Associated Symptoms in the Ten Days Before Diagnosis of Kawasaki Disease

Baker, Annette L.; Lü, Minmin; Minich, L. LuAnn; Atz, Andrew M.; Klein, Gloria L.; Korsin, Rosalind; Lambert, Linda M.; Li, Jennifer S.; Mason, Wilbert H.; Radojewski, Elizabeth; Vetter, Victoria L.; Newburger, Jane W.

doi:10.1016/j.jpeds.2008.10.006

Cited by 113 publications

(93 citation statements)

References 12 publications

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“…(5) If the echocardiogram is positive, treatment should be given within 10 days of fever onset or after the tenth day of fever in the presence of clinical and laboratory signs (C-reactive protein [CRP] week of illness and predominantly large weight-bearing joints, especially the knees and ankles, in the second to third week of illness. 102,103 Respiratory findings include peribronchial and interstitial infiltrates on chest radiography; nodular infiltrates occur rarely. Erythema and induration at the site of a previous vaccination with bacille Calmette-Guérin is common in children with KD born in countries where it is used widely.…”

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confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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mentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

Self Cite

2,876

4,124

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“…3,4 However, there is still much to know about this group of resistant patients, and they warrant further investigation in order to determine factors that contribute to their resistance. Arthritis has previously been reported in Kawasaki disease in 7.5-45% of cases, in both acute or subacute phases, [7][8][9] and although determined to be a transient finding, 1,7 it has also been reported after immunoglobulin therapy. 10,11 It was hypothesized that arthritis would be associated with a higher degree of inflammation and thus immunoglobulin resistance.…”

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confidence: 99%

Immunoglobulin Resistance in Kawasaki Disease

Hartas

Hashmi

Pham-Peyton

et al. 2015

Pediatric Allergy, Immunology, and Pulmonology

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Background: The aim of this study was to identify risk factors for immunoglobulin resistance, including clinical symptoms such as arthritis and the pH of intravenous immunoglobulin. Methods: The data of children with Kawasaki disease who had received immunoglobulin were evaluated. Data regarding the brand of immunoglobulin administered were abstracted from the pharmacy records. Results: Eighty consecutive children with Kawasaki disease were evaluated (Mdn age = 28 months, 66% male). The prevalence of immunoglobulin resistance was 30%. Arthritis was a presenting symptom in the acute phase of Kawasaki disease in 8% (6/80, all male) and was seen in significant association with immunoglobulin resistance in comparison to those without arthritis (16.7% vs. 0.2%, p = 0.008). Next, the immunoglobulin brand types were divided into two groups: the relatively high pH group (n = 16), including Carimune (pH 6.6 -0.2), and the low pH group (n = 63), including Gamunex (pH 4-4.5) or Privigen (pH 4.6-5). Overall, no significant difference in immunoglobulin responsiveness was found between the low pH and the high pH groups (73% vs. 56%, p = 0.193), although the low pH group showed a trend toward a larger decrease in erythrocyte sedimentation rate ( p = 0.048), lower steroid use ( p = 0.054), and lower coronary involvement ( p = 0.08) than those in the high pH group. Conclusions: Children presenting with arthritis in the acute phase of Kawasaki disease may be at risk for immunoglobulin resistance.

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“…In addition to diagnostic criteria, KD patients may have many nonspecific clinical features like irritability, vomiting, diarrhea, cough, weakness, abdominal pain, arthralgia and myalgia 1,2,7 . Baker et al 7 found irritability in 50% and weakness in 19% of 198 KD patients and they speculated that these nonspecific symptoms may reflect diffuse vasculitis or be the sequelae of an infectious trigger(s) of KD. Myalgia and fatigue are considered as features that suggest a vasculitic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Kawasaki disease shock syndrome: a rare and severe complication of Kawasaki disease

et al. 2016

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Kawasaki disease is an acute systemic vasculitis that occurs most commonly in young children. It affects medium-sized muscular arteries and the coronary arteries are the predominant site of involvement. Morbidity and mortality is generally due to coronary artery aneurysms that develop during the chronic phase. Although it is well known that Kawasaki disease can cause myocarditis, tachycardia and heart failure during acute stage, Kawasaki disease shock syndrome has been recently described. It is characterized by hypotension, signs and symptoms of poor perfusion and a shock-like state. Herein we describe two cases of Kawasaki disease shock syndrome that were treated in the pediatric intensive care unit and followed a course without morbidity or mortality.

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Associated Symptoms in the Ten Days Before Diagnosis of Kawasaki Disease

Cited by 113 publications

References 12 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Immunoglobulin Resistance in Kawasaki Disease

Kawasaki disease shock syndrome: a rare and severe complication of Kawasaki disease

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