Kawasaki disease: Medical therapies

Newburger, Jane W.

doi:10.1111/chd.12502

Cited by 18 publications

(13 citation statements)

References 11 publications

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“…Delayed IVIG treatment is considered to be an independent risk factor for the development of CALs, especially in patients with high levels of CRP and ESR. 14,[30][31][32] Nevertheless, about 10-20% of patients receiving IVIG are refractory to this therapy and they are also at higher risk for developing CALs. In this situation, adjunctive therapies include retreatment with IVIG, a tapering course of corticosteroids, infliximab, cyclosporine, cyclophosphamide and other immunomodulatory therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors associated with IVIG resistance include: male sex, young age, high CRP, high neutrophil count, and KD shock syndrome. 14,[30][31][32][33][34] In our case, a second febrile episode associated with diarrhea and vomiting appeared on the 23rd day of the disease, and a second dose of IVIG was administrated with rapid resolution of fever. A persistent elevated level of IL-6 on the 20th day of the disease (31.22 pg/mL; NV <7 pg/mL) was correlated with a recrudescent fever episode.…”

Section: Discussionmentioning

confidence: 99%

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<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

Lazea¹,

Man

Sur³

et al. 2019

TCRM

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Diagnosis of Kawasaki disease (KD) is based on well-established clinical criteria. In incomplete or atypical KD, the diagnosis is challenging, because of the paucity of clinical signs or because of the presence of clinical manifestations that generally are not seen in KD. We describe the case of a 3-year-old female patient with persistent high fever, vomiting, watery diarrhea, metabolic acidosis and severe hypopotassemia. On the fourth day of fever, bilateral conjunctivitis, mucous and extremity changes were registered. Urine changes as glycosuria and proteinuria were also noticed. Echocardiography revealed ectasia of the left anterior descending coronary artery, and diagnosis of KD was established. The treatment consisted of intravenous immunoglobulin (IVIG) and oral aspirin. Recurrence of disease was recorded on the 23rd day of the disease, with favorable evolution after the second dose of IVIG was infused.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

Lazea¹,

Man

Sur³

et al. 2019

TCRM

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“…Patients were categorized as having complete and incomplete KD. Incomplete KD was defined as in a child with prolonged unexplained fever, fewer than 4 of the principal clinical findings, and compatible laboratory or echocardiographic findings [ 9 ]. Patients with KD develop a recrudescent or persistent fever at least 36 hours after the end of their IVIG infusion and are termed as IVIG-resistant KD.…”

Section: Methodsmentioning

confidence: 99%

A Retrospective Cohort Study of Intravenous Immunoglobulin Therapy in the Acute Phase of Kawasaki Disease: The Earlier, the Better?

Zhang

et al. 2021

Cardiovascular Therapeutics

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Background. Although intravenous immunoglobulin (IVIG) is expected to prevent coronary artery abnormalities of Kawasaki disease (KD) in the acute phase, the timing and effectiveness of IVIG remain to be determined. The association of timing of IVIG administration in KD patients with coronary artery abnormalities is evaluated in this cohort study. Methods. We systematically studied KD patients from two participating institutions between 2015 and 2017. To reveal the effectiveness of IVIG treatment, these patients were classified into four groups regarding the time of IVIG treatment. Primary outcome was coronary artery abnormalities by echo at diagnosis and 12 months follow-up; secondary outcomes included inflammatory markers. Results. A total of 1281 patients were included in this study. The best time of IVIG treatment cut-off values in 12 months follow-up for predicting coronary artery abnormalities was days 7.5 of illness onset. According to the best time of IVIG treatment cut-off values, all patients were classified into 4 groups. Group 1 was defined as earlier IVIG treatment administration on days ≤4 of the illness ( n = 77 ). Group 2 was defined with days 5-7 ( n = 817 ), group 3 with days 8-10 ( n = 249 ), group 4 with days >10 ( n = 138 ). A greater proportion of IVIG-resistant KD patients were group 4 than the other three groups, and there were significant differences ( p < 0.05 ). The incidence of coronary artery lesions (CALs) and coronary artery aneurysms (CAAs) in group 3 and group 4 was higher than that in group 1 ( p < 0.05 ) and group 2 ( p < 0.05 ) during a 12-month follow-up. Additionally, the incidence of CALs in group 1 was higher than that in group 2 but without statistical significance ( p > 0.05 ). The OR was significantly higher for those who started IVIG administration more than 7 days from the onset was positively associated with the occurrence of CALs (OR, 5.3; 95% CI, 2.0-13.9) and CAAs (OR, 13.5; 95% CI, 2.9-14.1) 12 months after initial onset. Multivariate regression revealed that the timing of IVIG treatment and IVIG-resistance was independent risk factors of CALs. Conclusions. IVIG treatment less than 7 days after illness onset are found to be sufficient for preventing developing coronary artery abnormalities in KD patients. Earlier IVIG treatment administration within 4 days may not increase the higher incidence of coronary artery abnormalities and IVIG resistance (Chinese Clinical Trial Registry:ChiCTR1800015800).

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“…Mnogi od njih odgovoriće na ponovljenu dozu IVIG. Ostale opcije za lečenje refrakterne KB obuhvataju pulsnu primenu glukokortikoida (Miura, 2018), ciklosporin A, rapamicin ili biološke (anticitokinske) agense, na prvom mestu antagoniste faktora ne-kroze tumora (Newburger, 2017). Svi pobrojani agensi pokazali su učinak u pojedinim slučajevima, ali i dalje postoji problem pomanjkanja randomizovanih kliničkih studija odgovarajućeg obima koje bi omogućile obrazovanje čvrstih i ujednačenih preporuka za terapijski pristup kod refrakterne KB.…”

Section: Lečenjeunclassified

Kavasakijeva Bolest

Janić¹

2019

SCEPED

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UvodKavasakijeva bolest (KB) je akutni sistemski vaskulitis krvnih sudova srednjeg kalibra koji prevashodno pogađa decu uzrasta do 5 godina (Hedrich i sar., 2018). Reč je o jednom od najčešćih oblika vaskulitisa u dečjoj dobi (uz Henoh-Šenlajnovu purpuru). Oboljenje je dobilo ime po Tomakisuu Kavasakiju, koji je 1967. godine izvorno opisao pedesetoro dece s ovim oblikom vaskulitisa (Kawasaki, 1967). Glavne odlike KB su povišena telesna temperatura, promene na koži i sluzokožama, konjunktivitis i vratna limfadenopatija. Mada svi arterijski krvni sudovi u organizmu mogu da budu zahvaćeni zapaljenjskim procesom, oboljenje najčešće pogađa koronarne arterije, čijim oštećenjem može da izazove ozbiljne sekvele usled stvaranja aneurizme.KB češće pogađa dečake nego devojčice. Prosečna incidencija u Evropi iznosi 5-10 na 100.000 dece uzrasta do 5 godina (Singh i sar., 2015), dok u Japanu dostiže oko 250 na 100.000 (Makino i sar., 2015).

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Kawasaki disease: Medical therapies

Cited by 18 publications

References 11 publications

<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

A Retrospective Cohort Study of Intravenous Immunoglobulin Therapy in the Acute Phase of Kawasaki Disease: The Earlier, the Better?

Kavasakijeva Bolest

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