Kawasaki disease: An update

Abstract

Kawasaki disease (KD) was first reported in Japan more than 30 years ago, but the original diagnostic clinical criteria defined by Dr. Kawasaki are still authentic. The cause of KD remains unknown. Several epidemiologic and clinical observations suggest that it is caused by one or multiple infectious agents, each of which can result in the clinical manifestation of the disease. Advances have been made in the management of the disease with the introduction of aspirin and intravenous immunoglobulin (IVIG) that have had a significant impact on lowering the rate of coronary artery aneurysms and death from the disease. Questions remain regarding the management of those patients whose disease does not respond to IVIG. Some patients with severe KD who are resistant to IVIG may benefit from IV pulse steroids therapy. It remains to be seen whether steroid or other anti-inflammatory agents play a role in the management of patients with KD. Further research studies are needed to identify the possible cause, define the treatment, and predict the long-term outcome of this enigmatic disease.

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients

“…The most common dysplastic disease is fibromuscular dysplasia (FMD), which may affect many noncoronary arterial beds, especially the renal arteries, carotid arteries, and iliac arteries (11,12). The vasculitic diseases may also affect any arterial bed, and the spectrum of clinical syndromes associated with vasculitis is broad (13)(14)(15)(16)(17)(18)(19)(20). Large vessels (the aorta and its first-and second-order branches) may be involved by giant cell arteritis (Takayasu's disease), Behçet's syndrome, relapsing polychondritis, and vasculitis associated with arthropathies.…”

“…†Mortality and complication rates are based on n equals 4800, patency rates are based on n equals 1003. ‡Based on a random-effects meta-analysis of the results from various sources, each weighted with the inverse of the variance(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). §Based on a random-effects meta-regression analysis of the results from various sources, each weighted with the inverse of the variance(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46).Reprinted from Kandarpa K, Becker, BJ, Hunink, M, et al J Vasc Interv Radiol 2001;12:683-95 (438a).…”

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…†Mortality and complication rates are based on n equals 4800, patency rates are based on n equals 1003. ‡Based on a random-effects meta-analysis of the results from various sources, each weighted with the inverse of the variance (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). §Based on a random-effects meta-regression analysis of the results from various sources, each weighted with the inverse of the variance (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) (448).…”

A young man with myocardial infarction and a calcified coronary artery aneurysm on chest radiography

“…Eighty‐five percent of cases occur in children under 5 years of age, with a peak incidence between 1 and 2 years and has a fatality rate of 0.4% (higher under 2 years age). In the acute stage, the treatment of this vasculitic disease includes intravenous gamma‐globulin as a single infusion over 12 h and aspirin (2,3). In addition to pyrexia, Kawasaki disease is associated with a generalised morbilliform/urticarial rash within first 5 days as well as erythema of mucus membranes and induration of hands and feet with finger and toe desquamation 10–20 days after onset of fever.…”