Evaluation of the Temporal Association between Kawasaki Disease and Viral Infections in South Korea

Kim, Jun Seok; Park, Sohee; Kwon, Bo Sang; Han, Jieun; Park, Yong Won; Hong, Young Mi

doi:10.4070/kcj.2014.44.4.250

Cited by 33 publications

(41 citation statements)

References 20 publications

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“…It is the most important cause of acquired heart disease in children in developed countries [1]. Concomitant respiratory viral infections have been described in 8-42% of patients, and bacterial infections were found in 33% of patients [2][3][4][5][6][7][8]. The clinical presentation of patients with and without concomitant infection is similar [2,8].…”

Section: Introductionmentioning

confidence: 99%

Profile of resistance to IVIG treatment in patients with Kawasaki disease and concomitant infection

Dionne

Poupart

et al. 2018

PLoS ONE

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IntroductionKawasaki disease (KD) can be associated with concomitant viral or bacterial infections. Children with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications. Although concomitant infection does not affect coronary outcome, it is unknown how it influences the response to IVIG treatment.MethodologyRetrospective cohort study between 2008 and 2016 in a tertiary pediatric university hospital, including 154 children, of which 59 (38%) had concomitant infection.ResultsChildren with concomitant infection were more likely to have fever 48 hours after initial IVIG treatment (36% vs 20%, p = 0.05) and to be treated with a second dose (33% vs 18%, p = 0.04). Children with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p = 0.04), and 48 hours after IVIG administration (111 vs 59 mg/L, p = 0.003). Nevertheless, there was no statistically significant difference in the prevalence of coronary complications (Z-score > 2.5) between children with and without concomitant infection (36% vs 39%, p = 0.68).ConclusionChildren with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment. This association increases the likelihood of receiving a second dose of IVIG but not the risk of coronary complication. Accordingly, prospective studies to distinguish true IVIG resistance from infection induced persistent fever is warranted.

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Section: Introductionmentioning

confidence: 99%

Profile of resistance to IVIG treatment in patients with Kawasaki disease and concomitant infection

Dionne

Poupart

et al. 2018

PLoS ONE

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“…It is a reasonable open hypothesis that Kawasaki disease is caused by an unidentified microorganism that induces striking immune perturbations in genetically susceptible individuals. Although the efforts to find a causative microorganism have failed [2][3][4] , the suspicion of an association between some unidentified microorganism and Kawasaki disease remains [4][5][6][7] . Investigations to identify a genetic susceptibility locus in Kawasaki disease also have been performed recently [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Use of corticosteroids during acute phase of Kawasaki disease

Yu¹

2015

WJCP

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In spite of initial intravenous immunoglobulin (IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. Three options of using corticosteroids for the treatment of patients during the acute phase of Kawasaki disease, have been considered. The first is their use exclusively for patients unresponsive to IVIG treatment. The second is their use in combination with IVIG as the routine first line therapy for all patients. The last is the use in the combination as the first line therapy for selected patients at a high risk being unresponsive to initial IVIG. However, it is uncertain that the corticosteroids as the second line treatment are better than the additional IVIG in patients unresponsive to initial IVIG. The combination of corticosteroids and IVIG as the routine first line therapy also have not enough evidences. The last option of using corticosteroids - the combination of corticosteroids and IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.

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“…In Korea, KD showed the highest incidence in summer and winter and the lowest incidence in February and October. 4) 16) The monthly fluctuation in the incidence of KD and the detection of viruses suggests the etiologic importance of the precedence of infection in the development of KD.…”

Section: Discussionmentioning

confidence: 99%

“… 5) 9) Many studies have been carried out to identify infectious agents responsible for KD. 4) 5) 10) However, there is no definitive conclusion regarding this subject.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Function in Kawasaki Disease Patients with Respiratory Symptoms

et al. 2015

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Background and ObjectivesRespiratory symptoms are often observed in children with Kawasaki disease (KD) during the acute phase. The association of respiratory viruses in children with KD was investigated using multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) and tissue Doppler echocardiography.Subjects and Methods138 KD patients were included from January 2010 to June 2013. We compared 3 groups (group 1: n=94, KD without respiratory symptoms; group 2: n=44, KD with respiratory symptoms; and group 3: n=50, febrile patients with respiratory symptoms). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide (NT-proBNP). Echocardiographic measurements were compared between group 1 and group 2. RT-PCR was performed using nasopharyngeal secretion to screen for the presence of 14 viruses in groups 2 and 3.ResultsThe incidence of KD with respiratory symptoms was 31.8%. The duration of fever was significantly longer, and coronary artery diameter was larger in group 2 than in group 1. Tei index was significantly higher and coronary artery diameter larger in group 2 than group 1. Coronary artery diameter, C-reactive protein levels, platelet count, alanine aminotransferase levels, and NT-pro BNP levels were significantly higher and albumin levels lower in group 2 compared with group 3.ConclusionNT-pro BNP was a valuable diagnostic tool in differentiating KD from other febrile viral respiratory infections. Some viruses were more frequently observed in KD patients than in febrile controls. Tei index using tissue Doppler imaging was increased in KD patients with respiratory symptoms.

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Evaluation of the Temporal Association between Kawasaki Disease and Viral Infections in South Korea

Cited by 33 publications

References 20 publications

Profile of resistance to IVIG treatment in patients with Kawasaki disease and concomitant infection

Profile of resistance to IVIG treatment in patients with Kawasaki disease and concomitant infection

Use of corticosteroids during acute phase of Kawasaki disease

Cardiac Function in Kawasaki Disease Patients with Respiratory Symptoms

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