First‐line corticosteroids for Kawasaki disease: pulse vs. multiple dose

Abstract Background Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. Methods A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008–2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. Results Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. Conclusion As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.

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The Benefits and Respective Side-Effects of PE Therapy for Intractable Kawasaki Disease

Journal of Clinical Medicine ◽

10.3390/jcm10051062 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1062

Author(s):

Masaaki Mori ◽

Susumu Yamazaki ◽

Takuya Naruto

Keyword(s):

Kawasaki Disease ◽

Effective Means ◽

Ivig Therapy ◽

Treatment Method ◽

Treatment Result ◽

High Dose ◽

Line Treatment ◽

Coronary Artery Lesions ◽

First Line ◽

First Line Treatment

Kawasaki disease (KD) is a vasculitis syndrome that frequently develops coronary artery lesions (CALs). In the treatment of KD, the utility of high-dose intravenous immuno-globulin (IVIG) therapy has already been clarified, and it has been established as the first-line treatment method. However, since approximately 10% of patients are refractory to this IVIG therapy and 2.6% of all patients have coronary sequelae, 500 children with KD still remain every year in Japan. In this disease, it is necessary to calm inflammation within 10 days of onset in order to suppress CALs caused by a large amount of persistent inflammatory cytokines. Indeed, the early suppression of inflammation is an effective means of suppressing the onset of CALs. Here, we describe the pathophysiology of Kawasaki disease and plasma exchange (PE), which is a therapeutic method that can calm the hyper-cytokine state of this disease. The treatment result of PE for IVIG-refractory Kawasaki disease is outstanding, and an extremely large effect can be expected if it can be started before the appearance of CALs. It seems that it should always be considered as one of the powerful additional treatments in the future.

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First-Line Therapy for Adult Patients with Acute Asthma Receiving a Multiple-Dose Protocol of Ipratropium Bromide Plus Albuterol in the Emergency Department

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/ajrccm.161.6.9908115 ◽

2000 ◽

Vol 161 (6) ◽

pp. 1862-1868 ◽

Cited By ~ 104

Author(s):

GUSTAVO J. RODRIGO ◽

CARLOS RODRIGO

Keyword(s):

Emergency Department ◽

Multiple Dose ◽

Ipratropium Bromide ◽

Acute Asthma ◽

Adult Patients ◽

First Line ◽

First Line Therapy ◽

Line Therapy

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Characterizing the differences between multisystem inflammatory syndrome in children and Kawasaki disease

Scientific Reports ◽

10.1038/s41598-021-93389-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Maskit Bar-Meir ◽

Alex Guri ◽

Max E. Godfrey ◽

Avram R. Shack ◽

Philip J. Hashkes ◽

...

Keyword(s):

Kawasaki Disease ◽

Independent Predictor ◽

Gastrointestinal Symptoms ◽

First Line ◽

Case Definitions ◽

Intermediate Group ◽

First Line Therapy ◽

Medical Centers ◽

Line Therapy ◽

Inflammatory Syndrome

AbstractTo characterize the new SARS-Co-V-2 related multisystem inflammatory syndrome in children (MIS-C) among Israeli children and to compare it with Kawasaki disease (KD). We compared, in two medical centers, the clinical and laboratory characteristics of MIS-C, KD and an intermediate group, which met the case definitions of both conditions. MIS-C patients were older, were more likely to be hypotensive, to have significant gastrointestinal symptoms, lymphopenia and thrombocytopenia and to have non-coronary abnormal findings in their echocardiogram. Lymphopenia was an independent predictor of MIS-C. Most of our MIS-C patients responded promptly to corticosteroid therapy. KD incidence in both centers was similar in 2019 and 2020. Although there is clinical overlap between KD and MIS-C, these are separate entities. Lymphopenia clearly differentiates between these entities. MIS-C patients may benefit from corticosteroids as first-line therapy.

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