scholarly journals Clinical Features of Kawasaki Disease during SARS-CoV-2 Epidemic: A Single-Center Retrospective Study

2021 ◽  
Vol 2 (3) ◽  
pp. 5-8
Author(s):  
Toshimasa Nakada
Keyword(s):  
Retrospective Study ◽  
Kawasaki Disease ◽  
Clinical Features ◽  
Acute Phase ◽  
Clinical Findings ◽  
Male Gender ◽  
Inotropic Agents ◽  
Significant Difference ◽  
The Usa ◽  
Acute Phase Treatment

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, causing coronavirus disease 2019 (COVID-19), has rapidly spread worldwide. Recently, cases of Kawasaki-like syndrome associated with COVID-19 (MIS‐C/PIMS) have been reported in the USA and Europe. However, the clinical features of Kawasaki disease (KD) in Japan during the SARS-CoV-2 epidemic remain unclear. Therefore, this retrospective study aimed to evaluate the clinical features of KD in our department during the year of the COVID-19 pandemic (2020). Data were obtained from 45 KD patients who underwent acute-phase treatment from January 2018 to December 2020. The patients were divided into three groups: (1) 2018 group, in which 18 patients receiving acute-phase treatment during 2018; (2) 2019 group, in which 17 patients receiving acute-phase treatment during 2019; and (3) 2020 group, in which 10 patients receiving acute-phase treatment during 2020. The comparison of the clinical findings, treatments, and outcomes among the three groups (2018 vs. 2019 vs. 2020 group) revealed a significant difference in the rate of the male gender (72.2% vs. 41.2% vs. 10.0%, P < 0.010), recurrence (0.0% vs. 0.0% vs. 25.0%, P = 0.015), and coronary artery lesions (16.7% vs. 0.0% vs. 0.0%, P = 0.044). No patients required ventilation assistance or inotropic agents and met the diagnostic criteria of MIS‐C/PIMS. Further studies are warranted to elucidate the clinical features of KD during the SARS-CoV-2 epidemic.

Abstract 54: The Correlation Between IgE And The Level Of Interleukin-21 In Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Hae-Yong Lee
Keyword(s):  
Kawasaki Disease ◽  
Serum Level ◽  
Acute Phase ◽  
Immunoglobulin E ◽  
Significant Difference ◽  
History Of ◽  
Interleukin 21 ◽  
Christian Hospital ◽  
Age Range ◽  
Chemiluminescent Method

Purpose: It has been reported that serum level of immunoglobulin E (IgE) is increased in patients with Kawasaki disease (KD) after acute phase. However the exact mechanism of increasing IgE is yet to be revealed. We investigated whether the interleukin-21 (IL-21) could be related with the high IgE in KD. Instead of IL-4, IL-21 was focused in this study because it has been reported that its level is increased in various autoimmune vasculitis. Methods: From June 2008 to June 2010, 49 patients with KD admitted in Wonju Severance Christian Hospital and 13 controls with high fever due to unknown infection who had no history of KD were included in this study. The sera from patients and controls were collected and checked in terms of immunoglobulin E (Chemiluminescent method, Siemens, Munich, Germany) and IL-21 (ELISA, eBioscience, San Diego, USA). Results: The median age of patients with KD was 3 years of age (range: 0.4-10) and that of controls was 7 years of age (range: 1-12). The group of patients with KD was composed of 39 complete KD and 10 incomplete KD. Among patients with KD, 10 patients had coronary arterial dilatation (CAD) and 39 patients had no coronary complications. The median value of IL-21 in patients with KD was significantly increased as 466 pg/mL (range: 0-1544) while that value in controls was <62.5 pg/mL (range: 0- 825 pg/mL) ( P < 0.01). We could not find the significant correlation between the serum level of IgE and that of IL-21 in patients with KD (Spearman R=0.2, P = 0.08) though 30% of patients with KD showed increased IgE more than 100 IU/mL. In addition, our data showed no significant difference between CAD group and non CAD group in terms of serum IL-21. Conclusion: Our data showed firstly that IL-21 is increased in patients with KD. There was no significant correlation between high IgE and the level of IL-21.

scholarly journals Useful predictors of Kawasaki disease without complications before initial acute-phase treatment

2021 ◽  
Vol 7 (3) ◽  
pp. 018-027
Author(s):  
Toshimasa Nakada
Keyword(s):  
Kawasaki Disease ◽  
Acute Phase ◽  
Systemic Vasculitis ◽  
Rescue Therapy ◽  
Ivig Therapy ◽  
Therapy Resistance ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Ivig Resistance ◽  
Acute Phase Treatment

Kawasaki disease (KD) is an acute febrile systemic vasculitis that primarily affects children younger than 5 years, with coronary artery lesions (CALs) as its severe complications. Intravenous immunoglobulin (IVIG) therapy resistance has been implicated in CAL development, and its known predictors are as follows: Egami score, Kobayashi score, C-reactive protein (CRP), albumin, CRP-to-albumin ratio, and neutrophil-to-lymphocyte ratio (NLR). However, the most useful predictor for IVIG resistance in patients with KD without complications before initial acute-phase treatment remains unclear. Therefore, this study aimed to determine the most useful predictor for IVIG resistance in such patients. This retrospective study included data from 202 patients with KD who underwent acute-phase treatment from January 2009 to March 2021. Among 46 IVIG-resistant patients, 22 patients required rescue therapy (rescued patients), while the remaining 24 received no rescue therapy for resistance and had no CALs. Among the 6 indices, NLR had the highest sensitivity and specificity for the detection of all IVIG-resistant patients and rescued patients (0.724 and 0.728, respectively), and logistic regression analysis showed that the NLR was the sole independent predictor both for the IVIG-resistant patients and for the rescued patients (P < 0.001 and = 0.002, Odds ratio = 5.797 and 5.814, 95% confidence interval = 2.687–12.504 and 1.954–17.299, respectively). NLR was the useful predictor for all IVIG-resistant patients and rescued patients among those with KD without complications before initial acute-phase treatment.

scholarly journals Clinical Features in Children With Kawasaki Disease Shock Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhimin Zheng ◽  
Yanzhi Huang ◽  
Zhiyi Wang ◽  
Jia Tang ◽  
Xiaoqian Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Clinical Features ◽  
Artery Aneurysm ◽  
Left Ventricular ◽  
Current Evidence ◽  
Albumin Concentration ◽  
Case Control Studies ◽  
Significant Difference

Objective: This study aimed to identify the clinical features of Kawasaki disease shock syndrome (KDSS) in children.Methods: The case-control studies of KDSS and KD children up until April 30, 2021 were searched in multiple databases. The qualified research were retrieved by manually reviewing the references. Review Manager 5.3 software was used for statistical analysis.Results: The results showed that there was no significant difference in the incidence of male and female in children with KDSS. Children with KDSS compared with non-shocked KD, there were significant difference in age, duration of fever, white blood cell (WBC) count, percentage of neutrophils (NEUT%), platelet count (PLT), c-reactive protein level (CRP), alanine transaminase concentration (ALT), aspartate transaminase concentration (AST), albumin concentration (ALB), sodium concentration (Na), ejection fraction, and length of hospitalization as well as the incidence of coronary artery dilation, coronary artery aneurysm, left ventricular dysfunction, mitral regurgitation, pericardial effusion, initial diagnosis of KD, intravenous immunoglobulin (IVIG) resistance and receiving second dose of IVIG, vasoactive drugs, hormones, and albumin. In contrast, there was no difference in the hemoglobin concentration, erythrocyte sedimentation rate, and the incidence of conjunctival injection, oropharyngeal change, polymorphous rash, extremity change, and incomplete KD.Conclusion: Current evidence suggested that the children with KDSS had more severe indicators of inflammation and more cardiac abnormalities. These patients were resistant to immunoglobulin treatment and required extra anti-inflammatory treatment.Systematic Review Registration: PROSPERO registration number CRD42021241207.

scholarly journals Low- versus high-concentration intravenous immunoglobulin for children with Kawasaki disease in the acute phase

2021 ◽  
Author(s):  
Takanori Suzuki ◽  
Nobuaki Michihata ◽  
Tetsushi Yoshikawa ◽  
Kazuyoshi Saito ◽  
Hiroki Matsui ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Propensity Score ◽  
Confidence Interval ◽  
Intravenous Immunoglobulin ◽  
Acute Phase ◽  
Instrumental Variable ◽  
Risk Difference ◽  
High Concentration ◽  
Ivig Resistance ◽  
Significant Difference

Abstract Purpose: Few studies have compared the effects of low-concentration (5%) and high-concentration (10%) intravenous immunoglobulin (IVIG) preparations for patients with Kawasaki disease (KD) in the acute phase. The purpose of this study was to compare outcomes between low- and high-concentration IVIG preparations in children with KD, using a national inpatient database in Japan.Method: We used the Diagnostic Procedure Combination database to identify patients with KD treated with IVIG from April 2012 to March 2020. We identified those receiving high- and low-concentration IVIG preparations as an initial treatment. The outcomes included the proportions of patients with coronary artery abnormalities (CAAs) and IVIG resistance, length of stay, and medical costs. Propensity score-matched analyses were conducted to compare the outcomes between the two groups. Instrumental variable analyses were performed to confirm the results.Result: We identified 48,046 patients with KD and created 4:1 propensity score-matched pairs between the low- and high-concentration IVIG groups. There was a significant difference in the percentage with IVIG resistance between the two groups (20.6% vs 24.1%; risk difference, 3.5% [95% confidence interval, 2.3-4.7]; p < 0.001). However, there was no significant difference in CAAs (1.6% vs 1.6%; risk difference, 0.013% [95% confidence interval, −0.34 to 0.37]; p = 0.953). The instrumental variable analyses showed similar results.Conclusions: The proportion of CAAs did not differ significantly between those receiving low- and high-concentration IVIG. To confirm the results of this study, prospective studies adjusting for duration of IVIG administration and duration of observation are needed.

scholarly journals Acute Phase Treatment and Medium-Term Outcomes in Kawasaki Disease

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Toshimasa Nakada
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Acute Phase ◽  
Coronary Artery Stenosis ◽  
Ivig Therapy ◽  
Initial Therapy ◽  
Artery Stenosis ◽  
Cardiac Events ◽  
Medium Term ◽  
Acute Phase Treatment

An acute phase treatment for prevention of coronary artery stenosis caused by Kawasaki disease (KD) has not been established. The objective of this study was to clarify the medium-term outcomes of patients who received acute phase treatment in our department. This retrospective study included data from 214 patients with KD who received acute phase treatment from January 2009 to May 2020. A total of 196 (92.1%) received an initial single dose of intravenous immunoglobulin (IVIG) therapy. One patient with status epilepticus at presentation received initial IVIG plus steroid therapy. A total of 17 patients did not receive IVIG. The rate of coronary artery lesions (CALs) 1 month and 1 year after KD onset were 1.9% and 0.9%, respectively. Two patients had CAL 1 year after KD onset. However, no patients had coronary artery stenosis. One patient with a right giant CAL had a medium CAL before initial therapy. During a median follow-up period of 3 years and 4 months, no patients had cardiac events that required therapy.

scholarly journals A Retrospective Study on Clinical Features of Early Neonatal Jaundice in Term Babies at Ratchaburi Hospital, Thailand

2019 ◽  
pp. 1-10
Author(s):  
Khine Lynn Phyu ◽  
Kaung Zaw ◽  
Htoo Htoo Kyaw Soe ◽  
Nan Nitra Than ◽  
Htay Lwin ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Features ◽  
Medical Records ◽  
Neonatal Jaundice ◽  
Abo Incompatibility ◽  
Significant Difference ◽  
Common Causes ◽  
Common Etiology ◽  
Almost All ◽  
Work Up

Background: Neonatal jaundice is a common condition that sometimes lead to devastating neurological consequence such as kernicterus. Aim: This study was aimed to find out the clinical features and etiology of neonatal jaundice in term newborn admitted to Ratchaburi Hospital. Study Design:  Hospital-based retrospective study Methodology: The study was conducted by reviewing 117 medical records of neonatal jaundice who were admitted at Ratchaburi Regional Hospital, Bangkok, Thailand from 1st October 2007 to 30th September 2008. Both the patient’s and their mother’s profiles, etiology and clinical features of jaundice were extracted. Results: The results showed that the most common etiology was inconclusive jaundice (64.9%) followed by ABO incompatibility (17.9%) and breast feeding jaundice (10.2%). Other less common causes were G6PD deficiency, minor blood group incompatibility and cephalhematoma. The onset of the neonatal jaundice usually occurred on the 2nd to the 4th day of life and almost all newborns responded well to phototherapy. Most of interventions were started on the 2nd day of life. Moreover, exchange transfusion was needed in four cases. The maximum and minimum haematocrit was significantly lower while Nucleated Red Cell (NRC) count and percent of reticulocytes counts were significantly higher in haemolysis group than in non-haemolysis group,. Conclusion: From our study, the most common etiology was inconclusive jaundice which is followed by ABO incompatibility but non-immune hemolysis and polycythemia were not encountered. There was significant difference of hematocrit, NRC and reticulocytes between hemolytic and non-hemolytic groups. Detailed approach of history taking and physical examination, early investigations of jaundice work up and septic work up are recommended in eliciting various etiologies and preventing complications.

Malattia di Kawasaki: quale dose di immunoglobuline nei bambini grandi?

2020 ◽  
Vol 23 (9) ◽  
pp. 231-233
Author(s):  
Lorenzo Mambelli ◽  
Alessandra Iacono ◽  
Giovanna Rametta ◽  
Federico Marchetti
Keyword(s):  
Retrospective Study ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Treatment Effects ◽  
Ivig Treatment ◽  
Japanese Children ◽  
Ivig Resistance ◽  
Coronary Aneurysms ◽  
Significant Difference ◽  
Randomised Controlled

In a retrospective study conducted on a population of Japanese children with a weight ≥ 25 kg and with Kawasaki disease, no significant difference has been observed for the onset of coronary aneurysms, intravenous immunoglobulin (IVIg) resistance, duration of the hospitalisation and adverse treatment effects among the groups treated with 2 g/kg and 1 g/kg doses of IVIg. New randomised controlled studies are desirable to check the most appropriate IVIg dose for old children, also considering the cortisone treatment in association with the IVIg treatment firstly.

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