An update on<scp>K</scp>awasaki disease<scp>II</scp>: Clinical features, diagnosis, treatment and outcomes

Yim, Deane; Curtis, Nigel; Cheung, Michael; Burgner, David

doi:10.1111/jpc.12221

Cited by 53 publications

(34 citation statements)

References 96 publications

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“…Atypical KD was diagnosed when there was a high suspicion for KD based on atypical clinical features such as vomiting, diarrhea, abdominal pain, and heart failure, with coronary artery dilatation on echocardiography or more than three supplemental laboratory criteria and with fever persisting for at least 5 days [8,10,12]. The supplemental laboratory criteria are as follows: C-reactive protein (CRP) ≥ 3.0 mg/dL and/or erythrocyte sedimentation rate (ESR) ≥ 40 mm/h with (1) albumin ≤ 3.0 g/dL, (2) anemia for age, (3) elevation of alanine aminotransferase, (4) platelets after 7 days ≥ 450,000/mm 3 , (5) white blood cell (WBC) count ≥ 15,000/mm 3 , and (6) urine WBC ≥ 10 per high-power field [8,10].…”

Section: Methodsmentioning

confidence: 99%

“…The classic diagnosis of KD has generally been based on the presence of fever persisting at least 5 days, changes in the extremities, lips, and oral cavity, polymorphous exanthema, bilateral bulbar conjunctival injection without exudate, and cervical lymphadenopathy, >1.5 cm in diameter and usually unilateral [8]. However, in many patients, the clinical manifestations of KD are atypical and incomplete for definitive diagnosis for KD, which can lead to a delay in diagnosis and possibly a worse prognosis for CAA than occurs with typical KD [11,12]. Thus, rapid suspicion and accurate diagnosis of KD based on clinical manifestations, laboratory studies, and echocardiographic examination, followed by appropriate treatment, may be essential to prevent CAA [8,13].…”

Section: Introductionmentioning

confidence: 99%

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Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children

Kim

Choi

et al. 2014

BMC Pediatr

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BackgroundKawasaki disease (KD) is an acute febrile vasculitis that causes coronary artery abnormality (CAA) as a complication. In some patients, an association has been noted between elevated liver enzymes or an abnormal gallbladder (GB) and hepatobiliary involvement in KD. In this study, we aimed to evaluate clinical, laboratory, and ultrasonographic (USG) risk factors of hepatobiliary involvement for the intravenous immunoglobulin (IVIG) resistance and the development of CAA in children with KD.MethodsFrom March 2004 through January 2013, clinical features, laboratory data, echocardiographic findings, and USG findings were retrospectively reviewed regarding the response to IVIG treatment and coronary artery complications in 67 children with KD. Acute acalculous cholecystitis (AAC) was diagnosed based on USG criteria.ResultsAmong all factors, only the prothrombin time international normalized ratio was significantly different between the IVIG-response and IVIG-resistance groups (p = 0.024). CAA was statistically more frequent in the AAC group (n = 24) than in the non-AAC group (n = 43) (23.3% vs. 58.3%, p = 0.019). Among the laboratory factors, segmented neutrophil percentage, total bilirubin level, and C-reactive protein were significant in children with CAA (p = 0.014, p = 0.009, and p = 0.010). Abnormal GB findings on USG were significantly more frequent in children with CAA than in those without CAA (p = 0.007; OR = 4.620; 95% confidence interval [CI]: 1.574–13.558). GB distension on USG was the only significant risk factor for CAA (p = 0.001; OR = 7.288; 95% CI: 2.243–23.681) by using multiple logistic regression analysis.ConclusionFor children in the acute phase of KD, USG findings of the GB, especially GB distension, may be an important risk factor for CAA as a complication.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children

Kim

Choi

et al. 2014

BMC Pediatr

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“…12 17 Aspirin is given, although dosing regimens vary. 17 18 Additional corticosteroids have been recommended in some countries for severe and evolving cases. 17 About 15% of patients do not respond to immunoglobulin, and subsequent treatment often comprises a second infusion of immunoglobulin and intravenous methylprednisolone.…”

Section: How Is Kawasaki Disease Managed?mentioning

confidence: 99%

“…17 About 15% of patients do not respond to immunoglobulin, and subsequent treatment often comprises a second infusion of immunoglobulin and intravenous methylprednisolone. [12][13][14][15][16][17][18][19] Most children in industrialised countries have few long term sequelae if treated promptly and appropriately. A small proportion of children with major coronary artery damage will require ongoing specialist management.…”

Section: How Is Kawasaki Disease Managed?mentioning

confidence: 99%

Kawasaki disease

Harnden¹,

Tulloh²,

Burgner³

2014

BMJ

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This is one of a series of occasional articles highlighting conditions that may be more common than many doctors realise or may be missed at first presentation. The series advisers are Anthony Harnden, professor of primary care, Department of Primary Care Health Sciences, University of Oxford, and Richard Lehman, general practitioner, Banbury. To suggest a topic for this series, please email us at practice@bmj.com.

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“…Die Exstirpation ist gleichzeitig auch die Therapie. [ 126 ] . Die schwersten Komplikationen werden durch Nebensymptome hervorgerufen, zum einen die kardiale Beteiligung mit Ausbildung von Aneurysmen und Thrombosen der Koronararterien [ 127 ] , zum anderen neurologische Symptome mit nicht-infektiösen Hirnhautentzündungen und zentralem Hörverlust.…”

Section: Castlemanunclassified

Erkrankungen der Halslymphknoten im Kindesalter

Lang

Kansy

2014

Laryngo-Rhino-Otol

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The lymph nodes are an essential part of the body's immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) - a critical aspect especially among children - and can represent an early clinical sign in their exposed position on a child's slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance - from banal infections to malignant diseases - demand a clear and considered approach to the child's individual clinical presentation. Such an approach is described in the following paper.

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An update onKawasaki diseaseII: Clinical features, diagnosis, treatment and outcomes

Abstract: This is the second of two updates on Kawasaki disease. The first review focused on epidemiology and aetio-pathogenesis. Here, we review the clinical features and diagnosis of Kawasaki disease, as well as recent evidence on treatment, follow-up and cardiovascular outcomes.

Cited by 53 publications

References 96 publications

Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children

Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children

Kawasaki disease

Erkrankungen der Halslymphknoten im Kindesalter

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