Inflammatory Processes in Kawasaki Disease Reach their Peak at the Sixth Day of Fever Onset: Laboratory Profiles According to Duration of Fever

Abstract

We evaluated the inflammatory indices according to the fever duration in children with Kawasaki disease (KD), and determined duration when the inflammatory processes in KD reach their peak. Children with KD (n=152) were classified into 7 groups according to fever duration: at the third day or earlier (n=20), fourth (n=33), fifth (n=46), sixth (n=15), seventh (n=15), eighth (n=9), and at the ninth day or later after fever onset (n= 14). The levels of various laboratory indices were determined 3 times: before, 24 hr and 7 days after intravenous immunoglobulin administration (2 g/kg). WBC and neutrophil counts, and C-reactive protein level were the highest at the sixth day. Levels of hemoglobin, albumin, and high density lipoprotein cholestrol were the lowest at the sixth day. Although these indices were not significant statistically between groups, the indices showed either bell-shaped or U-shaped distribution of which peak or trench were at the sixth day. These findiugs showed that the inflammatory processes in KD reach peak on the sixth day of fever onset. This finding is important because a higher single-dose intravenous immunoglobulin treatment before the peak day may help reduce the coronary artery lesions in KD.

Kawasaki disease in Greek children: a retrospective study

“…Erythrocyte sedimentation rate and C‐reactive protein measured in consecutive days showed their maximum values at the end of the first week from the onset of fever, remaining high for as long as the disease was active, thus guiding the treatment and further follow up. This is in accordance with the observations of other studies from other parts of the world 22–24 . Also, in accordance with other studies, the occurrence of thrombocytosis was detected in the subacute phase of the disease (peaked in the 2nd or 3rd week).…”

Features of Kawasaki disease at the extremes of age

“…Cervical lymphadenopathy is clearly an insensitive diagnostic sign of KD in younger children 29,33 and its absence in <6 months of age group is unhelpful in establishing the diagnosis. Thrombocytosis in the second week of KD is an important but non‐specific laboratory finding, and may help to make the diagnosis of incomplete KD in late acute stage of KD 19 . The thrombocytosis was most marked in the youngest children in the current study.…”

“…Rigorous application of the classical diagnostic criteria in younger children is inappropriate and will result in missed diagnoses 3 . It is well recognised that KD may be overlooked in younger children if strict diagnostic criteria are applied, 12,13 , 28 and recently published less stringent diagnostic algorithms may prove particularly useful in this age group 3,19 , 20 …”

“…The greater intensity of inflammation, manifest by more prolonged fever duration, non‐responsiveness of IVIG treatment and/or higher values of inflammatory indices may correlate with a higher incidence of CAL, although many studies have not corrected for potential age‐related differences in normal values 19,24 , 32 . In the current study, older children had a longer total duration of fever and higher values in inflammatory indices including slower resolution of erythrocyte sedimentation rate than younger patients, suggesting more marked inflammation with increasing age.…”

“…those with at least four of the five standard diagnostic criteria; rash, cervical lymphadenopathy, peripheral changes, oropharyngeal changes and non‐purulent conjunctivitis 3 ). Incomplete KD was defined as less than four clinical criteria, irrespective of their echocardiographic findings, 3,18 , 19 37 cases of incomplete KD cases were excluded from this analysis. As KD is a familiar and frequent diagnosis in Korea and treatment may be commenced before the fifth day of the illness, children without 5 days of fever, but with at least four diagnostic criteria were included 3,20 .…”