Risk factors for coronary artery abnormalities in children with Kawasaki disease: a 10-year experience

Marić, Lorna Stemberger; Knezović, Ivica; Papić, Neven; Miše, Branko; Roglić, Srđan; Markovinović, Leo; Tešović, Goran

doi:10.1007/s00296-014-3186-9

Cited by 30 publications

(26 citation statements)

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“…Other complications include irregular surface and perivascular brightness of the coronary wall. The complications of untreated KD can be severe and life‐threatening . Coronary artery abnormalities were noted in as much as 80% infants aged <3 months in our cohort.…”

Section: Discussionsupporting

confidence: 87%

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Clinical features and mid‐term follow‐up in infants younger than 3 months with Kawasaki disease in a Chinese population

Zhang

Huang

et al. 2018

J Paediatrics Child Health

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Aim To explore the clinical features and mid‐term follow‐up of Kawasaki disease (KD) in infants younger than 3 months of age in a Chinese population. Methods We performed a retrospective analysis of clinical signs, laboratory data, echocardiography results and outcomes for patients with KD diagnosed at our hospital from January 2009 to December 2013. A total of 1150 children were diagnosed with KD, and 200 KD patients were enrolled in this study. Group 1 included 40 children younger than 3 months of age. We randomly selected a control group as Group 2 included 160 children older than 3 months of age who fulfilled diagnostic criteria for KD and maintained follow‐up for more than 1 year. Results There was a significant difference in clinical manifestations between the two groups, except respiratory infection. Group 1 was more likely to have incomplete presentation (P < 0.001). There were no significant differences in laboratory data except for white blood cell counts between the two groups. Coronary artery abnormalities were significantly different between the two groups (P < 0.001). At a mean follow‐up of 18 months (range 12–48 months), all patients with coronary artery abnormalities, except for giant coronary aneurysms, returned to normal in terms of diameter as assessed by echocardiography. Conclusions Infants younger than 3 months of age with KD often present with incomplete criteria, and diagnosis may be delayed. In addition, there may be a higher risk of developing coronary artery abnormalities. All patients except those with giant coronary aneurysms recovered well without complications at mid‐term follow‐up.

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Section: Discussionsupporting

confidence: 87%

“…The complications of untreated KD can be severe and life-threatening. [14][15][16] Coronary artery abnormalities were noted in as much as 80% infants aged <3 months in our cohort. This is an alarming figure considering the long-term consequences of coronary artery lesions.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and mid‐term follow‐up in infants younger than 3 months with Kawasaki disease in a Chinese population

Zhang

Huang

et al. 2018

J Paediatrics Child Health

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“…Lack of response to fever treatment in patients with KD is one of the risk factors for subsequent coronary artery abnormalities (10). Furthermore, MAS is also accompanied by prolonged fever (11).…”

Section: Discussionmentioning

confidence: 99%

Prolonged Fever and Intravenous Immunoglobulin Resistance in Kawasaki Disease: Should Macrophage Activation Syndrome Be Considered?

et al. 2019

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Introduction:Macrophage activation syndrome (MAS) is a rare and potentially fatal complication of Kawasaki disease (KD). Typically, MAS presents as the exacerbation of KD, manifested by prolonged fever and resistance to treatment. Early and accurate diagnosis might be challenging due to overlapping features of MAS and intravenous immunoglobin (IVIG)-resistant KD and lack of validated diagnostic criteria. Case Presentation: In this article, we report four cases of KD with prolonged fever that were eventually diagnosed and treated as MAS. Three cases were boys and one infant was a girl. The mean age of the cases was 29 months. Three cases had typical and one case had atypical KD. Two cases had abnormal findings in echocardiography and three cases had hepatomegaly. In laboratory evaluation, all of them had thrombocytopenia, increased liver enzymes, and hyperferritinemia. All the patients were treated with intravenous high-dose methylprednisolone (pulse therapy) after IVIG therapy, two cases with oral cyclosporine, and one case with infliximab. There was no mortality in our cases, and in long-term follow-up, all the patients had normal clinical, laboratory, and echocardiography findings. Conclusions: KD resistant to IVIG and sustained fever have high diagnostic values in MAS with underlying KD.

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“…Maric ve ark. 'nın (26) yaptığı çalışmada, hastalığın ikinci haftasındaki trombositoz da koroner arter lezyonu için risk faktörü iken, aynı çalışmada hastaların %2,7'sinde kalp kapağı yetmezliği ve %3,6'sında konjestif kalp yetmezliği bildirilmiştir. Çalışmamızda, 5 (%41,6) hastada Harada skoru pozitif saptanırken, bunlardan yalnızca birinde koroner tutulum vardı.…”

Section: Discussionunclassified

Kawasaki disease: An evaluation of children in Erzurum

Kara¹,

Güllü²,

Balaban³

2017

BUCH

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ÖZAmaç: Kawasaki hastalığı (KH) çocukluk çağında edinilmiş kalp hastalıklarının en sık nedenlerindendir. Ülkemizdeki insidansı bilinmeyen hastalık multisistemik vaskülitik bir sendrom olup, pek çok organı ve sistemi etkilemektedir. Yöntem: Erzurum Bölge Eğitim ve Araştırma Hastanesinde KH tanısı konulan hastaların klinik ve laboratuvar bulguları retrospektif olarak incelendi. Bulgular: Hastaların yaş ortalaması 4,1±2,4 yıldı, 8'i (%66,6) erkek, 4'ü (%33,3) kızdı. Hastaların başvuruda ortalamaları 8,5±3,5 gündü, semptomları mevcuttu. On (%83,3) hastaya akut, 2 (%16,6) hastaya subakut KH (12 ve 17 gün) tanısı konuldu. Hastaneye en sık başvuru üçer olguyla 4. ve 9. aylarda oldu. Tüm hastaların en az 5 günden beri süren ateşi ve oral mukoza değişiklikleri mevcuttu. Diğer sık bulgular, on birer (%91,7) hastada konjunktivit ve polimorfik ekzantemdi. On (%83,3) hastanın komplet, 2 (%16,6) hastanın inkomplet KH vardı. İkişer (%16,6) hastada safra kesesi hidropsu ve BCG aşısı reaktivasyonu saptandı. Çalışmada, beyaz küre sayısı, C-reaktif protein ve eritrosit sedimentasyon hızı ortalama değerleri normal sınırların üzerindeydi. Trombositoz 4 (%33,3), hiponatremi 8 (%66,6), hipoalbüminemi 3 (%25) ve steril piyüri 3 (%25) hastada gözlendi. Dört (%33,3) hastada ekokardiyografide bulgu (2'sinde sol koroner arterde dilatasyon, 2'sindeyse intravenöz immünglobulin [IVIG] tedavisiyle gerilemiş olan hafif mitral yetmezlik ve sol ventrikül fonksiyonlarında azalma) saptandı. Tüm hastalara tanı anında IVIG, hastaların 9'una yüksek doz, 3'üne düşük doz asetil salisilat başlandı. Bir (%8,3) hastaya ikinci doz IVIG verildi. Koroner dilatasyonu bulgularının 3. ve 6. aydaki kontrollerde gerilese de devam ettiği görülerek asetil salisilat tedavilerine devam edildi. Sonuç: Nadir görülen ancak yüksek morbidite riskine sahip KH ülkemizde Doğu Anadolu bölgesinde de görülmektedir. Hızlı tedaviyle komplikasyonlar önlenebileceği için hastalığın hakkında farkındalığın artması önemlidir. Anahtar kelimeler: Asetil salisilat, intravenöz immünglobulin, Kawasaki hastalığı ABSTRACTObjective: Kawasaki disease (KD) is a frequently seen acquired childhood heart disease. This multisystemic vasculitic syndrome involves most organs and systems. The incidence in Turkey is unknown. Methods: Patients with KD at the Erzurum Regional Training and Research Hospital were retrospectively evaluated. Results: Patients' mean age was 4.1±2.4 years; eight (66.6%) patients were male and four (33.3%) female. Symptoms persisted for a mean 8.5±3.5 days. Ten (83.3%) patients were diagnosed with acute KD and two (16.6%) with subacute KD. Admission was most common in the 4 th and 9 th months with three cases each. All patients had fever for at least five days and oral mucosa changes. Other findings were conjunctivitis and polymorphic exanthems in 11 (91.7%) patients. Ten (83.3%) patients had complete KD and two 2 (16.6%) incomplete KD. Two (16.6%) patients had gallbladder hydrops and two (16.6%) had BCG vaccine reactivation. White blood cell count, CRP, and ESR were above norma...

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Risk factors for coronary artery abnormalities in children with Kawasaki disease: a 10-year experience

Cited by 30 publications

References 24 publications

Clinical features and mid‐term follow‐up in infants younger than 3 months with Kawasaki disease in a Chinese population

Clinical features and mid‐term follow‐up in infants younger than 3 months with Kawasaki disease in a Chinese population

Prolonged Fever and Intravenous Immunoglobulin Resistance in Kawasaki Disease: Should Macrophage Activation Syndrome Be Considered?

Kawasaki disease: An evaluation of children in Erzurum

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