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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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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Mehrban S, Tahghighi F, Aghaei Moghadam E, Ziaee V. Multisystem inflammatory syndrome in children and Kawasaki disease; comparison of their clinical findings and one-year follow-up-a cross-sectional study. Ital J Pediatr 2023; 49:90. [PMID: 37475054 PMCID: PMC10360261 DOI: 10.1186/s13052-023-01489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Studies on Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki Disease (KD) have yielded inconsistent results and are lacking in Asian and African countries. This study aimed to compare the laboratory and clinical features, short-term outcomes, and one-year follow-ups of a large cohort of MIS-C and KD patients. METHODS Data from 176 MIS-C and 56 KD patients admitted to Tehran Children's Medical Center between January 2021 and January 2022 were collected. Patients were followed up until January 2023. RESULTS While lymphopenia and thrombocytopenia were more prevalent in MIS-C (73.2% vs. 20% in KD, p < 0.001), KD patients exhibited a higher median white blood cell count and prevalence of anemia, along with higher fibrinogen and erythrocyte sedimentation rate levels (p < 0.001, p < 0.001, p = 0.005, p < 0.001, respectively). MIS-C patients also exhibited lower ejection fraction, a greater occurrence of pericardial effusion, and a higher incidence of coronary aneurysms and ectasia, and ascites. Echocardiography after seven days of treatment showed a reduction in pathologies for both groups, but it was significant only for MIS-C. After one year, coronary artery abnormalities remained in only six cases. CONCLUSIONS In conclusion, this study highlights differences between MIS-C and KD, including laboratory indices as well as echocardiographic and abdominal ultrasound findings. These findings contribute valuable data on Iranian patients to the existing literature on this topic and have significant implications for accurate diagnosis and improved management of pediatric patients presenting with these conditions.
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Affiliation(s)
- Saghar Mehrban
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Tahghighi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Aghaei Moghadam
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Ziaee
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.
- Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Kim JH, You J. Comparison of Clinical Manifestations of Kawasaki Disease According to SARS-CoV-2 Antibody Positivity. J Korean Med Sci 2023; 38:e181. [PMID: 37337806 DOI: 10.3346/jkms.2023.38.e181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/26/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the most common cause of acquired heart disease in paediatric patients, with infectious agents being the main cause. This study aimed to determine whether there are differences in the clinical manifestations of KD between patients with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. METHODS From January 1, 2021 to August 15, 2022, 82 patients with analysable echocardiographic data were diagnosed with KD. Twelve patients with multisystem inflammatory syndrome in children were excluded. Serologic tests were performed by chemiluminescence immunoassay for both the nucleocapsid (N) and the spike (S) proteins in blood samples. Among the 70 patients diagnosed with KD at Jeonbuk University Children's Hospital, the SARS-CoV-2 antibody test was performed in 41 patients. RESULTS The SARS-CoV-2 antibody test results for the N antigen were positive in 12 patients, while those for S protein were positive in 14 patients. N antigen SARS-CoV-2 antibody-positive KD was different from N antigen SARS-CoV-2 antibody-negative KD in terms of sex (male predominance in the positive group, 83.3% vs. female predominance in the negative group 62.1%, P = 0.008) and the incidence of refractory KD (41.7% vs. 10.3%, P = 0.034). The pro-B-type natriuretic peptide level was lower in the N-antigen SARS-CoV-2 antibody-positive KD group than that in the negative group (518.9 ± 382.6, 1,467.0 ± 2,417.6, P = 0.049). No significant differences in the echocardiographic findings between both groups were noted. In the multi-variable analysis, SARS-CoV-2 antibody (N antigen) was the only predictor of refractory KD (odds ratio, 13.70; 95% confidence interval, 1.63-115.44; P = 0.016). CONCLUSION High incidence of intravenous immunoglobulin-refractory KD may occur in up to 40% of the patients having recent history of coronavirus disease 2019. For patients having KD with N-type SARS-CoV-2 antibody positivity, adjunctive treatment, such as corticosteroids, can be considered as the first line of treatment.
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Affiliation(s)
- Jin Ho Kim
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
| | - Jihye You
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
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Bajolle F. [Diagnosis and management of Kawasaki disease]. Rev Prat 2023; 73:179-186. [PMID: 36916262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
DIAGNOSIS AND MANAGEMENT OF KAWASAKI DISEASE. Kawasaki disease (KD) is a multi-systemic vasculitis predominantly affecting children under 5 years of age. KD's incidence is 30 times higher in Asia than in France. Elective lesional tropism for coronary arteries makes it the leading cause of acquired heart disease in children in developed countries. Diagnosis is based on the presence of fever of 5 days or more and the presence of at least for clinical criteria of cutaneous-mucosal inflammation. KD is believed to be the result of an aberrant inflammatory response to an infectious trigger in a genetically predisposed individual. Timely initiation of treatment with intravenous immunoglobulin has reduced the incidence of coronary artery aneurysms from 25% to 5%. Severe KD requires rapid treatment intensification. Coronary artery lesions are the main determinant of the prognosis. Acute coronary syndrome in adults can be a result of long-term sequelae of the disease. Different imaging techniques are required to adequately follow these patients according to the American Heart Association recommendations.
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Affiliation(s)
- Fanny Bajolle
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique ; centre de référence M3C, hôpital Necker-Enfants malades, Paris, France
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5
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Gallego DF, Ruiz MEZ, Marshall DA. Oblivion: autopsy findings of a 31-year-old man with sudden cardiac arrest, a case report of a sequalae of Kawasaki disease. Autops Case Rep 2022; 12:e2021404. [PMID: 36312877 PMCID: PMC9613377 DOI: 10.4322/acr.2021.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
A 31-year-old man presented to the hospital after suffering a sudden cardiac arrest. Despite optimal therapy, the patient passed away. His medical history included febrile rash at age 2. At autopsy, there was aneurysmal dilation and severe coronary artery stenosis by atherosclerotic plaques and myocardial fibrosis. These findings were presumed to be due to complications of Kawasaki disease, given the remote history of severe febrile rash as a toddler and the presence of chronic coronary artery injury, recanalization, and thrombosis with ischemic heart disease leading to sudden cardiac collapse and death.
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Affiliation(s)
| | - Maria Eugenia Zuluaga Ruiz
- Universidad del Valle, Grupo de Investigación en Rehabilitación de la Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Desiree Ann Marshall
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
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6
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Wang H, Tang Y, Yan W, Xu Q, Li X, Qian W. Breastfeeding has no protective effects on the development of coronary artery lesions in Kawasaki disease: a retrospective cohort study. BMC Pediatr 2022; 22:353. [PMID: 35725463 DOI: 10.1186/s12887-022-03422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Kawasaki disease (KD) is a self-limiting vasculitis with an unknown etiology. It has been reported that breastfeeding has a potential protective effect on KD development. However, whether breastfeeding has an effect on the development of coronary artery lesions (CALs) remains unclear. Methods We retrospectively reviewed the medical records of patients with the main diagnosis of KD hospitalized in our hospital from May 2017 to November 2018. Standardized telephone interviews were carried out to obtain feeding practices before KD was onset. Results Two hundred and ninety-three (51.6%) were exclusively breastfed, 223 (39.3%) were partially breastfed and 52 (9.2%) were formula fed. There were no significant differences in the characteristics regarding age, gender, incomplete KD, intravenous immunoglobulin (IVIG) resistance, and the laboratory variables among the three groups. With formula feeding as a reference, patients exclusively breastfed and partially breastfed seemed to have a higher incidence of CALs, even after adjusting confounders, but were not statistically significant. After grouping patients who were older than six months into formula feeding, partial breastfeeding for < 2 months, partial breastfeeding for ≥ 2 and < 4 months, partial breastfeeding for ≥ 4 and < 6 months and exclusively breastfeeding based on the length of breastfeeding, the results remained the same (P > 0.05). Conclusions Breastfeeding has no protective effect on the development of CALs in KD. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03422-y.
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Mercier JC, Ouldali N, Basmaci R. [Multisystemic inflammatory syndrome in children (MIS-C) associated with Covid]. Rev Prat 2021; 71:1009-1015. [PMID: 35147323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Multisystemic inflammatory syndrome in children (mis-c) Asociated with covid Although children are less susceptible to sars-cov-2 and less symptomatic than adults with low mortality, clusters of Septic shock associated with elevated cardiac biomarkers and unusual vasoplegia have been recently described and Treated by inotropes, vasopressors, and fluid loading. Both clinical symptoms (i.e., high and persistent fever, gastrointestinal Disorders, skin rash, conjunctivitis and dry cracked lips) and biological signs (e.g., elevated crp/procalcitonin, high Levels of ferritinemia) resembled kawasaki disease. In most instances, intravenous immunoglobin therapy with glucosteroids Improved the cardiac function and led to full recovery within a few days. However, adjunctive biotherapy (e.g., Anti-il-1ra, anti-il-6 monoclonal antibodies) was sometimes necessary. Although almost all children fully recovered Within a few days, some of them developed late coronary artery dilation or aneurysm. Thus, a new "multisystem inflammatory Syndrome in children" (mis-c) associated with sars-cov-2 has been identified, and its pathophysiology better Understood.
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Affiliation(s)
| | - Naïm Ouldali
- CCA, membre du Pediatric-Biocovid Study Group, service de pédiatrie générale, hôpital Robert-Debré, Paris, France
| | - Romain Basmaci
- PU-PH, membre du Pediatric-Biocovid Study Group, service de pédiatrie générale, AP-HP, hôpital Louis-Mourier, Colombes ; Inserm UMR 1137 (IAME) ; université de Paris, France
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Santos RM, Massoti MRB, Coronel MRG, Maia FF, Miana LA, Jatene MB. Surgical Correction of Ascending Aortic Aneurysm Without Coronary Dilatation After Kawasaki Disease in a 3-Year-Old Child. Braz J Cardiovasc Surg 2021; 37:952-954. [PMID: 34673520 DOI: 10.21470/1678-9741-2020-0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kawasaki disease (KD) is an inflammatory condition that may affect genetically predisposed individuals in pediatric ages after infectious/environmental triggering. An infrequent finding associated with KD is ascending aortic aneurysm during or after the acute phase of the disease. In this Multimedia presentation, we describe a three-year-old girl submitted to surgical treatment.
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Affiliation(s)
- Rômullo M Santos
- Department of Pediatric Cardiac Surgery, Instituto do Coração, São Paulo, São Paulo, Brazil
| | - Maria Raquel B Massoti
- Department of Pediatric Cardiac Surgery, Instituto do Coração, São Paulo, São Paulo, Brazil
| | | | - Frederico Faria Maia
- Department of Pediatric Cardiac Surgery, Instituto do Coração, São Paulo, São Paulo, Brazil
| | - Leonardo Augusto Miana
- Department of Pediatric Cardiac Surgery, Instituto do Coração, São Paulo, São Paulo, Brazil
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Kuroda Y, Uchida T, Hamasaki A, Yamashita A, Mizumoto M, Akabane K, Ishizawa A, Sadahiro M. Surgical Treatment for a Super-Giant Right Coronary Artery Aneurysm Induced by Kawasaki Disease. Braz J Cardiovasc Surg 2021; 36:433-435. [PMID: 34387979 PMCID: PMC8357373 DOI: 10.21470/1678-9741-2019-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 32-year-old man diagnosed with Kawasaki disease at the age of three years presented with coronary artery aneurysm (CAA). The aneurysm increased in size, and the patient was referred to our hospital for surgery. Preoperative computed tomography scan showed a super-giant right CAA and giant left CAAs; surgery was performed. The super-giant right CAA was resected, and the ostium of the right coronary artery was closed; then, coronary artery bypass grafting was performed. The left CAAs were not treated surgically because the risk of rupture was low. Here, we describe the successful surgical treatment of a right super-giant CAA.
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Affiliation(s)
- Yoshinori Kuroda
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tetsuro Uchida
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Azumi Hamasaki
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Yamashita
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masahiro Mizumoto
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kentaro Akabane
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Ai Ishizawa
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
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Mercier JC, Maroni A, Levy M, Melki I, Meinzer U, Gaschignard J, Beyler C, Santos A. [COVID-19 in children: SARS-CoV-2-related inflammatory multisystem syndrome mimicking Kawasaki disease]. Bull Acad Natl Med 2021; 205:579-586. [PMID: 33753947 PMCID: PMC7969823 DOI: 10.1016/j.banm.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/17/2020] [Indexed: 12/04/2022]
Abstract
SARS-CoV-2 pandemics is characterized by a high level of infectivity and a high mortality among adults at risk (older than 65 years, obesity, diabetes, systemic hypertension). Following a common viral pneumonia, a multisystem inflammatory syndrome sometimes occurs, including an Acute Respiratory Distress Syndrome (ARDS) carrying a high mortality. Unlike most common respiratory viruses, children seem less susceptible to SARS-CoV-2 infection and generally develop a mild disease with low mortality. However, clusters of severe shock associated with high levels of cardiac biomarkers and unusual vasoplegia requiring inotropes, vasopressors and volume loading have been recently described. Both clinical symptoms (i.e., high and persistent fever, gastrointestinal disorders, skin rash, conjunctivitis and dry cracked lips) and biological signs (e.g., elevated CRP/PCT, hyperferritinemia) resembled Kawasaki disease. In most instances, intravenous immunoglobin therapy improved the cardiac function and led to full recovery within a few days. However, adjunctive steroid therapy and sometimes biotherapy (e.g., anti-IL-1Ra, anti-IL-6 monoclonal antibodies) were often necessary. Although almost all children fully recovered within a week, some of them developed coronary artery dilation or aneurysm. Thus, a new 'Multisystem Inflammatory Syndrome associated with SARS-CoV-2' has been recently described in children and helps to better understand Kawasaki disease pathophysiology.
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Affiliation(s)
- J-C Mercier
- Professeur émérite, Université de Paris, Plateforme COVIDOM, AP-HP, ARS Île de France, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 47, rue Copernic, 75116 Paris, France
| | - A Maroni
- CCA, PHC, Service de réanimation pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - M Levy
- CCA, PHC, Service de réanimation pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - I Melki
- PH, MCU-PH, PHU, Service de pédiatrie générale, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
- Centre de référence pour les maladies rhumatologiques auto-immunes et systémiques (RAISE), Institut IMAGINE, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - U Meinzer
- PH, MCU-PH, PHU, Service de pédiatrie générale, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
- Centre de recherche sur l'inflammation, Inserm UMR-1149, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - J Gaschignard
- PH, MCU-PH, PHU, Service de pédiatrie générale, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
- Université de Paris, Faculté de médecine Paris Diderot, Site Bichat
| | - C Beyler
- PH, Service de cardiologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - A Santos
- PHC, Service des Urgences pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
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Komarov R, Ismailbaev A, Chragyan V, Kadyraliev B, Sá MPBO, Ruhparwar A, Weymann A, Zhigalov K. State-of-the-Art Pediatric Coronary Artery Bypass Surgery: a Literature Review. Braz J Cardiovasc Surg 2020; 35:539-548. [PMID: 32864935 PMCID: PMC7454630 DOI: 10.21470/1678-9741-2019-0366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary artery pathologies. Methods We analyzed 61 publications dedicated to the indications, methods, and results of coronary bypass surgery in children. Due to the small size of this cohort, case reports are also included in our review. Results The main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P<0.001). Acute and late coronary events after arterial switch operation for the transposition of the great arteries, anomalous origin of the left coronary artery from the pulmonary artery, and left main coronary artery atresia are the main congenital heart diseases where surgical correction involves interventions on the coronary arteries. Conclusion The internal thoracic artery is a reliable and durable conduit that demonstrates proven growth potential in children.
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Affiliation(s)
- Roman Komarov
- Department of Cardiovascular Surgery, I.M. Sechenov University Hospital, First Moscow State Medical University, Moscow, Russia
| | - Alisher Ismailbaev
- Department of Cardiovascular Surgery, I.M. Sechenov University Hospital, First Moscow State Medical University, Moscow, Russia
| | - Vagi Chragyan
- Department of Cardiovascular Surgery, S.G. Sukhanov Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical University, Perm, Russia
| | - Bakytbek Kadyraliev
- Department of Cardiovascular Surgery, S.G. Sukhanov Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical University, Perm, Russia
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, PE, Brazil
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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Bergman CM, Howell J. Critical Cardiopulmonary Event Series: Four Simulations for Pediatric ICU Fellows, Critical Care Nurses, and Pediatric Residents. MedEdPORTAL 2020; 16:10889. [PMID: 32342011 PMCID: PMC7182043 DOI: 10.15766/mep_2374-8265.10889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/22/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Critical cardiopulmonary events arising from congenital or acquired heart diseases are infrequent in some pediatric critical care units but can be associated with significant morbidity and mortality when encountered. We developed four simulation cases for interprofessional pediatric critical care teams (fellows, residents, and nurses) to provide participants with high-acuity cardiopulmonary scenarios in safe learning environments. The included cases were coarctation of the aorta, Kawasaki disease, myocarditis, and tetralogy of Fallot. METHODS The simulations were typically 15 minutes in duration and took place within the pediatric intensive care unit. The scenarios began with handoff of the patient to the primary nurse, who recruited the assistance of resident physicians and ultimately a pediatric critical care medicine fellow as the scenario escalated. Upon completion, participants engaged in a structured, interactive debriefing session for 40 minutes. Afterward, they were asked to complete an anonymous feedback form that was collected and analyzed. RESULTS Based on aggregate postsimulation survey responses from 114 learners, participants reported that these simulation exercises improved their knowledge and ability to manage acutely deteriorating cardiac patients. Additionally, learners rated the impact of the simulation on their practice highly (average score >4 for each group of participants on a 5-point Likert scale). Feedback was analyzed and categorized into three domains: (1) Pediatric Medicine Learning Objectives, (2) Teamwork Strategies, and (3) Opportunities for Simulation Improvements. DISCUSSION This series advances self-reported learner knowledge and skills surrounding management of cardiopulmonary events while also providing opportunities to enhance teamwork and communication skills.
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Affiliation(s)
- Charles Mac Bergman
- Pediatric Resident (PGY 4), New York Presbyterian–Weill Cornell Medical Center
| | - Joy Howell
- Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Pediatric Critical Care Medicine, New York Presbyterian–Weill Cornell Medical Center
- Pediatric Critical Care Medicine Fellowship Program Director, New York Presbyterian–Weill Cornell Medical Center
- Vice Chair for Diversity, New York Presbyterian–Weill Cornell Medical Center
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Gillispie M, Muscal E, Rama J, Falco C, Brown A. Pediatric Rheumatology Curriculum for the Pediatrics Resident: A Case-Based Approach to Learning. MedEdPORTAL 2018; 14:10767. [PMID: 30800967 PMCID: PMC6342410 DOI: 10.15766/mep_2374-8265.10767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/16/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Pediatric rheumatologic disease occurs more frequently than several other chronic pediatric diseases but is often underrecognized. It is estimated that in the US, one in 250 children has some form of juvenile arthritis and 300,000 children have a form of rheumatologic disease. However, there are only approximately 400 practicing pediatric rheumatologists nationwide. METHODS Kern's six-step method was used to develop a pediatric rheumatology curriculum based on respondents' perceived lack of training and comfort with four key areas: workup, musculoskeletal exam, laboratory interpretation, and referral to rheumatology. These cases were developed for second-year pediatric and second- and third-year internal medicine-pediatric residents rotating with the service. The curriculum was composed of four 30-minute case discussions as well as an observed musculoskeletal exam session. RESULTS In 2017, weekly case study sessions reached 34 trainees. Survey results from these trainees are representative of our overall results and reveal that learners felt the content of the cases helped increase comfort with compiling pertinent history and information of symptoms consistent with autoimmune disease, recognizing physical exam findings of autoimmune disease, ordering and interpreting laboratory studies in children with concerns for autoimmune disease, and referring to pediatric rheumatology. DISCUSSION This case-based curriculum exposed residents to presentations of the more common autoimmune diseases encountered in the pediatric population. The curriculum helps fill a gap in pediatric training through increased exposure to this subset of chronic diseases and expands physical examination skills not typically taught in general pediatrics.
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Affiliation(s)
- Miriah Gillispie
- Fellow, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
| | - Eyal Muscal
- Associate Professor, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
- Associate Professor, Department of Neurology, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
| | - Jennifer Rama
- Assistant Professor, Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine at Texas Children's Hospital
| | - Carla Falco
- Assistant Professor, Department of Pediatrics, Section of Hospital Medicine, Baylor College of Medicine at Texas Children's Hospital
| | - Amanda Brown
- Assistant Professor, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
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Kim HJ, Choi EH, Lim YJ, Kil HR. The Usefulness of Platelet-derived Microparticle as Biomarker of Antiplatelet Therapy in Kawasaki Disease. J Korean Med Sci 2017; 32:1147-1153. [PMID: 28581272 PMCID: PMC5461319 DOI: 10.3346/jkms.2017.32.7.1147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/09/2017] [Indexed: 11/20/2022] Open
Abstract
Little is known about platelet dynamics and the effect of antiplatelet therapy in Kawasaki disease (KD). This study sought to define platelet activation dynamics in KD patients by assaying platelet-derived microparticles (PDMPs). We measured plasma PDMPs levels in 46 patients with KD using an enzyme-linked immunosorbent assay (ELISA). Blood samples were collected before, at 2-5 days, and 9-15 days after intravenous immunoglobulin (IVIG) infusion, 2 months and 4-5 months after the onset of KD. We measured PDMP levels in 23 febrile and 10 afebrile control patients. In the acute phase of KD patients, PDMP levels increased significantly after IVIG treatment (12.04 ± 5.58 nmol before IVIG infusion vs. 19.81 ± 13.21 nmol at 2-5 days after IVIG infusion, P = 0.006). PDMP levels were negatively correlated with age and positively correlated with procalcitonin levels in the acute phase of KD. No significant difference was found in PDMP levels between KD patients with and without coronary artery lesion (CAL). Elevated PDMP levels after IVIG therapy significantly decreased below the pre-IVIG level in subacute phase (19.81 ± 13.21 nmol at 2-5 days after IVIG infusion vs. 8.33 ± 2.02 nmol at 9-15 days after IVIG infusion, P < 0.001), and PDMP levels stayed below the pre-IVIG level in the convalescent phase, during which antiplatelet therapy was given. However, PDMP levels rebounded after discontinuing aspirin in 17 patients. In conclusion, enhanced platelet activation was noted before treatment of KD and peaked immediately after IVIG treatment. Recurrent rising of PDMP levels was observed after discontinuing aspirin, although there were no significant differences between the PDMP levels at 2 months after the onset of KD and those at 4-5 months after the onset of the disease.
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Affiliation(s)
- Hyun Jung Kim
- Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea
| | - Eun Hye Choi
- Eulji Medi-Bio Research Institute, Eulji University School of Medicine, Daejeon, Korea
| | - Yeon Jung Lim
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hong Ryang Kil
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea.
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Ghareep AN, Alkuwari M, Willington F, Szmigielski W. Kawasaki Disease: Diagnosis and Follow-Up by CT Coronary Angiography with the Use of 128-Slice Dual Source Dual Energy Scanner. A Case Report. Pol J Radiol 2015; 80:526-8. [PMID: 26688702 PMCID: PMC4671404 DOI: 10.12659/pjr.894680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/29/2015] [Indexed: 12/18/2022] Open
Abstract
Background Kawasaki Disease (KD) is a rare acute febrile illness due to multi-organ vasculitis. It most often affects children under five years of age. Coronary artery aneurysms are seen in about 25% of children with KD. Selective invasive coronary angiography was considered to be the gold standard for diagnosis and follow-up of coronary artery aneurysms, thrombosis and stenosis in patients with KD. Echocardiography is a non-invasive tool for imaging of this condition but it does have some limitations. Recently, a high-quality multislice CT coronary angiography has been advocated in the diagnosis of KD. Case Report We report a case of a 5-year-old boy who was diagnosed with Kawasaki disease and followed up by CT coronary angiography, which provided required excellent imaging findings in the terms of the number, size and location of coronary aneurysms. Conclusions Based on imaging results of our case it can be stated that high-quality CT coronary angiography with the use of multi-slice dual source ultra-fast scanner can be considered a better and safer non-invasive diagnostic tool, an alternative to invasive catheter selective coronary angiography in the diagnosis and long-term follow-up of patients with KD, especially when echocardiographic images are limited or technically challenging.
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Affiliation(s)
- Abdel-Naser Ghareep
- Clinical Imaging Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maryam Alkuwari
- Clinical Imaging Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Francis Willington
- Clinical Imaging Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Wojciech Szmigielski
- Clinical Imaging Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Hematian MN, Torabi S, MalaKan-Rad E, Sayadpour-Zanjani K, Ziaee V, Lotfi-Tolkaldany M. Noninvasive Evaluation of Myocardial Systolic Dysfunction in the Early Stage of Kawasaki Disease: A Speckle-Tracking Echocardiography Study. Iran J Pediatr 2015. [PMID: 26199701 PMCID: PMC4505983 DOI: 10.5812/ijp.25(3)2015.198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Evaluation of myocardial function by speckle-tracking echocardiography is a new method for the early diagnosis of systolic dysfunction. Objectives: We aimed to determine myocardial speckle-tracking echocardiography indices in Kawasaki Disease (KD) patients and compare them with the same indices in control subjects. Patients and Methods: Thirty-two patients (65.5% males) with KD and 19 control subjects with normal echocardiography participated in this study. After their demographic characteristics and clinical findings were recorded, all the participants underwent transthoracic echocardiography. Strain (S), Strain Rate (SR), Time to Peak Strain (TPS), and Strain Rate (TPSR), longitudinal velocity and view point velocity images in the two, three, and four-chamber views were semi-automatically obtained via speckle-tracking echocardiography. Results: Among the patients, Twenty-four cases (75%) were younger than 4 years. Mean global S and SR was significantly reduced in the KD patients compared to controls (17.03 ± 1.28 vs. 20.22 ± 2.14% and 1.66 ± 0.16 vs. 1.97 ± 0.25 1/second, respectively), while there were no significant differences regarding mean TPS, TPSR, longitudinal velocity and view point velocity. Using repeated measure of analysis of variances, we observed that S and SR decreased from base to apical level in both groups. The change in the pattern of age adjusted mean S and SR across levels was significantly different between the groups (P < 0.001 for both parameters). Conclusions: We showed changes in S and SR assessed in KD patients versus control subjects in the acute phase of KD. However, we suggest that further studies be undertaken to compare S and SR in the acute phase and thereafter in KD patients.
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Affiliation(s)
| | - Shirin Torabi
- Gonabad University of Medical Sciences, Gonabad, IR Iran
- Corresponding author: Shirin Torabi, Gonabad University of Medical Sciences, P. O. Box: 9691844177, Gonabad, IR Iran. Tel: +98-9153025709, Fax: +98-53572-3815, E-mail:
| | - Elaheh MalaKan-Rad
- Children’s Medical Center, Pediatric Center of Excellence, Tehran, IR Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Keyhan Sayadpour-Zanjani
- Children’s Medical Center, Pediatric Center of Excellence, Tehran, IR Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Vahid Ziaee
- Children’s Medical Center, Pediatric Center of Excellence, Tehran, IR Iran
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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Abstract
Body fat is an important source of adipokine, which is associated with energy balance and inflammatory and immune responses. However, the role of adipokines in coronary artery complications in Kawasaki disease (KD) has not yet been fully explained. We investigated whether serum adipokine level can be a useful marker for patients with KD who are at higher risk of developing coronary artery lesion (CAL). We measured adipokine levels and other inflammatory parameters in 40 patients with KD, 32 febrile controls, and 15 afebrile controls. Interleukin (IL)-6, tumor necrosis factor (TNF)-α and other laboratory parameters were also measured before and after intravenous immunoglobulin therapy, and in the convalescent phase. At admission, the serum resistin levels in KD children were significantly higher than those in controls (177.56 ng/mL in KD children, 76.48 ng/mL in febrile controls, and 17.95 ng/mL in afebrile controls). In patients with KD, resistin levels were significantly associated with decreased hemoglobin levels (P=0.049) and increased IL-6 levels (P=0.014). The serum IL-6 levels were significantly higher and body mass index was significantly lower in the group of KD with CALs than those without CALs (228.26 ng/mL vs. 39.18 ng/mL and 15.09 vs. 16.60, respectively). In conclusion, resistin is significantly elevated in KD patients, although it has no prognostic value of predicting coronary artery lesion in the acute stage.
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Affiliation(s)
- Hyun Jung Kim
- Department of Pediatrics, Eulji Universitiy School of Medicine, Daejeon, Korea
| | - Eun Hye Choi
- Eulji Medi-Bio Research Institute, Eulji University, Daejeon, Korea
| | - Hong Ryang Kil
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
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Shamsizadeh A, Ziaei Kajbaf T, Razavi M, Cheraghian B. Clinical and epidemiological characteristics of kawasaki disease. Jundishapur J Microbiol 2014; 7:e11014. [PMID: 25485046 PMCID: PMC4255208 DOI: 10.5812/jjm.11014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 07/23/2013] [Accepted: 05/17/2014] [Indexed: 01/17/2023] Open
Abstract
Background: Kawasaki disease (KD) is an acute multisystem vascular syndrome of unknown etiology that is the leading cause of acquired heart disease in children of developed counties. Objectives: We aimed to evaluate the epidemiological characteristics and clinical manifestations of KD in children residing in the southwest of Iran. Patients and Methods: In this retrospective study, we reviewed the medical records of all children with KD who had been admitted to the main children’s hospital of Ahvaz, southwest Iran, from March 2000 to March 2010. Data regarding clinical and epidemiological characteristics, management, and the outcome of disease for each patient were obtained. The patients were divided into cardiac and non-cardiac groups based on echocardiographic results. Results: In total, 104 patients with KD (66 boys and 38 girls) were enrolled in this study. The male to female ratio was 1.7:1. The mean ± SD age of the patients was 33.6 ± 24.2 months. Most (87.2%) cases were from urban areas. The disease occurred more frequently during winter and spring. Furthermore, 61.5% of the children had the criteria of classic KD, and 38.5% were labeled as incomplete KD. The mean ± SD of the duration of hospital stay was 6.9 ± 2.4 days. The mean time between illness and admission to the hospital was 6.47 ± 2.6 days. The most common sign was fever, followed by conjunctivitis and oral changes. In total, 20% of the patients had cardiac abnormalities. There was no significant statistical difference between the cardiac and non-cardiac groups according to age, sex, clinical manifestations, laboratory findings, and cessation of fever. The duration of hospital stay and the time between onset of illness and diagnosis were longer in the cardiac group. All patients received intravenous immunoglobulin and aspirin. Only one patient continued to have cardiac abnormalities after 6 months of follow-up. Conclusions: Kawasaki disease is not rare in southwest of Iran. The age, gender distribution and clinical findings are similar to that of other reports. Patients with cardiac abnormalities had delayed treatment and prolonged hospital stays.
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Affiliation(s)
- Ahmad Shamsizadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Aboozar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding author: Ahmad Shamsizadeh, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-9161136128, Fax: +98-6114433715, E-mail:
| | - Tahereh Ziaei Kajbaf
- Aboozar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Maryam Razavi
- Aboozar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Bahman Cheraghian
- School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Seo JH, Yu JJ, Ko HK, Choi HS, Kim YH, Ko JK. Diagnosis of incomplete kawasaki disease in infants based on an inflammation at the bacille calmette-guérin inoculation site. Korean Circ J 2012; 42:823-9. [PMID: 23323120 PMCID: PMC3539048 DOI: 10.4070/kcj.2012.42.12.823] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 07/31/2012] [Indexed: 01/05/2023] Open
Abstract
Background and Objectives This study was intended to test how the inflammation at the Bacille Calmette-Guérin (BCG) inoculation site (BCGitis) can be a useful a diagnostic feature of Kawasaki disease (KD). Subjects and Methods All subjects were infants at the time of admission, and had received BCG vaccination during their neonatal period. There were 54 patients with complete KD (group 1) and 29 patients with incomplete KD (group 2). All 83 patients had BCGitis during the acute phase of illness. Data regarding the coronary artery diameters in 31 age-matched controls were used for comparison. Results The 2 patient groups did not differ in clinical and laboratory variables. During the acute phase, the median z scores of the left anterior descending coronary artery (LAD) diameter were 0.20, 0.42, and -0.48 in groups 1, 2, and control respectively, and that of right coronary artery (RCA) diameters were -0.15, -0.16, and -1.17 respectively. The z scores in both patient groups were greater than those in controls (p=0.0014 in LAD and p<0.0001 in RCA between group 1 and controls; p=0.0023 in LAD and p<0.0001 in RCA between group 2 and controls). A similar pattern was observed during the subacute and convalescent phases. Conclusion BCGitis is a useful feature in the diagnosis of incomplete KD in infants who received BCG vaccine during neonatal period.
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Affiliation(s)
- Ji Hye Seo
- Department of Pediatrics, College of Medicine, University of Ulsan, Seoul, Korea
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Abstract
An infant with recent atypical, treatment-refractory Kawasaki disease presented with marked eosinophilia. Workup failed to identify an etiology. The eosinophilia spontaneously resolved. Eosinophilia has been observed in the acute phase of Kawasaki disease, but has not been reported following recovery.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa, USA
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Do YS, Kim KW, Chun JK, Cha BH, Namgoong MK, Lee HY. Predicting factors for refractory kawasaki disease. Korean Circ J 2010; 40:239-42. [PMID: 20514335 PMCID: PMC2877789 DOI: 10.4070/kcj.2010.40.5.239] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 10/26/2009] [Accepted: 10/30/2009] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives About 10-15% of Kawasaki disease (KD) is refractory to intravenous immunoglobulin (IVIG) therapy. This study was designed to investigate the predicting factors for refractory KD. Subjects and Methods We reviewed retrospectively the clinical records of 77 patients with typical KD admitted at Wonju Christian Hospital from January, 2005, to December, 2008. The variance of laboratory and demographic parameters between the IVIG-responsive group and IVIG-resistant group were analyzed. Thirteen patients with urinary tract infections were randomly collected as a febrile control group. Results Among 77 patients diagnosed with complete KD, 13 patients (16.9%) were IVIG-resistant. The febrile period and hospital days were significantly longer in the IVIG-resistant group than IVIG-responsive group (p<0.001, p=0.002). Serum levels of albumin and sodium were significantly lower in the IVIG-resistant group (p=0.025). The Kobayashi score could differentiate these two groups (p=0.015). Fewer lymphocytes was observed during the subacute phase in the IVIG-resistant group (p=0.032). Coronary arterial dilatations (CADs) were observed in 10.9% (7/64) of IVIG-responders and 38.5% (5/13) of IVIG-resistant patients (p=0.038). Conclusion The percentage of neutrophils and lymphocytes in patients with KD, in addition to known risk factors for refractory KD, may help predict IVIG-resistance in patients with KD.
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Affiliation(s)
- Young-Sun Do
- Department of Pediatrics and Adolescent Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Hsueh KC, Lin YJ, Chang JS, Wan L, Tsai YH, Tsai CH, Chen CP, Tsai FJ. Association of interleukin-10 A-592C polymorphism in Taiwanese children with Kawasaki disease. J Korean Med Sci 2009; 24:438-42. [PMID: 19543506 PMCID: PMC2698189 DOI: 10.3346/jkms.2009.24.3.438] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 07/22/2008] [Indexed: 11/20/2022] Open
Abstract
Elevated serum levels of interleukin-10 (IL-10) have been reported in patients with Kawasaki disease (KD). IL-10 reduces the inflammatory actions of macrophages and T cells and it may play a significant role in the regulation of inflammatory vascular damage associated with systemic vasculitis. The aim of this study was to examine whether -592 IL-10 promoter polymorphism is a susceptibility or severity marker of KD in Chinese patients in Taiwan. The study included 105 KD patients and 100 normal controls. Genotype and allelic frequencies for the IL-10 gene polymorphism in both groups were compared. There were no significant between-group differences in the genotype distribution of IL-10 A-592C gene polymorphism (P=0.08). However, the frequency of the -592*A allele was significantly increased in the patients with KD compared with controls (71.9% vs. 61.0%, P=0.019). The odds ratio for developing KD in individuals with IL-10-592*A allele was 1.64 (95% confidence interval, 1.06-2.52) compared to individuals with the IL-10-592*C allele. No significant difference was observed in the genotype and allelic frequencies for the IL-10 A-592C polymorphism between patients with and without coronary artery lesions. The IL-10-592*A allele may be involved in the development of KD in Taiwanese children.
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Affiliation(s)
- Kai-Chung Hsueh
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Ying-Ju Lin
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Jeng-Sheng Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Lei Wan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Yu-Hsin Tsai
- Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
| | - Chang-Hai Tsai
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fuu-Jen Tsai
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
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