Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis

Pilania, Rakesh Kumar; Jindal, Ankur Kumar; Bhattarai, Dharmagat; Naganur, Sanjeev; Singh, Surjit

doi:10.3389/fped.2020.526969

Cited by 27 publications

(20 citation statements)

References 125 publications

(195 reference statements)

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“…Whittaker et al have shown that NT-pro-BNP levels were elevated in 83% patients, while troponins were increased in 68% patients [42]. 2D-echocardiography should be carried out for identification of myocarditis, pericarditis, valvular abnormalities and CAAs [48,56,57]. The electrocardiogram may show changes of myocardial strain.…”

Section: Laboratory Featuresmentioning

confidence: 99%

“…Cardiovascular complications are the most prominent manifestations in patients with MIS-C. Cardiac biomarkers including NT-pro-BNP and troponin levels are extremely high compared to historical KD cohorts and indicate heart failure and myocardial damage in MIS-C. Symptomatic myocarditis has been reported in 40-80% of patients with MIS-C [7,8,11,40]. In contrast, symptomatic myocarditis is seen in < 5% of patients with KD [46][47][48]. Pouletty et al reported that severe disease requiring intensive care due to myocarditis was seen in approximately 50% of patients with MIS-C and the risk was higher in older children [8].…”

Section: Cardiovascular Complicationsmentioning

confidence: 99%

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Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management

et al. 2020

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Multisystem inflammatory syndrome (MIS-C) is a pediatric hyperinflammation disorder caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It has now been reported from several countries the world over. Some of the clinical manifestations of MIS-C mimic Kawasaki disease (KD) shock syndrome. MIS-C develops 4-6 weeks following SARS-CoV-2 infection, and is presumably initiated by adaptive immune response. Though it has multisystem involvement, it is the cardiovascular manifestations that are most prominent. High titres of anti-SARS-CoV-2 antibodies are seen in these patients. As this is a new disease entity, its immunopathogenesis is not fully elucidated. Whether it has some overlap with KD is still unclear. Current treatment guidelines recommend use of intravenous immunoglobulin and high-dose corticosteroids as first-line treatment. Mortality rates of MIS-C are lower compared to adult forms of severe COVID-19 disease. Keywords Multisystem inflammatory syndrome (MIS-C) • Kawasaki disease (KD) • Hyperinflammation • Coronavirus disease 2019 • Kawasaki-like disease Background Kawasaki disease (KD) is a medium vessel vasculitis of undetermined etiology usually affecting children below 5 years [1-3]. Rowley et al. had hypothesized as far back as 2004 that an unidentified respiratory infectious agent with tropism to vascular tissue, likely a virus, could be linked to the etiology of KD [4]. This putative RNA virus, presumably a ubiquitous one, resulted in persistent infection in bronchial epithelium and macrophages and was associated with intracytoplasmic inclusions [5, 6]. Rheumatology INTERNATIONAL Jayakanthan Kabeerdoss and Rakesh Kumar Pilania are the joint first authors and they contributed equally. Disclaimer We hereby state that this manuscript is original and no part of the manuscript has either been published before, or is under consideration of publication elsewhere. The definition of scientific term alluded to, in the manuscript have been duly cited.

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Section: Laboratory Featuresmentioning

confidence: 99%

Section: Cardiovascular Complicationsmentioning

confidence: 99%

Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management

et al. 2020

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“…Symptomatic myocarditis was found in 40–80% of patients with MIS-C [ 13 , 14 ]. In contrast, symptomatic myocarditis is seen in < 5% of KD patients [ 15 – 17 ]. Pouletty et al documented the presence of severe myocarditis in approximately 50% of MIS-C patients with higher risk in older children [ 13 ].…”

Section: Research Strategymentioning

confidence: 99%

The importance of heart and brain imaging in children and adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C)

et al. 2021

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Multisystem Inflammatory Syndrome in Children (MIS-C) recently reported in a minority of children affected by SARS-CoV-2, mimics Kawasaki disease (KD), a medium vessel vasculitis of unknown cause. In contrast to acute COVID-19 infection, which is usually mild in children, 68% of patients with MIS-C will need intensive care unit. Myocarditis and coronary artery ectasia/aneurysm are included between the main cardiovascular complications in MIS-C. Therefore, close clinical assessment is need it both at diagnosis and during follow-up. Echocardiography is the cornerstone modality for myocardial function and coronary artery evaluation in the acute phase. Cardiovascular magnetic resonance (CMR) detects diffuse myocardial inflammation including oedema/fibrosis, myocardial perfusion and coronary arteries anatomy during the convalescence and in adolescents, where echocardiography may provide inadequate images. Brain involvement in MIS-C is less frequent compared to cardiovascular disease. However, it is not unusual and should be monitored by clinical evaluation and brain magnetic resonance (MRI), as we still do not know its effect in brain development. Brain MRI in MIS-C shows T2-hyperintense lesions associated with restricted diffusion and bilateral thalamic lesions. To conclude, MIS-C is a multisystem disease affecting many vital organs, such as heart and brain. Clinical awareness, application of innovative, high technology imaging modalities and advanced treatment protocols including supportive and anti-inflammatory medication will help physicians to prevent the dreadful complications of MIS-C.

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“…This disease with the effect on medium-sized arteries manifests as persistent fever, erythema of the lips and oral mucosa, bilateral non-purulent conjunctivitis, skin rashes, swelling and redness of the hands and feet, and cervical lymphadenopathy and usually follows with a short period of respiratory or gastrointestinal symptoms [ 1 , 4 , 5 ]. As cardiac complications are the most concerning ones, it is essential to adopt efficient methods to diagnose and treat this self-limited disease [ 9 ]. If no treatment is performed, the development of coronary artery aneurysms (CAAs) may observe in 15–25% of children with KD [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

A 10-year cross-sectional retrospective study on Kawasaki disease in Iranian children: incidence, clinical manifestations, complications, and treatment patterns

et al. 2021

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Background Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. Methods A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008–2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. Results Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. Conclusion As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.

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Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis

Cited by 27 publications

References 125 publications

Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management

Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management

The importance of heart and brain imaging in children and adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C)

A 10-year cross-sectional retrospective study on Kawasaki disease in Iranian children: incidence, clinical manifestations, complications, and treatment patterns

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