Effects of Gamma-Globulin on the Cardiac Sequelae of Kawasaki Disease

Abstract

Our aim was to delineate the effect of various factors, such as sex, age, serum albumin levels, and the timing of gamma-globulin (GG) therapy, on cardiac sequelae of Kawasaki disease. The patients with Kawasaki disease who were reported at the 1995-1996 nationwide survey and received 2000 mg/kg at specified hospitals were selected as the subjects of the study. A total of 2221 patients actually received the basic dose. The relationships of the GG therapy with the cardiac sequelae, sex, age, timing of GG administration (the date of initiation and duration of the regimen following disease onset), and serum albumin levels were examined by using logistic regression analysis. The odds ratios for the cardiac sequelae in patients with Kawasaki disease were high in males (1.63), in those under the age of 1 year (1.54), and in those with a serum albumin level <3.2 g/dl (2.64). The odds ratio was low in those who received GG before day 8 of the illness (0.69) or in those for whom the administration period was for 2 days or less (0.67). To prevent cardiac sequelae of Kawasaki disease it is desirable that GG therapy be started as soon as possible and completed within 2 days.

Late Intravenous Immunoglobulin Treatment in Patients With Kawasaki Disease

“…[1][2][3][4][5][6] Because the coronary artery changes usually begin on days 7 to 10, 7 treatment within 10 days, especially within 7 days, of illness onset is optimal. 6,8,9 On the other hand, the effectiveness of treatment on and after 10 days of illness has not yet been clarified. 6,10 There have been no clinical trials comparing the effectiveness of late IVIG with placebo, possibly because of the difficulty of ethically performing such a study.…”

Kawasaki disease: What is the epidemiology telling us about the etiology?

“…These children may present a diagnostic challenge 6 and the lack of a specific diagnostic test may delay treatment and thus worsen prognosis. 7 Moreover, to confuse the clinical picture further, there is increasing concern that the diagnostic criteria are too narrow. 'Atypical' or 'incomplete' KD is a description used for children presenting with the characteristic fever but fewer than four classical signs.…”

Refractory Progression of Coronary Aneurysms, a Case of Delayed Onset Kawasaki Disease as Depicted by Cardiac Computed Tomography Angiography

“…In about 50% of children with KD, coronary artery dilation may be seen by the 10th day and male infants are at the highest risk for the development of coronary aneurysms 17 . Enlargement of the left main coronary artery (LM) is usually seen with ectasia of the LAD and/or Cx coronary arteries 7 .…”