Increased Detection Rate of Kawasaki Disease Using New Diagnostic Algorithm, Including Early Use of Echocardiography

Heuclin, T.; Dubos, François; Hue, V.; Godart, François; Francart, Charles; Vincent, P; Martinot, A.

doi:10.1016/j.jpeds.2009.04.058

Cited by 69 publications

(39 citation statements)

References 28 publications

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“…92 Studies evaluating the incomplete KD diagnostic algorithm first proposed in the 2004 guidelines 1 suggest its usefulness in identifying patients who require treatment and in preventing coronary artery aneurysms. 93,94 Incomplete KD occurs most commonly in infants, who are at substantial risk of developing coronary artery abnormalities and who may have prolonged fever as the sole clinical finding or have subtle or fleeting clinical signs in addition to fever. Laboratory findings and cardiovascular sequelae in incomplete and complete cases appear the same.…”

Section: Incomplete (Atypical) Kdmentioning

confidence: 99%

“…Use of the algorithm appears to be largely successful in ensuring that children at highest risk are treated with IVIG. 93,94 In view of the low risks associated with IVIG administration and the high risks of coronary artery aneurysms among children who do not receive timely treatment, the current algorithm should be applied to the child with suspected incomplete KD until an evidence-based algorithm or a specific diagnostic test for KD becomes available.IVIG should be instituted as early as possible within the first 10 days of illness onset of fever, that is, as soon as the diagnosis can be established. Patients with a delayed diagnosis of KD (ie, later than day 10 of fever) may still be candidates for treatment.…”

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confidence: 99%

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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

2,876

4,124

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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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Section: Incomplete (Atypical) Kdmentioning

confidence: 99%

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

2,876

4,124

View full text Add to dashboard Cite

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“…They commented on the difficulty in making the diagnosis in young infants [69]. Case reports of other unusual presentations [eg, GI bleeding, lupuslike illness in a recurrent case, arthritis, rhabdomyolysis] have been published.…”

Section: Diagnosis Of Incomplete Kawasaki Diseasementioning

confidence: 99%

Kawasaki Disease: The Coronary Affection Perspective

Elshamaa¹

2017

Cardiothorac Vasc Sci

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Kawasaki disease (KD) is an acute, febrile systemic vasculitis of an unknown etiology. KD has now surpassed rheumatic fever as the leading cause of acquired heart disease in the United States (U.S.) among children younger than 5 years. Although there has been a great deal of research into the cause of KD, there is no known etiology. The lack of a diagnostic test can result in significant delays in treatment, often resulting in cardiovascular sequelae ranging from asymptomatic coronary artery ectasis or aneurysm formation to giant coronary artery aneurysms with thrombosis, myocardial infarction, and sudden death in untreated children. Continued research is integral to the evolution of the management of patients with KD because understanding the mechanism of pathogenesis would allow the development of a diagnostic test and, therefore, more rapid and comprehensive treatment. I review these facts and the coronary affection from the diagnostic and the mechanistic standpoints.

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“…les formes atypiques et/ou incomplètes qui peuvent représenter jusqu'à 36 % des cas [28][29][30]. Certains auteurs distinguent les formes incomplètes (< 4 critères en plus de la fièvre) des formes atypiques (atteinte prédominante généralement non rencontrée dans le cadre de la MK, par exemple atteinte rénale ou neurologique) (Tableau 5).…”

Section: Maladie De Kawasakiunclassified

Classification des vascularites de l’enfant

Merlin

2012

Revue du Rhumatisme Monographies

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Increased Detection Rate of Kawasaki Disease Using New Diagnostic Algorithm, Including Early Use of Echocardiography

Cited by 69 publications

References 28 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

Kawasaki Disease: The Coronary Affection Perspective

Classification des vascularites de l’enfant

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