Kawasaki disease in children

Abstract

Kawasaki disease (KD) is an acute self-limiting systemic vasculitis of unknown aetiology. It is the most common cause of acquired heart disease in young children. The intense inflammatory process has a predilection for the coronary arteries, resulting in the development of aneurysmal lesions, arterial thrombotic occlusion or, potentially, sudden death. There is no specific diagnostic test; however, treatment with immunoglobulin and aspirin effectively reduces cardiac complications from 25% to 4.7% in the UK. Inflammation of the myocardium, endocardium or pericardium can occur early in the disease and endothelial dysfunction along with abnormalities of myocardial blood flow may require continuing medication, interventional catheterisation or even cardiac surgery. Several new pharmacological treatments may have important roles to play in managing KD in children and adolescents. This review discusses the history of the disease, the diagnostic challenges, epidemiology, aetiology, pathology, immunopathogenesis, treatment, genetic influences and the long-term cardiovascular sequelae.

Mycoplasma pneumoniae as an Under- Recognized Agent of Vasculitic Disorders

“…It has been considered a systemic vasculitic disease with a predilection for the coronary arteries, resulting in the development of coronary aneurysm in the most severe cases [for review, see Pinna et al, 2008;Wood & Tulloh, 2009]. Though only a very small number of cases have been reported from Western countries [Leen & Ling, 1996;Vitale et al, 2010], reports of Kawasaki disease in association with M. pneumoniae infection are not infrequent in the Japanese literature.…”

“…Based on this assumption, there may be some inherent difference in genetic background in terms of the link between M. pneumoniae infection and susceptibility to Kawasaki disease. Although the pathomechanism of Kawasaki disease itself is not yet fully understood, the disease is generally believed to be immune-mediated [Pinna et al, 2008;Wood & Tulloh, 2009]. Mycoplasma pneumoniae has several arrays for immunomodulation, including cytokine production and T cell/B cell activation, and thereby could be a trigger of Kawasaki disease.…”

Coronary Artery Disease and Systemic Vasculitis: Case Report and Review

“…It is complicated by coronary arterial aneurysms ( Figure 2) and stenosis in approximately 20 to 25% of untreated patients and subsequently can lead to myocardial infarction and/or sudden death. (De Castro et al, 2009;La Pellegrin et al, 2011;Tsuda et al, 2011;Wood & Tulloh, 2009). …”

“…(Caballero-Mora et al, 2011;De Castro et al 2009;Fukazawa & Ogawa, 2009;La Pellegrin et al, 2011;Tsuda et al, 2011;Wood & Tulloh, 2009 Despite treatment of acute phase with intravenous immunoglobulin and aspirin, up to 5% of Kawasaki disease patients, still continued to develop serious cardiac life-threatening complications, mainly giant coronary aneurysms and thrombotic stenoses, resulted in myocardial infarction and/or death. (Caballero-Mora et al, 2011;De Castro et al, 2009;Hata & Onouchi, 2009;LaPellegrin et al, 2011;Lin et al, 2011;Tsuda et al, 2011;Wood & Tulloh, 2009).…”

The study on post-operative wound infections at Vizianagaram in Andhra Pradesh, India

“…Wilson et al quantified the infection as mild, moderate and severe. 8 Using their scoring system, after 5 consecutive day wound inspections, the criteria are presence of erythema beyond 5mm of the incision, presence of wound discharge and its nature, separation of deep tissues. 9 They evolve the scoring system depending on the proportion of the surgical wound involved.…”