Abstract 10: Effect of coincident infections in acute Kawasaki disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Toshiaki Jibiki ◽  
Yuji Hashimoto ◽  
Masaki Kanazawa ◽  
Izumi Kato ◽  
Yoshinori Morita ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Course ◽  
Acute Otitis Media ◽  
Gastrointestinal Symptoms ◽  
Treatment Decision ◽  
Admission Diagnosis ◽  
Upper Respiratory Tract ◽  
Laboratory Findings ◽  
Number Of Patients ◽  
Acute Kawasaki Disease

We investigated prevalence of coincident infections in acute Kawasaki disease (KD) to know the possible effects of infections on diagnosis of KD, clinical course, therapy decision and coronary outcomes. Single center consecutive 344 KD patients hospitalized in our institution, between January 2009 and December 2013 were retrospectively analyzed. Patients those were positive for bacterial culture, rapid antigen tests or elevated levels of pathogen specific antibodies were counted as KD patients with infection. Pathogen unproven patients those presented with apparent respiratory or gastrointestinal symptoms regarding infections were also counted as KD patients not to underestimate number of patients with suspected infections. Overall, 125 KD patients were grouped as KD patients with infection (Group1). Group1 included 125 patients with 73 upper respiratory tract infection, 21 bronchitis, 7 pneumonia, 3 acute otitis media and 21 gastroenterocolitis, respectively. Remaining 219 KD patients were grouped as KD without infection (Group2). Appropriate antibiotic or antiviral treatments were done for each pathogen proven infection. Distribution of age and sex, day of admission, diagnosis and treatment, prevalence of initial treatment regimen and rate of additional therapy, duration of fever, laboratory findings except serum albumin value, and coronary outcomes were similar between the groups. We showed that presence of coincident infections have no effects on clinical course, treatment decision and coronary outcomes on KD.

scholarly journals Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis

2020 ◽  
Vol 9 (4) ◽  
pp. 941 ◽  
Author(s):  
Israel Júnior Borges do Nascimento ◽  
Nensi Cacic ◽  
Hebatullah Mohamed Abdulazeem ◽  
Thilo Caspar von Groote ◽  
Umesh Jayarajah ◽  
...  
Keyword(s):  
Scoping Review ◽  
Clinical Symptoms ◽  
Meta Analysis ◽  
Laboratory Data ◽  
Gastrointestinal Symptoms ◽  
Common Disease ◽  
Imaging Data ◽  
Laboratory Findings ◽  
Number Of Patients ◽  
Novel Coronavirus

A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%–99%; n = 4410), cough (61%, 95% CI 39%–81%; n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%–55%; n = 3778), dyspnea (26%, 95% CI 12%–41%; n = 3700), headache in 12% (95% CI 4%–23%, n = 3598 patients), sore throat in 10% (95% CI 5%–17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%–17%, n = 1744). Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 × 109/L, 95% CI 0.83–1.03 × 109/L, n = 464) and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54–45.91 mg/dL; n = 1637). Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%–1.0%; n = 53,631). Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.

scholarly journals Сare pathways of children with acute rhinological symptoms

2021 ◽  
pp. 43-51
Author(s):  
E. P. Karpova ◽  
D. A. Tulupov
Keyword(s):  
Respiratory Diseases ◽  
Acute Otitis Media ◽  
Well Being ◽  
Symptomatic Therapy ◽  
Care Pathways ◽  
Upper Respiratory Tract ◽  
Nasal Decongestants ◽  
Number Of Patients ◽  
Acute Respiratory Diseases ◽  
Acute Rhinitis

Acute respiratory diseases are one of the most common reasons for visiting a doctor in pediatric practice. Most episodes of this pathology have a viral etiology, signs of inflammation from the upper respiratory tract and proceed with symptoms of acute rhinitis (acute nasopharyngitis). The most of episodes of acute rhinitis last no more than 10 days and end with the patient’s recovery. The most common complications of acute rhinitis in children are acute rhinosinusitis and acute otitis media. These diseases are often mild and rarely have complications. However, a large number of patients with acute respiratory diseases increases the likelihood of a situation in which the doctor will encounter a problem patient. The article proposes care pathways for practitioners to manage patients with acute rhinological symptoms lasting up to 10 days and from 10 days to 3 months. The care pathways are based on several key points. No1: each patient must be analyzed for the presence of alarming symptoms, upon detection of which the patient should be urgently hospitalized. No2: all patients should be dynamically observed by a doctor until complete recovery, the patient should not receive treatment without the supervision of a doctor. No3: the basis of treatment is drugs for symptomatic therapy, which are selected depending on the dominant symptom that has the greatest impact on the patient’s well-being. To eliminate nasal mucosal edema, it is rational to use nasal decongestants (original oxymetazoline) for children of all ages; the course and dosages are determined according to the age of the child. Antibacterial drugs should be prescribed strictly according to indications in the presence of convincing data for the bacterial etiology of the disease.

Giant coronary artery aneurysms complicating Kawasaki disease in Mexican children

2017 ◽  
Vol 28 (3) ◽  
pp. 386-390 ◽  
Author(s):  
Luis M. Garrido-García ◽  
Edna Morán-Villaseñor ◽  
Marco A. Yamazaki-Nakashimada ◽  
Patricia Cravioto ◽  
Fernando Galván
Keyword(s):  
Risk Factors ◽  
Kawasaki Disease ◽  
Acute Stage ◽  
Coronary Artery Aneurysms ◽  
Laboratory Findings ◽  
Mexican Children ◽  
A Value ◽  
Coronary Aneurysms ◽  
Duration Of Illness ◽  
Acute Kawasaki Disease

AbstractBackgroundOne of the most important complications of Kawasaki disease is the development of giant coronary aneurysms. Risk factors for their development are still not clear.MethodsA retrospective analysis was conducted at the National Institute of Paediatrics in Mexico City, Mexico. It included all patients with a diagnosis of acute Kawasaki disease between August, 1995 and August, 2015. Clinical and laboratory findings, as well as echocardiographic measurements, were recorded. Patients with giant coronary aneurysms (z-score⩾10) were compared with the rest of the patients. A value of p<0.05 was considered statistically significant. Odds ratios and their 95% confidence intervals were calculated to define risk factors.ResultsDuring the study period, 416 patients were diagnosed with Kawasaki disease. Of them, 34 developed giant coronary aneurysms during the acute stage of the disease. In the multivariate analysis, patients younger than 1 year, those with a higher duration of illness at the time of diagnosis, and those who received additional intravenous immunoglobulin showed a significantly higher frequency of giant coronary aneurysms.ConclusionsOne of the main factors associated with the development of giant coronary aneurysms was the delay in the diagnosis of Kawasaki disease. This finding highlights the importance of maintaining a high suspicion of the disease, which would enable an early diagnosis and prompt treatment and decrease the risk for developing giant coronary aneurysms.

Novel heterozygous PIK3CD mutation presenting with only laboratory markers of combined immunodeficiency

2020 ◽  
Vol 7 (2) ◽  
pp. 49-55
Author(s):  
Amarilla B. Mandola ◽  
Harjit Dadi ◽  
Brenda Reid ◽  
Chaim M. Roifman
Keyword(s):  
Newborn Screening ◽  
Catalytic Domain ◽  
Clinical Course ◽  
Phenotypic Variability ◽  
Severe Combined Immunodeficiency ◽  
Clinical Manifestations ◽  
Combined Immunodeficiency ◽  
Laboratory Findings ◽  
Number Of Patients ◽  
Increased Risk

Introduction: Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Delta (PIK3CD) is one part of a heterodimer forming the enzyme phosphoinositide 3-kinase (PI3K), found primarily in leukocytes. PIK3CD generates phosphatidyl-inositol 3,4,5-trisphosphate (PIP3), and is involved in cell growth, survival, proliferation, motility, and morphology. An increasing number of patients have been described with heterozygous PIK3CD gain-of-function (GOF) mutations, leading to combined immunodeficiency with both B- and T-cell dysfunction. Patients suffer recurrent respiratory infections, often associated with bronchiectasis and ear and sinus damage, as well as severe recurrent or persistent infections by herpesviruses, including EBV-induced lymphoproliferation. Aim: To present the clinical phenotypic variability of a novel PI3KCD mutation within a family. Methods: Patient information was collected prospectively and retrospectively from medical records. Comprehensive immune work up, genetic, and signaling evaluation was performed. Results: We describe here 2 patients, daughter and mother, with heterozygous PIK3CD mutation identified by whole exome sequencing and Sanger confirmation. The child was screen-positive by newborn screening for severe combined immunodeficiency (SCID). Cellular assays revealed an increase in the baseline phosphorylation of T cells in the patient. Furthermore, both patients had hyper-activation of the catalytic domain, resulting in increased phosphorylation of AKT upon activation. Discussion: GOF mutations affecting the PIK3CD gene are associated with an increased risk for lymphoproliferation leading to Activated PIK3-delta syndrome (APDS). The clinical course of APDS is highly variable, ranging from combined immunodeficiency with recurrent infections, autoimmune complications, and requiring stem cell transplantation, through isolated antibody deficiency, to asymptomatic adults. Our patient is the first to be identified by newborn screening for SCID. Surprisingly, the clinical course has so far been unremarkable, as well, the mother appears to be completely asymptomatic. Nevertheless, the persistent lymphopenia indicates PIK3CD dysfunction. Because of the wide gap between laboratory findings and clinical manifestations, this kindred poses both a diagnostic as well treatment challenge. Statement of novelty: We report here a novel PIK3CD mutation diagnosed due to abnormal newborn screen for SCID.

scholarly journals Clinical Profile of Kawasaki Disease (KD) in Children admitted at Dhaka Shishu Hospital

2017 ◽  
Vol 8 (2) ◽  
pp. 216-219
Author(s):  
Mamun Miah ◽  
Kazi Zahidul Hoque ◽  
Md Ashraful Islam ◽  
Akhand Tanzi Sultana ◽  
Shubhra Prakash Paul ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Features ◽  
Gastrointestinal Symptoms ◽  
Cervical Lymphadenopathy ◽  
Heart Association ◽  
Cardiovascular Complications ◽  
Unknown Etiology ◽  
Conjunctival Hyperemia ◽  
Laboratory Findings ◽  
Presenting Symptoms

Background : Kawasaki disease (KD) is an acute, febrile, self-limiting vasculitis of the medium-and small-sized arteries of unknown etiology. Recently its incidence is increasing worldwide.Objective : The aim of this study was to evaluate its presenting symptoms, clinical features and laboratory tests for the diagnosis of complete and incomplete KD in children.Materials & Methods : Medical records of 20 children with KD admitted in Dhaka Shishu Hospital from January, 2011 to December 2014, were reviewed. Demographic features, diagnostic clinical features of KD, and additional clinical findings including arthritis and/or arthralgia, gastrointestinal symptoms, respiratory symptoms and central nervous system symptoms were recorded for each patient. Besides, available laboratory findings collected on admission before Intravenous Immunoglobulin (IVIG) administration were reviewed. The diagnosis of complete and incomplete KD was made using the American Heart Association (AHA) recommendations.Results : About two-thirds of the children (65%) were 30 – 60 months, 20% were < 30 months and 15% were 60 or above 60 months old with mean age being 42 months. Over half (55%) of the children were female and 50% affected in summer season. Of the five principal signs, polymorphous skin rash was predominant (90%), followed by changes in oral mucosa or lip (85%), conjunctival hyperemia (75%), cervical lymphadenopathy (70%) and changes in distal extremities and gastrointestinal symptoms (each 65%). Majority of the children had raised WBC (75%), raised ESR (95%), increased platelet count (70%) and elevated CRP (75%). Uveitis was a predominant complication (45%), followed by facial paralysis (30%) and neurosensory hypoacusia (20%). Cardiovascular complications were less commonly found (30%). Neither age nor sex was found to be associated with type of Kawasaki disease (p = 0.450 and p = 0.535 respectively). Sixty percent of the patient fulfilled the criteria of complete KD and the rest incomplete KD. However, cervical lymphadenopathy and changes in distal extremity were significantly common in complete KD than those in incomplete KD (p = 0.019 and p = 0.05 respectively).Conclusion : In this study 60% of the patient fulfilled the criteria of complete KD and the rest incomplete KD.Northern International Medical College Journal Vol.8(2) January 2017: 216-219

scholarly journals Clinical and laboratory findings of patients with the possible diagnosis of influenza hospitalized in affiliated hospitals of Babol University of Medical Sciences, 2015-2016

2018 ◽  
Vol 31 (3) ◽  
pp. 113-116 ◽  
Author(s):  
Mostafa Javanian ◽  
Arefeh Babazadeh ◽  
Soheil Ebrahimpour ◽  
Mehran Shokri ◽  
Masomeh Bayani
Keyword(s):  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Medical Sciences ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Epidemiological Characteristics

Abstract The clinical and para clinical manifestations of influenza in various patients have range from an autoimmune disease to a life-threatening respiratory infection. In addition, the severity of the disease is influenced by factors such as demographic factors, underlying diseases, and immune response. Therefore, in this study, we evaluated the clinical, laboratory and epidemiological characteristics of patients with this type of influenza in Babol (north of Iran). This study was conducted as a descriptive cross-sectional study from October 2015 to March 2016. Subsequently, in this study, records of 123 patients with clinical signs of the influenza-like disease who have undergone the clinical sign in hospitals affiliated to Babol University of Medical Sciences were reviewed. Of 123 patients admitted to a possible diagnosis of influenza, 58 patients (47.2%) were PCR positive for H1N1, while seventy nine (64.2%) participants were women and 21 (17.1%) had diabetes or underlying lung disease. Most of the involved age groups were of individuals above the age of 50. These were followed by the 21-35 years-old. Fever (78%), cough (65.9%), shivering (58.5%) and myalgia (56.1%) were the most common clinical symptoms. Increased levels of transaminases (43.1%), leukocytosis (35.8%) and thrombocytopenia (34.2%) were as well reported in patients as the most frequently reported para clinical findings. In the present study, the most usual clinical symptoms were fever, cough, chill, and myalgia, while gastrointestinal symptoms were also noticeably observed in patients. In an experimental study, a significant number of patients showed leukocytosis and thrombocytopenia and increased transaminases.

scholarly journals Distinctive clinical and laboratory features of COVID-19 and H1N1 influenza infections among hospitalized pediatric patients

2021 ◽  
Author(s):  
Ali Alsuheel Asseri ◽  
Ayed A. Shati ◽  
Saleh M. Al-Qahtani ◽  
Ibrahim A. Alzaydani ◽  
Ahmed A. Al-Jarie ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Unit Length ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
H1n1 Influenza ◽  
Laboratory Findings ◽  
Number Of Children ◽  
Cell Counts ◽  
Number Of Patients ◽  
Total Intensive Care Unit

Abstract Background It had been documented in many studies that pediatric coronavirus disease 2019 (COVID-19) is characterized by low infectivity rates, low mortalities, and benign disease course. On the other hand, influenza type A viruses are recognized to cause severe and fatal infections in children populations worldwide. This study is aimed to compare the clinical and laboratory characteristics of COVID-19 and H1N1 influenza infections. Methods A retrospective study comprising 107 children hospitalized at Abha Maternity and Children Hospital, Southern region of Saudi Arabia, with laboratory-confirmed COVID-19 and H1N1 influenza infections was carried out. A complete follow-up for all patients from the hospital admission until discharge or death was made. The clinical data and laboratory parameters for these patients were collected from the medical records of the hospital. Results Out of the total enrolled patients, 73 (68.2%) were diagnosed with COVID-19, and 34 (31.8%) were diagnosed with H1N1 influenza. The median age is 12 months for COVID-19 patients and 36 months for influenza patients. A relatively higher number of patients with influenza had a fever and respiratory symptoms than COVID-19 patients. In contrast, gastrointestinal symptoms were observed in a higher number of COVID-19 patients than in influenza patients. A statistically significant increase in white cell counts is noted in COVID-19 but not in influenza patients (P < 0.05). There are no obvious variations in the mean period of duration of hospitalization between COVID-19 and influenza patients. However, the total intensive care unit length of stay was longer for influenza compared to COVID-19 patients. Conclusions A considerable number of children infected with COVID-19 and H1N1 influenza were noted and reported in this study. There were no significant variations in the severity of the symptomatology and laboratory findings between the two groups of patients. Significant differences between these patients in some hospitalization factors and diagnosis upon admission also were not observed. However, more severe clinical manifestations and serious consequences were observed among pediatric patients hospitalized with influenza infections than among those with COVID-19.

Multi-dimensional Visualisation of Laboratory Findings and Functional Test Results for Analysing the Clinical Course of Disease in Medicine

1995 ◽  
Vol 34 (03) ◽  
pp. 302-308 ◽  
Author(s):  
C. J. Luz ◽  
W. Giere ◽  
R. Lüdecke ◽  
D. Jonas ◽  
A. J. W. Goldschmidt
Keyword(s):  
Clinical Course ◽  
Test Results ◽  
Geometrical Figure ◽  
Laboratory Findings ◽  
Course Of Disease ◽  
Quantitative Examination ◽  
Ward Rounds ◽  
Patient’S History ◽  
Graphical Primitive ◽  
Computerized Medical Record

Abstract:The illustration of a patient’s history by a graphical primitive is discussed. Illustration technology is presented which simultaneously represents quantitative examination findings (e. g., laboratory values) and qualitative findings (e. g., from function diagnostics) by a single geometrical figure. Depending on the medical results, this figure takes on characteristic forms which can be identified as patterns typical for a specific disease. The procedure developed is integrated in a user interface which is implemented in the form of a computerized medical record for use on a pentop computer. This portable computer assists the physician during ward rounds, supplies additional, intelligence-based information, serves quality control, and streamlines working procedures making them more efficient.

scholarly journals Desquamation in Kawasaki Disease

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 317
Author(s):  
Ling-Sai Chang ◽  
Ken-Pen Weng ◽  
Jia-Huei Yan ◽  
Wan-Shan Lo ◽  
Mindy Ming-Huey Guo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Laboratory Data ◽  
Ivig Treatment ◽  
Low Grade ◽  
High Grade ◽  
Laboratory Findings ◽  
Coronary Artery Abnormalities ◽  
Cell Counts ◽  
Hands And Feet

(1) Background: Desquamation is a common characteristic of Kawasaki disease (KD). In this study, we analyzed patients’ varying desquamation levels in their hands or feet, in correlation with clinical presentation, to assess the relationship. (2) Methods: We retrospectively reviewed children with KD. We analyzed their age, laboratory data before intravenous immunoglobulin (IVIG) treatment and coronary artery abnormalities (CAA) based on the desquamation level of their hands and feet. We classified the desquamation level from 0 to 3 and defined high-grade desquamation as grade 2 and 3. (3) Results: We enrolled a total 112 patients in the study. We found the hands’ high-grade desquamation was positively associated with age and segmented neutrophil percentage (p = 0.047 and 0.029, respectively) but negatively associated with lymphocyte and monocyte percentage (p = 0.03 and 0.006, respectively). Meanwhile, the feet’s high-grade desquamation was positively associated with total white blood cell counts (p = 0.033). Furthermore, we found that high-grade hand desquamation had less probability of CAA formation compared with that of a low grade (7.1% vs. 40.8%, p = 0.016). (4) Conclusions: This report is the first to demonstrate that the desquamation level of hands or feet in KD is associated with different coronary artery abnormalities and laboratory findings.

scholarly journals Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course

2020 ◽  
Vol 10 (01) ◽  
pp. e137-e140
Author(s):  
Mosaad Abdel-Aziz ◽  
Nada M. Abdel-Aziz ◽  
Dina M. Abdel-Aziz ◽  
Noha Azab
Keyword(s):  
Clinical Features ◽  
Clinical Symptoms ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Angiotensin Converting Enzyme 2 ◽  
Compulsory Vaccination ◽  
Specific Factors ◽  
Novel Coronavirus ◽  
Radiographic Data

AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.

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