The diagnosis and management of Kawasaki disease

Royle, Jenny; Burgner, David; Curtis, Nigel

doi:10.1111/j.1440-1754.2005.00555.x

Cited by 38 publications

(33 citation statements)

References 105 publications

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“…The clinical signs of KD are similar to those of many other childhood illnesses. The disease is often complicated by coronary artery abnormalities (CAA), including dilatation and/or aneurysms, and thus is a leading cause of acquired heart disease in children 6,7. Some clinical features other than the classic diagnostic criteria are intense irritability, cough, diarrhea, sterile pyuria, arthritis, arthralgia, redness and induration at the site of a Bacille–Calmette–Guerin (BCG) scar.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study

Kayıran

Dindar

Gürakan

2010

Clinics

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BACKGROUND:Kawasaki disease (KD) is an acute, self‐limiting vasculitis of unknown etiology. The incidence of KD is increasing world wide. However, the epidemiological data for KD in Turkey has not been well described.OBJECTIVE:To describe the demographic, clinical, and laboratory features of children with KD who were diagnosed and managed in the American Hospital, Istanbul, Turkey.METHOD:Patients with KD were retrospectively identified from the hospital discharge records between 2002 and 2010. Atypical cases of KD were excluded. A standardized form was used to collect demographic data, clinical information, echocardiography and laboratory results.RESULTS:Thirty‐five patients with KD, with a mean age of 2.5±1.9 years, were identified. Eighty‐five point seven per cent of patients were under 5 years of age. A seasonal pattern favouring the winter months was noticed. In addition to fever and bilateral conjunctival injection, changes in the oral cavity and lips were the most commonly detected clinical signs in our cases. Coronary artery abnormalities were detected in nine patients. The majority of our patients had started treatment with intravenous immunoglobulin in the first 10 days of the onset of fever, and only one patient required systemic steroids for intravenous immunoglobulin‐resistant KD. The coronary artery abnormalities resolved in all nine patients within 8 months.CONCLUSION:This study is the most comprehensive series of children from Turkey with KD included in Medline. As adult‐onset ischemic heart disease may be due to KD in childhood, further prospective clinical investigations are needed to understand the epidemiology, management and long‐term follow‐up of the disease.

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Section: Introductionmentioning

confidence: 99%

An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study

Kayıran

Dindar

Gürakan

2010

Clinics

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“…[13][14][15] According to published studies, improved prognosis requires initiating treatment before the 10th day of fever. 13 In Brazil, where systematic surveys of KD are insufficient, 17 many infectious diseases, caused by bacterial, viral, protozoan and helminth agents, are considerably more common than KD, but have clinical presentations similar to the initial febrile period of KD, when proper diagnosis and institution of IVIG treatment are believed to be critical. These conditions represent a significant problem for diagnosing KD, especially when there is little awareness of the disease and its sequels.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] Although KD is uncommon, its coronary sequels have a major impact on pediatric care: in industrialized countries, KD is the major cause of acquired heart disease in childhood; in developing countries, it is second only to rheumatic fever. [13][14][15][16] The prevalence of coronary aneurisms and overall mortality are effectively reduced by aspirin associated with intravenous immunoglobulin (IVIG). Timing of intervention, however, is reportedly critical to reduce coronary artery disease to 4%-5%.…”

Section: Introductionmentioning

confidence: 99%

Perfil da doença de Kawasaki em crianças encaminhadas para dois serviços de reumatologia pediátrica do Rio de Janeiro, Brasil

Almeida¹,

Goldenzon²,

Rodrigues³

et al. 2010

Rev. Bras. Reumatol.

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Objectives:To describe a population of children diagnosed with Kawasaki's disease (KD) in pediatric rheumatology centers of Rio de Janeiro, Brazil, defining the magnitude of the delay period in diagnosing KD and initiating treatment due to confusion with common childhood febrile illnesses and the impact of this delay on the frequency of coronary sequels. Methods: Data analysis from hospital records summarized in a dedicated form, including name, gender, age, date of first recorded clinical signs, date of admission to the specialty service, information about symptoms, clinical evolution, intravenous immunoglobulin (IVIG) use and coronary sequels. Results: Of 125 patients, 63% were males. 40% were under 2 years at diagnosis. Average lapse between earliest signs and KD diagnosis was 12 days (mean fever duration, 14 d). Only 22.4% had a diagnosis of KD before entering the specialty service. For the remainder, initial hypotheses included: bacterial (60%) and viral infections (12%), rheumatological diseases (4%) and adverse vaccination reactions (1.6%). Hence, prevalent febrile illnesses of childhood were major confounding factors. For records (85.6%) mentioning treatment, 46.7% reported IVIG treatment, beginning after day 10 in 23 cases (21.5%). 20 patients (16%) presented coronary sequels, 9 of which were diagnosed late, including 3 given IVIG after day 10, and 6 given no IVIG. We found no significant association between the frequency of coronary sequels and: a) sex; b) age; c) clinical criteria; d) initiation of IVIG treatment (before or after day 10). Conclusions: Common febrile illnesses of childhood often confound the diagnosis of KD.

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“…The use of high-dose IVIG and aspirin lowered the frequency of coronary artery complications caused by KD to below 5%11). Prompt reduction of inflammation and duration of fever, definitely before illness day 8 or 9, is essential when CALs begin to appear.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of patients with refractory Kawasaki disease based on treatment modalities

Kim

Lee

et al. 2016

Korean J Pediatr

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PurposeAlthough a significant number of reports on new therapeutic options for refractory Kawasaki disease (KD) such as steroid, infliximab, or repeated intravenous immunoglobulin (IVIG) are available, their effectiveness in reducing the prevalence of coronary artery lesions (CAL) remains controversial. This study aimed to define the clinical characteristics of patients with refractory KD and to assess the effects of adjuvant therapy on patient outcomes.MethodsWe performed a retrospective study of 38 refractory KD patients from January 2012 to March 2015. We divided these patients into 2 groups: group 1 received more than 3 IVIG administration+ steroid therapy, (n=7, 18.4%), and group 2 patients were unresponsive to initial IVIG and required steroid therapy or second IVIG (n=31, 81.6%). We compared the clinical manifestations, laboratory results, and echocardiographic findings between the groups and examined the clinical utility of additional therapies in both groups.ResultsA significant difference was found in the total duration of fever between the groups (13.0±4.04 days in group 1 vs. 8.87±2.30 days in group 2; P=0.035). At the end of the follow-up, all cases in group 1 showed suppressed CAL. In group 2, coronary artery aneurysm occurred in 2 patients (6.4 %). All the patients treated with intravenous corticosteroids without additional IVIG developed CALs including coronary artery aneurysms.ConclusionNo statistical difference was found in the development of CAL between the groups. Prospective, randomized, clinical studies are needed to elucidate the effects of adjunctive therapy in refractory KD patients.

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The diagnosis and management of Kawasaki disease

Cited by 38 publications

References 105 publications

An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study

An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study

Perfil da doença de Kawasaki em crianças encaminhadas para dois serviços de reumatologia pediátrica do Rio de Janeiro, Brasil

Clinical outcome of patients with refractory Kawasaki disease based on treatment modalities

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