Reaction of the BCG Scar in the Acute Phase of Kawasaki Disease in Mexican Children

Garrido-Garcı́a, Luis Martı́n; Castillo-Moguel, Ariel; Vázquez-Rivera, Mirella; Cravioto, Patricia; Galván, Fernando

doi:10.1097/inf.0000000000001633

Cited by 25 publications

(37 citation statements)

References 23 publications

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“…Similarly, reactivation of the bacillus Calmette-Gu erin (BCG) injection site is a pathognomonic clinical sign of KD and may be more commonly observed than cervical lymphadenopathy. 21,22 However, this has not been given enough consideration in the diagnostic criteria. Sterile pyuria, 23 peripheral arthritis, 24 hydrops of gall bladder 25 and myocarditis 4,26 are other important indicators of KD.…”

Section: Clinical Signs With Diagnostic Importance But Not Included Imentioning

confidence: 99%

Diagnosis of Kawasaki disease

2017

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Kawasaki disease (KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association (AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.

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Section: Clinical Signs With Diagnostic Importance But Not Included Imentioning

confidence: 99%

Diagnosis of Kawasaki disease

2017

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“…It is well known that incidence of BCG site reaction decreases with age. 2,7,8,15) In this study, the incidence of BCG site reaction peaked at 6 months to 18 months and declined with age. Similar result was found by a study in Japan, where BCG vaccination has been recommended for infants aged <1 year.…”

Section: Discussionmentioning

confidence: 48%

“…6) Comprehensive reports investigating the clinical characteristics of KD patients manifesting the BCG site reaction are rare. 7,8) The purpose of this study was to investigate the significance of the BCG site reaction as a diagnostic clinical finding and an outcome predictor in young children with KD.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of the Bacille Calmette-Guérin Site Reaction in Kawasaki Disease Patients Aged Less than 18 Months

Park

You

et al. 2018

Pediatr Infect Vaccine

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Purpose:The purpose of this study was to investigate the clinical significance of Bacille Calmette-Guérin (BCG) site reaction in terms of diagnosis and outcome prediction in young children with Kawasaki disease (KD). Methods: The incidence of BCG site reaction in the respective age ranges was investigated in 1,058 patients who were admitted at Asan Medical Center between January 2006 and February 2017. The 416 patients under 18 months of age were enrolled as subjects for the analysis of the association between BCG site reaction and other laboratory and clinical findings. The analysis was performed separately in complete and incomplete KD groups. Results: The incidence rate of BCG site reaction was peaked at 6-12 months (83%) and decreased with increasing age after 12 months in 1,058 patients (P<0.001). The incidence rate was above 70% in KD aged less than 18 months and more frequent than those of cervical lymphadenopathy. The logistic regression analyses showed that the principal clinical findings including conjunctivitis (P=0.781), red lips/oral mucosa (P=0.963), rash (P=0.510), cervical lymphadenopathy (P=0.363), changes in extremities (P=0.283) and the coronary artery aneurysm (P=0.776) were not associated with the BCG site reaction. Conclusions: The BCG site reaction could be a useful diagnostic tool independent to principal clinical findings in KD developing in children aged <18 months, who underwent BCG vaccination. Outcome of KD patients was not different between groups with or without the BCG site reaction in both complete KD and incomplete KD.

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“…Kawasaki is a systemic vasculitis disease that mainly affects children under 5 years of age . The incidence is slowly increasing in many countries, probably because of better awareness among paediatricians.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence is slowly increasing in many countries, probably because of better awareness among paediatricians. Its aetiology remains unknown and this means that specific diagnostic tests and prevention methods are lacking . This may lead to a delay in diagnosis and thus increase the possibility of severe complications, such as coronary artery aneurysms …”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Kawasaki disease before and after universal Bacille Calmette‐Guérin vaccination program was discontinued

et al. 2019

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Aim Bacille Calmette‐Guérin (BCG) vaccine (BCG) has been suggested to induce the primary immunity needed for the subsequent Kawasaki disease (KD). We studied the epidemiology of KD before and after the universal BCG vaccination ended in Finland in September 2006. Methods Kawasaki disease cases were retrieved from national health registries from 1996 to 2016 for annual incidence rates. We then compared 612 433 children born in the BCG vaccination era, from 1 January 1996 to 30 August 2006, to 604 163 born after BCG era, from 1 September 2006 to 31 December 2016. Results The annual incidence rates did not change after the BCG vaccination stopped. We found 370 first visits for KD by children born in the BCG era and 341 after universal BCG vaccination ended. The mean age at diagnosis increased from 2.6 years to 3.0 years (95% CI−0.64 to −0.012, P = .04) and the proportion of children with Kawasaki disease under 5 years decreased from 87% to 81% (95% CI 1%‐12%, P = .02). Conclusion Discontinuing the universal BCG vaccination programme did not change the incidence rates of KD. The increased age at diagnosis could suggest that the pathogenesis of KD may be associated with the immunological pathways primed by BCG immunisation.

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Reaction of the BCG Scar in the Acute Phase of Kawasaki Disease in Mexican Children

Abstract: In Mexico, a country with a National BCG Vaccination Program and a low incidence of KD, reaction at the BCG inoculation site could be a useful diagnostic sign of KD.

Cited by 25 publications

References 23 publications

Diagnosis of Kawasaki disease

Diagnosis of Kawasaki disease

Clinical Significance of the Bacille Calmette-Guérin Site Reaction in Kawasaki Disease Patients Aged Less than 18 Months

Epidemiology of Kawasaki disease before and after universal Bacille Calmette‐Guérin vaccination program was discontinued

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