scholarly journals Kawasaki Disease- Management Strategies Given Symptoms Overlap to COVID-19: A Review

2021 ◽  
Vol 59 (236) ◽  
Author(s):  
Linna Wang ◽  
Sheng Zhang ◽  
Ji Ma ◽  
Jing Ni ◽  
Juyan Wang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Inflammatory Disease ◽  
Early Treatment ◽  
Respiratory Infections ◽  
Management Strategies ◽  
Artery Aneurysm ◽  
Hemodynamic Instability ◽  
Cardiovascular Complications ◽  
Coronary Artery Aneurysms

Kawasaki disease is an acute, self-limiting vasculitis in children. Early treatment is necessary to prevent cardiovascular complications. The acute phase of Kawasaki disease may present with hemodynamic instability. An association between viral respiratory infections and Kawasaki disease has been reported. Studies have shown that Kawasaki and Kawasaki-like disease may be associated with and have symptoms overlapping COVID-19. Children with COVID-19 may present as Kawasaki-like disease with pediatric inflammatory multisystem syndrome, or macrophage activation syndrome. Clinicians need to be aware of the early diagnosis and management of Kawasaki disease to prevent the development of coronary artery aneurysms. The symptoms overlap of multisystem inflammatory disease seen in COVID-19 adds to the difficulties in timely diagnosis and treatment. Children with Kawasaki disease require regular follow-up plans for coronary artery aneurysms. This adds to the difficulties during the changed environment of COVID-19 for control and prevention. Missed diagnosis and early treatment of Kawasaki disease with immunoglobulin and aspirin results in the development of coronary artery aneurysm in up to 25% of cases, with grave consequences. Here, we briefly review the management of typical and atypical Kawasaki disease which has symptoms overlapping with the multisystem inflammatory disease as seen in COVID-19.

scholarly journals Management of sequelae of Kawasaki disease in adults

2018 ◽  
Vol 2017 (3) ◽  
Author(s):  
John B Gordon ◽  
Jane C Burns
Keyword(s):  
Young Adults ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Management Strategies ◽  
Collaborative Study ◽  
Calcium Score ◽  
Calcium Deposition ◽  
Coronary Artery Aneurysms ◽  
Study Results ◽  
Growing Population

Background: A growing population of young adults is presenting to cardiologists with late manifestations of Kawasaki disease (KD) that include cardiomyopathy, ischemia, and infarction. The management of these conditions differs in important ways from atherosclerotic heart disease, and yet there is little awareness in the adult cardiology community regarding the special challenges posed by the cardiovascular sequelae of KD. Methods: Observations were made on a population of 140 adult KD patients enrolled in the San Diego Adult KD Collaborative Study. Results: Coronary artery aneurysms resulting from KD in childhood are associated with a high risk of thrombosis and stenosis at the inlet or outlet of the aneurysm. These aneurysms are often highly calcified and may contain a large thrombus burden that may obscure the true size of the aneurysm. Pitfalls in the management of these patients stem largely from failure to recognize the nature of the lesions, which leads to attempts to dilate highly calcified stenotic segments and undersizing of stents. Intravascular ultrasound is helpful in appreciating the true dimensions of the aneurysm, which may be filled with thrombus. Thrombolysis and use of anti-platelet agents followed by systemic anti-coagulation are appropriate management strategies for patients presenting with acute infarction. Bypass grafting with the internal thoracic arteries can be a successful strategy, but care must be taken to avoid competitive flow through the native vessel leading to graft failure. In contrast to the individuals who developed coronary artery aneurysms, young adults who had documented normal echocardiograms associated with their acute KD in childhood and who have no evidence of calcium deposition in the arterial wall as assessed by computed tomography (CT) calcium score appear to have no increased cardiovascular risk in the medium term. Long-term outcomes for adults post-KD in childhood are still being defined. Conclusions: KD poses special management challenges for the adult cardiologist who must recognize the unique features of the cardiovascular lesions in this growing population of patients. 

Onset of Kawasaki disease immediately after birth

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Cristina Medeiros Ribeiro de Magalhães ◽  
Riccardo Pratesi ◽  
Lenora Gandolfi ◽  
Rosa Harume Uenishi ◽  
Claudia B. Pratesi
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
Rare Event ◽  
Cardiovascular Complications ◽  
Postnatal Period ◽  
Older Children ◽  
Coronary Artery Aneurysms ◽  
Common Causes ◽  
Therapeutic Measures

Abstract Kawasaki disease (KD) is one of the most common causes of childhood systemic vasculitis, with the potential to cause significant cardiovascular complications, especially if undiagnosed. An investigation of coronary artery abnormalities with the application of appropriate therapeutic measures can improve the prognosis in these infants, decreasing the risk of coronary artery aneurysms. Neonatal KD is a rare event, often characterized only by few of the clinical features observed in older children. In this case report, we describe a newborn male who presented an incomplete clinical presentation of KD, where symptoms of the disease erupted immediately after birth. The objective of this report is to draw the attention of pediatricians and neonatologists to the possible presence of KD in an asymptomatic newborn during the immediate postnatal period, even in the absence of the classic features of KD, such as fever.

scholarly journals A 13-Year-Old Boy Who Has Kawasaki Disease Shock Syndrome Presents with Parotitis

2019 ◽  
Vol 09 (01) ◽  
pp. 060-063 ◽  
Author(s):  
Yilmaz Yozgat ◽  
Selcuk Uzuner ◽  
Aysegul Dogan Demir ◽  
Mustafa Ogur ◽  
Can Yilmaz Yozgat ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Toxic Shock ◽  
Coronary Artery Aneurysms ◽  
Capillary Refill ◽  
First Case ◽  
Low Blood Pressure ◽  
Echocardiographic Examination

AbstractWe report a 13-year-old boy who (initially) had symptoms of toxic shock-like syndrome and mumps. Then, the patient was hospitalized in the pediatric intensive care unit (PICU) because of his ongoing hemodynamic instability (low blood pressure of 70/30 mm Hg and capillary refill time of > 4 seconds). During his stay in the PICU, the patient was treated with fluid resuscitation and vasoactive infusion and at the same time was diagnosed with Kawasaki disease shock syndrome (KDSS), when giant right coronary artery aneurysms were detected on echocardiographic examination. This case illustrates the risk of KDSS in patient who carries both parotitis and toxic shock-like syndrome. The clinicians should be cautious about detecting any types of coronary artery aneurysms in such patients. This is the first case of KDSS associated with parotitis reported in the literature.

Abstract O.72: The Spectrum Of Cardiovascular Lesions Requiring Intervention In Young Adults After Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
John B Gordon ◽  
Lori B Daniels ◽  
Andrew M Kahn ◽  
Matthew Vejar ◽  
Chisato Shimizu ◽  
...  
Keyword(s):  
Young Adults ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Vascular Inflammation ◽  
Cardiovascular Complications ◽  
Coronary Artery Aneurysms ◽  
History Of ◽  
Proximal Coronary Artery ◽  
Cardiothoracic Surgeon ◽  
Cardiovascular Interventions

Background: Coronary artery aneurysms resulting from vascular inflammation associated with Kawasaki disease (KD) in childhood may remain clinically silent until adulthood. Young adults presenting with large aneurysms, unstable angina, or myocardial infarction (MI) following KD in childhood present unique challenges to the interventional cardiologist and cardiothoracic surgeon. We present a range of management issues raised by this patient population. Methods: Participants who underwent cardiovascular interventions were identified from an observational cohort of 154 individuals with a history of KD enrolled in the San Diego Adult KD Collaborative. Of these 154 participants, 63 (40.9%) were originally diagnosed with KD and followed by one of the co-authors (JCB) and were designated as Cohort 1. The remaining 91 participants (Cohort 2) were referred by their physician or self-referred for participation in the study. Results: Of the 154 participants, 20 (12.9%; 2 from Cohort 1 and 18 from Cohort 2) underwent cardiovascular interventions: 9 had percutaneous interventions and 11 had surgery. Twelve participants had been diagnosed with KD in childhood, 7 had a history of a KD-compatible illness in childhood, and 1 had proximal coronary artery aneurysms compatible with KD. Fourteen participants were asymptomatic until experiencing a major cardiovascular event: 8 presented with an acute MI, 3 presented with angina, 1 presented with end-stage congestive heart failure requiring cardiac transplantation, and 2 presented with extremity claudication. Conclusions: Cardiovascular complications in individuals with a history of KD illustrate the following points: 1) Even small to moderate-sized aneurysms that “normalize” by echocardiography in childhood can lead to stenosis and thrombosis decades after the acute illness; 2) Coronary interventions without intravascular ultrasound may result in underestimation of vessel lumen diameter; 3) Failure to assess the extent of calcification may lead to suboptimal procedural outcomes, and 4) Patients with symptomatic peripheral aneurysms may benefit from endarterectomy or resection. Interventional cardiologists should be aware of the complications encountered in this growing population of young adults.

scholarly journals The Relationship Between TNF-Like Protein 1A and Coronary Artery Aneurysms in Children With Kawasaki Disease

2021 ◽  
Author(s):  
jing zhang ◽  
Haobo Weng ◽  
Qiongfei Pei ◽  
Penghui Yang ◽  
Wentao Fan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Development Process ◽  
Systemic Vasculitis ◽  
Artery Aneurysm ◽  
Unknown Etiology ◽  
Coronary Artery Aneurysms ◽  
Tnf Superfamily ◽  
The Relationship ◽  
Necrosis Factor

Abstract Background: Kawasaki disease (KD) is an acute, systemic vasculitis of unknown etiology that occurs predominantly in infants and children, and the most crucial complication of KD is coronary artery aneurysm (CAA). Tumor necrosis factor (TNF)-like protein 1A (TL1A) is a member of the TNF superfamily, which possesses the ability of maintaining vascular homeostasis and regulating immune response. This study aims to examine the serum TL1A levels in KD patients, and to investigate the relationship between TL1A and CAAs in children with KD.Methods: Blood samples were recruited from 119 KD patients, 35 febrile controls (FCs) and 37 healthy controls (HCs). The KD group was further divided into KD with CAAs (KD-CAAs) and KD non-CAAs (KD-NCAAs) groups. Serum TL1A levels were measured using enzyme-linked immunosorbent assays, and clinical parameters were collected in KD patients. Results: Serum TL1A levels in the acute phase of KD patients were significantly higher than that in the FC and HC groups. In particular, serum TL1A were substantially increased in the KD-CAA group than that in the KD-NCAA group. Furthermore, TL1A levels were positively correlated with the duration of fever, time point of IVIG and WBC levels, but negatively correlated with levels of RBC, Hb and Albumin in the KD group. Conclusions: TL1A might be involved in the KD-associated vasculitis, and might be a factor in the development process of CAAs.

Abstract 173: Coronary artery aneurysm measurement and z-score variability in Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Christina Ronai ◽  
Akiko Hamaoka-Okamoto ◽  
Christian Stopp ◽  
Jane W Newburger ◽  
Kevin Friedman
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Management Strategies ◽  
Artery Aneurysm ◽  
Intraobserver Reliability ◽  
Z Score ◽  
Z Scores

Background: Coronary artery (CA) z-scores are commonly used for clinical decisions in Kawasaki disease (KD). We evaluated reliability in CA measurement, reproducibility of z-score calculation, and frequency with which different z-score formulas lead to divergent management strategies. Methods: We randomly selected 21 KD patients (pts) with ≥1 CA z-score 1.5-3 and all KD pts with ≥ 1 CA z-score 7-14 (n=20). Two echocardiographers measured LMCA, LAD and RCA. Inter- and intraobserver reliability were calculated. T-tests were used to compare CA z-score using 3 commonly used formulas (Boston, DC and Montreal). Results: Median age at KD echo was 1.2 y (0.2-11.5 y). Interobserver reliability was high for LAD (intraclass correlation [ICC] 0.970) and RCA (ICC 0.943) and lower for LMCA (ICC 0.725). Intraobserver reliability was also high for LAD and RCA (ICC 0.991 and 0.999) and lower for LMCA (ICC 0.946). Z-scores for the 3 formulas were similar at smaller CA size, i.e., z < 3, but varied markedly at larger CA dimensions (Figure). Z-scores for the same CA dimension calculated by each of the 3 formulas resulted in disparate classification of normal vs. mild dilation in 7/21 (22%) pts, and different guidance for anticoagulation based on CA z ≥10 in 10/20 (50%) pts. Conclusion: Although CA measurements have high inter- and intraobserver agreement, CA z-scores vary dramatically based on the z-score formula, particularly at larger CA dimensions. Discrepancies in CA z-score between calculators impacts not only the distinction between normal and mild dilatation, but most importantly, the recommendation of anticoagulation for pts with larger CA dimensions.

scholarly journals A Case of Kawasaki Disease with Coronary Aneurysm Responding to the 4th IVIG Treatment

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Ju Young Kim ◽  
Hyun Jung Kim
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Artery Aneurysm ◽  
Febrile Illness ◽  
Coronary Aneurysm ◽  
Ivig Treatment ◽  
Coronary Artery Aneurysms ◽  
Steroid Pulse ◽  
The Third

Kawasaki disease is an acute febrile illness that usually occurs in children younger than 5 years of age. The use of intravenous immunoglobulin (IVIG) within the first 10 days of illness has been shown to reduce the incidence of coronary artery aneurysms significantly. The relative roles of repeated doses of intravenous immunoglobulin (IVIG) are controversial in refractory Kawasaki disease (KD). Most experts recommend the second retreatment with IVIG, 2 g/kg in refractory KD. However, the dose-response effect of the third or fourth IVIG was uncertain. Although there have been a significant number of reports on new therapeutic options for refractory KD, such as steroid, infliximab, methotrexate, and other immunosuppressants, their effectiveness in reducing the prevalence of coronary artery aneurysms was unproven. We present here KD patient with small coronary artery aneurysm who is resistant to the third IVIG and steroid pulse therapy but showed improvement immediately after the infusion of the 4th IVIG on fever day 18.

scholarly journals Fifteen-minute consultation: Kawasaki disease: how to distinguish from other febrile illnesses: tricks and tips

2020 ◽  
Vol 105 (3) ◽  
pp. 152-156
Author(s):  
Alison Kelly ◽  
Katie Sales ◽  
Mary Fenton-Jones ◽  
Robert Tulloh
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Febrile Illness ◽  
Febrile Child ◽  
Coronary Artery Aneurysms ◽  
Childhood Infections ◽  
Giant Coronary Artery Aneurysm ◽  
The Many

Kawasaki disease (KD) is challenging to diagnose because there is no specific laboratory test and the presentation is often similar to common childhood infections. We highlight some of those KD diagnostic challenges. KD, a self-limiting vasculitis, can cause coronary artery aneurysms. The aim is to optimise management during the acute febrile illness to try and prevent these because a giant coronary artery aneurysm is devastating enough without thinking that it might have been prevented. The conundrum for acute paediatricians is which clinical features best distinguish the febrile child with possible KD, needing intravenous immunoglobulin, from the many other children with febrile illnesses.

scholarly journals Infarto agudo do miocárdio silencioso associado a aneurisma de artéria coronária decorrente de doença de Kawasaki: relato de caso / Silent acute myocardial infarction associated with coronary artery aneurysm due to Kawasaki disease: case report

2018 ◽  
Vol 8 (3) ◽  
pp. 19-22
Author(s):  
Samir Duarte Ibrahim ◽  
Ana Laura Lopes Potente ◽  
Fernanda Pereira Maiolini
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Distal Part ◽  
Systemic Vasculitis ◽  
Artery Aneurysm ◽  
Inferior Wall ◽  
Coronary Artery Aneurysms ◽  
Coronary Aneurysms ◽  
Disease Case

A doença de Kawasaki é caracterizada por uma vasculite aguda sistêmica que ocorre na grande maioria dos casos em crianças menores de cinco anos de idade. A doença tem curso autolimitado e tratamento baseado no uso de imunoglobulina intravenosa e salicilatos. A principal gravidade se dá pelas possíveis complicações, sendo a mais grave a formação de aneurismas de artérias coronárias. O presente trabalho visa relatar o caso de uma paciente que não recebeu o diagnóstico de doença de Kawasaki na infância. Na vida adulta, durante ecocardiograma diagnosticou-se uma hipocinesia de parede inferior e parte distal do septo inferior. Em posterior angiografia, verificou-se artéria coronária direita ectásica em toda a sua extensão. Trata-se de um caso raro devido à formação de aneurismas coronarianos não tratados, após anos de doença, e sua manifestação isquêmica.Palavras-Chave: Síndrome de linfonodos mucocutâneos; Doença das coronárias; Infarto do miocárdioABSTRACTKawasaki disease is characterized by the presence of acute systemic vasculitis that occurs in most of cases in children under five years of age. The disease has an auto-limited path and the treatment is based on intravenous immunoglobulin and salicylates. The main gravity is due to the possible complications, and the most serious is the formation of coronary artery aneurysms. The present work aims to report the case of a patient, who did not receive the diagnosis of Kawasaki disease in childhood. In adulthood, an inferior wall hypokinesia and a distal part of the inferior septum were diagnosed by echocardiogram. In a subsequent angiography it was verified a ectasia right coronary artery throughout its extension. This is a rare case due to the formation of untreated coronary aneurysms after years of illness associated with ischemic manifestations.Keywords: Mucocutaneous lymph node syndrome;  Myocardial infarction; Coronary disease

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