpose of this study was to establish a laboratory data model that can differentiate between KD and other febrile diseases caused by an infection in order to prevent coronary artery complications in KD. Methods: This study consisted of a total of 800 children (249 KD and 551 age- and gender-matched non-KD febrile infection illness) as a case-control study. Laboratory findings were analyzed using univariable, multivariable logistic regression, and nomogram models. Results: We selected 562 children at random as the model group and 238 as the validation group. The predictive nomogram included high eosinophil percentage (100 points), high C-reactive protein (93 points), high alanine transaminase (84 points), low albumin (79 points), and high white blood cell (64 points), which generated an area under the curve of 0.873 for the model group and 0.905 for the validation group. Eosinophilia showed the highest OR: 5.015 (95% CI:-3.068-8.197) during multiple logistic regression. The sensitivity and specificity in the validation group were 84.1 and 86%, respectively. The calibration curves of the validation group for the probability of KD showed near an agreement to the actual probability. Conclusion: Eosinophilia is a major factor in this nomogram model and had high precision for predicting KD. This report is the first among the existing literature to demonstrate the important role of eosinophil in KD by nomogram.
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Affiliation(s)
- Xiao-Ping Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Yi-Shuang Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Han-Bing Xia
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Yi Sun
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Xin-Ling Lang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Qiang-Zi Li
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Chun-Yi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Ho-Chang Kuo
- Department of Pediatrics, Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Dong Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Xi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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Yozgat Y, Uzuner S, Demir AD, Ogur M, Yozgat CY, Turel O. A 13-Year-Old Boy Who Has Kawasaki Disease Shock Syndrome Presents with Parotitis. J Pediatr Intensive Care 2019; 9:60-63. [PMID: 31984160 DOI: 10.1055/s-0039-1697978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022] Open
Abstract
We report a 13-year-old boy who (initially) had symptoms of toxic shock-like syndrome and mumps. Then, the patient was hospitalized in the pediatric intensive care unit (PICU) because of his ongoing hemodynamic instability (low blood pressure of 70/30 mm Hg and capillary refill time of > 4 seconds). During his stay in the PICU, the patient was treated with fluid resuscitation and vasoactive infusion and at the same time was diagnosed with Kawasaki disease shock syndrome (KDSS), when giant right coronary artery aneurysms were detected on echocardiographic examination. This case illustrates the risk of KDSS in patient who carries both parotitis and toxic shock-like syndrome. The clinicians should be cautious about detecting any types of coronary artery aneurysms in such patients. This is the first case of KDSS associated with parotitis reported in the literature.
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Affiliation(s)
- Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Selcuk Uzuner
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Aysegul Dogan Demir
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa Ogur
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
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Diagnostic and Treatment Trends in Children With Kawasaki Disease in the United States, 2006-2015. Pediatr Infect Dis J 2019; 38:1010-1014. [PMID: 31365480 DOI: 10.1097/inf.0000000000002422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate variations in treatment practice and compliance with national guidelines for the diagnostic evaluation of children with Kawasaki disease (KD). STUDY DESIGN We used the Pediatric Hospital Information System database to analyze demographic, laboratory and treatment data from patients admitted with KD between January 1, 2006, and December 31, 2015. RESULTS During the study period, 12,089 children with KD were diagnosed. Nearly all patients had a complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein ordered. Fewer patients had alanine aminotransferase (48.6%) or a urinalysis (75.3%). A small percentage of children had abdominal imaging (11.5%), neck imaging (5.9%), and lumbar punctures (4.5%), and 36.0% of patients received antibiotic therapy. Obtaining echocardiograms pretreatment and the use of steroids and infliximab significantly increased over the study period (P < 0.001). For patients who failed initial intravenous immunoglobulin (IVIG) monotherapy, 82.0% received a second dose of IVIG, 7.7% received steroids, 6.5% received infliximab, and 3.9% received combination therapy. Patients receiving infliximab or steroids as second therapy had a higher response rate than those who received only a second IVIG dose (87.9% versus 83.0% versus 73.3%, P < 0.001). CONCLUSIONS KD remains a challenging diagnosis. Opportunities exist for earlier use of echocardiograms in the evaluation of children with potential KD. Significant variations in practice exist surrounding second-line therapy. Our data suggest superiority of second-line therapy use of infliximab or steroids over IVIG in terms of reducing need for additional therapies. Prospective, controlled studies are needed to confirm this finding.
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Tiewsoh K, Sharma D, Jindal AK, Bhisikar S, Suri D, Singh S. Acute Kidney Injury in Kawasaki Disease: Report of 3 Cases From North India and a Brief Review of Literature. J Clin Rheumatol 2019; 24:231-234. [PMID: 29293117 DOI: 10.1097/rhu.0000000000000687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Karalanglin Tiewsoh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research, Chandigarh, India
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Kawasaki shock syndrome in an Arab female: case report of a rare manifestation and review of literature. BMC Pediatr 2019; 19:295. [PMID: 31443702 PMCID: PMC6706932 DOI: 10.1186/s12887-019-1662-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kawasaki disease shock syndrome is a relatively new and rare complication of Kawasaki disease first described in 2009. CASE PRESENTATION This report describes a two-year-old Arab descent female presenting with a history of high-grade fever of 2 days duration with non-specific signs of viral illness and erythematous rash. The patients' condition deteriorated rapidly requiring admission to intensive care unit. In the intensive care unit, she developed a right upper quadrant mass that was diagnosed as hydrops of the gallbladder by ultrasonography. After one dose of intravenous immunoglobulin, the patient started to recover and was transferred out of intensive care after 2 days. CONCLUSION Among the complications of Kawasaki disease, shock syndrome is rare and usually will have deleterious results if not diagnosed and managed promptly.
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Ono R, Shimizu M, Yamamoto K, Umehara N, Manabe A. Kawasaki disease shock syndrome: Case report and cytokine profiling. Pediatr Int 2019; 61:620-622. [PMID: 31216599 DOI: 10.1111/ped.13864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/17/2019] [Accepted: 04/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Rintaro Ono
- Department of Pediatrics, St Luke's International hospital, Tokyo, Japan
| | - Masaki Shimizu
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kaoru Yamamoto
- Department of Pediatrics, St Luke's International hospital, Tokyo, Japan
| | - Naoki Umehara
- Department of Pediatrics, St Luke's International hospital, Tokyo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, St Luke's International hospital, Tokyo, Japan
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Pilania RK, Jindal AK, Guleria S, Singh S. An Update on Treatment of Kawasaki Disease. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00115-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
OBJECTIVE This study was performed to explore the clinical features of Kawasaki disease shock syndrome and analyse the association between the left ventricular ejection fraction and Kawasaki disease shock syndrome. METHODS We retrospectively reviewed the medical records of all consecutive inpatients with Kawasaki disease at Wenzhou Medical University Second Affiliated Hospital and Yuying Children's Hospital in Wenzhou, China from January 2009 to December 2016. We compared the clinical characteristics, laboratory data, and left ventricular ejection fraction between patients with and without Kawasaki disease shock syndrome and analysed the effect of the left ventricular ejection fraction on Kawasaki disease shock syndrome under different clinical conditions of Kawasaki disease. RESULTS In total, 1147 patients were diagnosed with Kawasaki disease. Of these 1147 patients, 17 were diagnosed with Kawasaki disease shock syndrome; 68 patients admitted to the hospital at the same time, ±2 weeks, with Kawasaki disease but without Kawasaki disease shock syndrome served as the control group. Compared with the control group, the Kawasaki disease shock syndrome group had a significantly higher incidence of coronary artery lesions, cardiac troponin I concentration, N-terminal prohormone of brain natriuretic peptide concentration, neutrophil count and ratio, alanine aminotransferase concentration, aspartate aminotransferase concentration, and C-reactive protein concentration and a significantly lower platelet count, serum albumin concentration, and left ventricular ejection fraction. A low left ventricular ejection fraction was associated with Kawasaki disease shock syndrome under different conditions of Kawasaki disease. CONCLUSION Among patients with Kawasaki disease, cardiac injury is more likely in those with Kawasaki disease shock syndrome than without, and a low left ventricular ejection fraction may be associated with the development of Kawasaki disease shock syndrome.
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