Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

Tulloh, Robert; Mayon-White, Richard; Harnden, Anthony; Ramanan, Athimalaipet V; Tizard, E. Jane; Shingadia, Delane; Michie, Colin; Lynn, Richard; Levin, Michael; Franklin, Orla; Craggs, Pippa; Davidson, Sue; Stirzaker, Rebecca; Danson, Mike; Brogan, Paul A.

doi:10.1136/archdischild-2018-315087

Cited by 80 publications

(76 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study had a high proportion of children with incomplete KD (35.7%), which is in line with other recent studies from Asia (16,17). Median duration of fever in our cohort of children with KD was 13.5 days that is higher compared to the European and North American cohorts (18,19). Duration of fever may have impacted MPA% values in children with KD, as most of our patients were diagnosed more than 10 days after the disease onset when the platelet counts begin to increase.…”

Section: Discussionsupporting

confidence: 91%

Monocyte Platelet Aggregates in Children with Kawasaki Disease- a Preliminary Study from a Tertiary Care Centre in North-West India

Vignesh

Rawat

Shandilya

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Platelet activation is an integral part of pathogenesis of Kawasaki disease (KD). However, there is paucity of literature on flow-cytometry based assessment of platelet activation in KD. We aimed to analyse monocyte-platelet aggregates (MPAs), one of the sensitive markers for platelet activation, by flow cytometry in children with KD.Findings: In this single-centre prospective study, we have enrolled 14 children with KD and results were compared with age-matched febrile (n=15) and healthy (n=13) controls. After gating monocytes in side-scatter plot, MPAs were identified based on CD14 and CD41 expression. Two (2) ml of blood samples for children with KD were collected at 3 phases of illness- acute stage before start of intravenous immunoglobulin or aspirin, 24 hours after completion of IVIg infusion, and 3 months after acute episode of KD. Children with KD had a significantly higher MPA% values [Median (IQR)- 41.3% (26.6, 52.7)] when compared with febrile [Median (IQR)- 5.98% (2.98-9.72)] and normal [Median (IQR)- 4.48% (2.57-5.59)] controls, p<0.01. On follow-up, the MPA% showed a gradual decline in children with KD, but even at 3 months, the value [Median (IQR)- 7.55% (4.15-14.6)] was higher compared to healthy controls [Median (IQR)- 4.48% (2.57-5.59)].Conclusions: Our results suggest that MPA% was significantly elevated in acute stages in children with KD and activated platelets may continue to persist even after systemic inflammation has subsided. Future studies are warranted whether objective evidence of platelet activation may guide the use of immunomodulatory and anti-platelet therapy in KD.

show abstract

Section: Discussionsupporting

confidence: 91%

Monocyte Platelet Aggregates in Children with Kawasaki Disease- a Preliminary Study from a Tertiary Care Centre in North-West India

Vignesh

Rawat

Shandilya

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In the UK 39% of infants develop coronary artery involvement, highlighting the need to recognise KD and treat urgently. 3…”

Section: The Persistently Febrile Very Young Childmentioning

confidence: 99%

“…2 Now around 300 children have KD each year in the UK (about 10 per 100 000 children per year under 5) and may have a lifetime of consequences if not treated promptly. 3 The decision of when to give intravenous immunoglobulin (IVIG) relies on clinical experience and skilled decision making, taking into account which clinical features fit with a diagnosis of KD. One gram of IVIG is derived from the combined plasma of >1000 donors.…”

Section: Introductionmentioning

confidence: 99%

Fifteen-minute consultation: Kawasaki disease: how to distinguish from other febrile illnesses: tricks and tips

Kelly

Sales

Fenton-Jones

et al. 2020

Arch Dis Child Educ Pract Ed

Self Cite

View full text Add to dashboard Cite

Kawasaki disease (KD) is challenging to diagnose because there is no specific laboratory test and the presentation is often similar to common childhood infections. We highlight some of those KD diagnostic challenges. KD, a self-limiting vasculitis, can cause coronary artery aneurysms. The aim is to optimise management during the acute febrile illness to try and prevent these because a giant coronary artery aneurysm is devastating enough without thinking that it might have been prevented. The conundrum for acute paediatricians is which clinical features best distinguish the febrile child with possible KD, needing intravenous immunoglobulin, from the many other children with febrile illnesses.

show abstract

“…Kawasaki disease (KD) was first described in Japan in 1967, predominantly affects young children and has potential life-long consequences 1–4. Its incidence in children under 5 years ranges from 322/100 000 in Japan and South East Asian countries, to 4.5–25/100 000 in Europe and USA3–5 and the disease has become increasingly common in the UK 6 7. Its cause is unknown, but epidemiological observations suggest an environmental agent causing an inflammatory process in genetically predisposed individuals 8.…”

Section: Introductionmentioning

confidence: 99%

“…The 10%–15% of patients who are unresponsive to IVIG may be treated with corticosteroids, infliximab or other immunosuppressive agents2 and are at increased risk of CAA, as are those in whom treatment is delayed 12 13. Following an acute episode of KD, British Paediatric Surveillance Unit data suggest that 19% of children overall and 39% of those aged under 1 year, still develop coronary involvement6 despite IVIG, partly related to delayed diagnosis and treatment. Such children are at long-term risk of coronary thrombosis, acute coronary syndrome and progressive coronary stenoses 13–15.…”

Section: Introductionmentioning

confidence: 99%

Lifetime cardiovascular management of patients with previous Kawasaki disease

Brogan¹,

Burns

Cornish³

et al. 2019

Heart

Self Cite

View full text Add to dashboard Cite

Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere.

show abstract

Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

Abstract: The UK and Ireland incidence of KD has increased and is more frequently seen in winter and rural areas. Delayed IVIG treatment is associated with CAA, suggesting earlier and adjunctive primary treatment might reduce complications to prevent CAA, particularly in the very young.

Cited by 80 publications

References 29 publications

Monocyte Platelet Aggregates in Children with Kawasaki Disease- a Preliminary Study from a Tertiary Care Centre in North-West India

Monocyte Platelet Aggregates in Children with Kawasaki Disease- a Preliminary Study from a Tertiary Care Centre in North-West India

Fifteen-minute consultation: Kawasaki disease: how to distinguish from other febrile illnesses: tricks and tips

Lifetime cardiovascular management of patients with previous Kawasaki disease

Contact Info

Product

Resources

About