Kawasaki disease recurrence in the COVID-19 era: a systematic review of the literature

AbstractKawasaki disease (KD) is a vasculitis of unknown origin of small and medium caliber blood vessels, especially involving coronary arteries and is the leading cause of acquired heart disease in childhood in developed countries. Although rarely, it can recur: most recurrences occur within 2 years of the initial episode. No data are available on incidence of recurrent KD in Europe and multiple recurrences are rarely seen. We reviewed the medical literature on Kawasaki disease recurrence and reported a new case of Kawasaki disease recurrence in a child with SARS-CoV-2 infection. We believe that in our case SARS Cov2 acted as a trigger capable to determine, in a genetically susceptible individual, a second recurrence of the disease. In the Covid-19 era we affirm the importance for Kawasaki disease to be tested for SARS Cov2 infection.

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An update on the epidemiology, length of stay, and cost of Kawasaki disease hospitalisation in the United States

Cardiology in the Young ◽

10.1017/s1047951119000982 ◽

2019 ◽

Vol 29 (06) ◽

pp. 828-832 ◽

Cited By ~ 2

Author(s):

Laxmi V. Ghimire ◽

Fu-Sheng Chou ◽

Narayan B. Mahotra ◽

Sharan P. Sharma

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Length Of Stay ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

Developed Countries ◽

The United States ◽

Hospital Charge ◽

Acquired Heart Disease ◽

The Developed Countries

AbstractBackground:Kawasaki disease is an acute vasculitis of childhood and is the leading cause of acquired heart disease in the developed countries.Methods:Data from hospital discharge records were obtained from the National Kids Inpatient Database for years 2009 and 2012. Hospitalisations by months, hospital regions, timing of admission, insurance types, and ethnicity were analysed. Length of stay and total charges were also analysed.Results:There were 10,486 cases of Kawasaki disease from 12,678,005 children hospitalisation. Kawasaki disease was more common between 0 and 5 years old, in male, and in Asian. The January–March quarter had the highest rate compared to the lowest in the July–September quarter (OR=1.62, p < 0.001). Admissions on the weekend had longer length of stay [4.1 days (95 % CI: 3.97–4.31)] as compared to admissions on a weekday [3.72 days (95 % CI: 3.64–3.80), p < 0.001]. Blacks had the longest length of stay and whites had the shortest [4.33 days (95 % CI: 4.12–4.54 days) versus 3.60 days (95 % CI: 3.48–3.72 days), p < 0.001]. Coronary artery aneurysm was identified in 2.7 % of all patients with Kawasaki disease. Children with coronary artery aneurysm were hospitalised longer and had higher hospital charge. Age, admission during weekend, and the presence of coronary artery aneurysm had significant effect on the length of stay.Conclusions:This report provides the most updated epidemiological information on Kawasaki disease hospitalisation. Age, admissions during weekend, and the presence of coronary artery aneurysm are significant contributors to the length of stay.

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The emergence of Kawasaki disease in India and China

Global Cardiology Science and Practice ◽

10.21542/gcsp.2017.21 ◽

2018 ◽

Vol 2017 (3) ◽

Cited By ~ 2

Author(s):

Ankur Kumar Jindal ◽

Vingesh Pandiarajan ◽

Raju Khubchandani ◽

Nutan Kamath ◽

Tapas Sabui ◽

...

Keyword(s):

Developing Countries ◽

Heart Disease ◽

Kawasaki Disease ◽

Developed Countries ◽

Resource Constrained ◽

Diagnosis And Management ◽

China And India ◽

The World ◽

Acquired Heart Disease ◽

India And China

Kawasaki disease (KD) is recognized as a leading cause of acquired heart disease in children in developed countries. Although global in distribution, Japan records the highest incidence of KD in the world. Epidemiological reports from the two most populous countries in the world, namely China and India, indicate that KD is now being increasingly recognized. Whether this increased reporting is due to increased ascertainment, or is due to a true increase in incidence, remains a matter of conjecture. The diagnosis and management of KD in developing countries is a challenging proposition. In this review we highlight some of the difficulties faced by physicians in managing children with KD in resource-constrained settings.

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Kawasaki disease

Challenging Concepts in Congenital and Acquired Heart Disease in the Young ◽

10.1093/med/9780198759447.003.0022 ◽

2020 ◽

pp. 291-302

Author(s):

Tarek Alsaied ◽

Justin T Tretter ◽

Andrew N Redington

Keyword(s):

Kawasaki Disease ◽

Treatment Options ◽

Significant Risk ◽

Developed Countries ◽

Coronary Imaging ◽

Coronary Aneurysms ◽

Acquired Heart Disease ◽

Immunoglobulin Treatment ◽

Long Term Prognosis

Kawasaki disease is the most common acquired heart disease in children in developed countries. Coronary involvement is reported in 30% of patients with no treatment and decreases to 5% with intravenous immunoglobulin treatment. Given the significant risk for coronary involvement, understanding the long-term prognosis is paramount to guide outpatient follow-up and treatment. This chapter presents the case of a 20-month-old child with Kawasaki disease and giant coronary aneurysms. The chapter reviews the diagnostic criteria and coronary imaging aspects, delves into the treatment options and prognosis, including immunoglobulin treatment.

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Lifetime cardiovascular management of patients with previous Kawasaki disease

Heart ◽

10.1136/heartjnl-2019-315925 ◽

2019 ◽

Vol 106 (6) ◽

pp. 411-420 ◽

Cited By ~ 8

Author(s):

Paul Brogan ◽

Jane C Burns ◽

Jacqueline Cornish ◽

Vinod Diwakar ◽

Despina Eleftheriou ◽

...

Keyword(s):

Kawasaki Disease ◽

Coronary Thrombosis ◽

Vascular Complications ◽

Developed Countries ◽

Cardiac Complications ◽

Inflammatory Disorder ◽

Delayed Treatment ◽

Acquired Heart Disease ◽

The Uk

Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere.

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Breastfeeding Reduce the Risk of Kawasaki Disease in a Chinese Population Based Case-Control Study

10.21203/rs.3.rs-55571/v1 ◽

2020 ◽

Author(s):

Feifei Si ◽

Yanfeng Yang

Keyword(s):

Kawasaki Disease ◽

Chinese Population ◽

Case Control Study ◽

Developed Countries ◽

Case Control ◽

Age Group ◽

Pediatric Age Group ◽

Acquired Heart Disease ◽

And Control ◽

Control Study

Abstract Backgroud: Kawasaki disease (KD) is the leading cause of acquired heart disease in the pediatric age group in developed countries. But its etiology is unknown. We assessed whether brestfeeding time can influence risk of KD. Methods: We collected feeding, clinical and laboratory details from 200 KD patients and 100 controls. Then we use SPSS to assess the comparison of the general characteristics of KD patients and control patients, and the Correlation of BF time with clinical and laboratory of KD patients. Results: The haemoglobin level was significantly lower in Kawasaki disease patients compared with controls (p<0.05). There were no significant differences between group of KD with coronary artery lesions (CALs) and group of KD without CALs in age, sex, WBC, platelet, HB, CRP . However, there were significantly decreased frequencies for the longer beestfeeding time in KD patients without CALs when compared with KD patients with CALs (OR=668, 95%CI=0.454-0.984，p=0.041). Moreover, HB level were positively correlated with brestfeeding time in patients with KD (r=0.163, p=0.028) Conclusion: We have shown that breast-feeding is associated with KD and the CALs. Brestfeeding may reduce the risk or KD with CALs. Brestfeeding may reduce the risk of KD with CALs.

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A case report of atypical Kawasaki disease presented with severe elevated transaminases and literature review

BMC Infectious Diseases ◽

10.1186/s12879-021-06101-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yifan Ren ◽

Chuanxin Zhang ◽

Xiaoqin Xu ◽

Yu Yin

Keyword(s):

Kawasaki Disease ◽

Clinical Symptoms ◽

Healthcare Providers ◽

Clinical Manifestations ◽

Developed Countries ◽

Clinical Criteria ◽

Reactive Protein ◽

Acquired Heart Disease ◽

Elevated Transaminases

Abstract Background Kawasaki disease (KD) is the most common cause of acquired heart disease among children in developed countries, in which the resulting coronary artery (CA) abnormalities cause myocardial ischemia, infarction, and death. Prompt diagnosis was essential, and supplemental information should be used to assist the diagnosis when classical clinical criteria are incomplete. The elevated levels of serum transaminases in most KD patients are mild. Herein, a case of atypical KD child with severely elevated transaminase was reported. Case presentation A child with clinical manifestations of fever, high C-reactive protein (CRP) and severely elevated transaminases was reported. The treatment effect of antibiotic and liver-protecting drugs was not satisfactory. A bilateral diffuse dilation of the CA was detected on echocardiography on day 5 of the illness; thus, atypical KD was diagnosed. Elevated transaminases declined rapidly to normal after the treatment of intravenous immunoglobulin (IVIG). A 1-month follow-up revealed that CA returned to normal, and 2-month, 6-months, and 1-year follow-up revealed the child was in good general health. Conclusions This case highlighted that atypical KD clinical symptoms were diverse, and severely elevated transaminases might provide a clue to healthcare providers for the diagnosis and management of atypical KD.

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Breastfeeding and Risk of Kawasaki Disease: A Nationwide Longitudinal Survey in Japan

10.1542/9781610022873-breastfeeding_and_risk ◽

2018 ◽

pp. 138-148

Author(s):

Takashi Yorifuji ◽

Hirokazu Tsukahara ◽

Hiroyuki Doi

Keyword(s):

Kawasaki Disease ◽

Confidence Interval ◽

Hospital Admissions ◽

Reference Group ◽

Developed Countries ◽

Population Based ◽

Longitudinal Survey ◽

Feeding Practice ◽

Protective Effects ◽

Acquired Heart Disease

BACKGROUND AND OBJECTIVES Kawasaki disease (KD) is the most common cause of childhood-acquired heart disease in developed countries. However, the etiology of KD is not known. Aberrant immune responses are considered to play key roles in disease initiation and breastfeeding can mature immune system in infants. We thus examined the association between breastfeeding and the development of KD. METHODS We used a nationwide population-based longitudinal survey ongoing since 2010 and restricted participants to a total of 37 630 children who had data on their feeding during infancy. Infant feeding practice was queried at 6 to 7 months of age, and responses to questions about hospital admission for KD during the period from 6 to 30 months of age were used as outcome. We conducted logistic regression analyses controlling for child and maternal factors with formula feeding without colostrum as our reference group. RESULTS A total of 232 hospital admissions were observed. Children who were breastfed exclusively or partially were less likely to be hospitalized for KD compared with those who were formula fed without colostrum; odds ratios for hospitalization were 0.26 (95% confidence interval: 0.12–0.55) for exclusive breastfeeding and 0.27 (95% confidence interval: 0.13–0.55) for partial breastfeeding. Although the risk reduction was not statistically significant, feeding colostrum only also provided a protective effect. CONCLUSIONS We observed protective effects of breastfeeding on the development of KD during the period from 6 to 30 months of age in a nationwide, population-based, longitudinal survey in Japan, the country in which KD is most common.

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Kawasaki Disease following administration of 13-valent pneumococcal conjugate vaccine in young children

Scientific Reports ◽

10.1038/s41598-019-51137-5 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chee Fu Yung ◽

Xiangmei Ma ◽

Yin Bun Cheung ◽

Bee Khiam Oh ◽

Sally Soh ◽

...

Keyword(s):

Kawasaki Disease ◽

Young Children ◽

American Heart Association ◽

American Heart ◽

Systemic Vasculitis ◽

Case Series ◽

Heart Association ◽

Developed Countries ◽

Increased Risk ◽

Acquired Heart Disease

Abstract Kawasaki disease (KD) is a systemic vasculitis mainly affecting young children and the leading cause of acquired heart disease in developed countries. We performed a self-controlled case series analysis to investigate the association between PCV13 and KD. All hospitalized KD cases <2 y old from our hospital in Singapore from 2010 to 2014 were included. Complete KD cases were classified based on the definitions of the American Heart Association. During the study period, 288 KD cases were identified. A total of 21 KD cases (12 were classified as Complete KD) had date of onset within the risk interval of day 1 to day 28 post PCV13. The age-adjusted Relative Incidence (RI) for KD following PCV13 dose 1, dose 2 and dose 3 were 1.40 (95%CI, 0.72 to 2.71), 1.23 (95% CI, 0.62 to 2.44) and 0.34 (95% CI, 0.08 to 1.40) respectively. There were seven Complete KD cases with onset during the risk interval after dose 1 of PCV13 (age-adjusted RI 2.59, 95%confidence interval (CI), 1.16 to 5.81). We did not detect a significant increased risk for overall KD among PCV13 recipients. However, a significant association between PCV13 and Complete KD was noted following receipt of the first dose of PCV13.

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Recurrent Kawasaki disease and cardiac complications: nationwide surveys in Japan

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-317238 ◽

2020 ◽

Vol 105 (9) ◽

pp. 848-852

Author(s):

Daisuke Sudo ◽

Nobuko Makino ◽

Yosikazu Nakamura

Keyword(s):

Kawasaki Disease ◽

Ivig Therapy ◽

Disease Recurrence ◽

Cardiac Complications ◽

High Dose ◽

Coronary Aneurysms ◽

History Of ◽

Initial Episode ◽

The Difference ◽

Recent Cohort

IntroductionBased on data obtained before high-dose (2 g/kg) intravenous immunoglobulin (IVIG) therapy prevailed in Japan, children with a history of Kawasaki disease (KD) were highly susceptible to disease recurrence and more likely to develop cardiac sequelae. We aimed to examine the epidemiological features of cardiac complications among patients with recurrent KD following the widespread use of high-dose IVIG therapy.DesignTwo cohorts of patients with recurrent KD retrieved from Japanese nationwide surveys (previous cohort: 1989–1994; recent cohort: 2003–2012) were compared.ResultsOf 1842 patients with recurrent KD in the recent cohort, 3.5% and 5.2% developed cardiac sequelae at the initial and second episodes, respectively, which were markedly decreased compared with those (>10%, respectively) in the previous cohort. Multivariate analyses showed that the risk factors for cardiac sequelae at the second episode were similar between the cohorts. Patients with recurrent KD in both cohorts were more likely to have coronary aneurysms at the second episode than at the initial episode. However, when patients with coronary aneurysms at the initial episode were excluded from analyses, the difference in the proportions of coronary aneurysms between KD episodes disappeared in the recent cohort. Residual rates of previously formed coronary aneurysms were similar between the cohorts (approximately 50%).ConclusionThis study suggests that KD recurrence is no longer a risk factor for developing cardiac complications, unless cardiac sequelae appear at the initial episode. However, residual rates of previously formed coronary aneurysms remain high. Therefore, the importance of carefully managing coronary aneurysms associated with KD remains unchanged.

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Is macrophage activation syndrome in Kawasaki disease underrecognized?

The Journal of Rheumatology ◽

10.3899/jrheum.200361 ◽

2020 ◽

pp. jrheum.200361 ◽

Cited By ~ 2

Author(s):

Valentina Natoli ◽

Silvia Rosina ◽

Angelo Ravelli

Keyword(s):

Heart Disease ◽

Kawasaki Disease ◽

Macrophage Activation Syndrome ◽

Macrophage Activation ◽

Developed Countries ◽

Unknown Etiology ◽

Pediatric Age ◽

Acquired Heart Disease ◽

Activation Syndrome

Kawasaki disease (KD) is an acute vasculitis of unknown etiology that predominantly affects children < 5 years of age. It is now the leading cause of acquired heart disease in the pediatric age in developed countries1.

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