Evaluation of the Efficacy of Treatment of Kawasaki Disease before Day 5 of Illness

Abstract

We evaluated the efficacy of treating Kawasaki disease earlier than Day 5 of illness with a standard dose of immunoglobulin and aspirin. We performed a case-control study of patients with Kawasaki disease admitted to Princess Margaret Hospital from 1994 to 1999. Patients with pretreatment coronary aneurysm or those treated after day 10 of illness were excluded. All patients received immunoglobulin (2 g/kg) and aspirin (80-100 mg/kg/day) until fever subsided for 48 hours. Immunoglobulin retreatment was given for persistent fever 48 hours after the first dose of immunoglobulin or recrudescent fever. The case group consisted of 15 patients who received treatment earlier than day 5 of illness, and the control group consisted of 66 patients who were treated on or after day 5. Patients' sex, age, duration of posttreatment fever, need for additional immunoglobulin, and coronary artery status were noted. Treatment efficacy was assessed by the duration of posttreatment fever and the prevalence of coronary artery aneurysms. Eighty-one patients were included in this study. There were 15 patients in the case group and 66 in the control group. No significant difference was noted in age and sex between the case and control groups. Thirty-three percent (5/15) and 8% (5/66) of the case and control groups, respectively, had persistent/ recrudescent fever 48 hours after the first dose of immunoglobulin that required retreatment ( p = 0.017). Thirteen percent (2/15) and 5% (3/66) of the case and control groups, respectively, had coronary aneurysms ( p = 0.158). Treatment of Kawasaki disease before day 5 of illness was associated with persistent/recrudescent fever that required retreatment. However, there was no significant increase in the prevalence of coronary aneurysm if retreatment was given.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

“…Treatment of Kawasaki disease before day 5 of illness appears no more likely to prevent cardiac sequelae than does treatment on days 5 to 7, but it may be associated with an increased need for IVIG retreatment. 150,151 IVIG also should be administered to children presenting after the 10th day of illness (ie, children in whom the diagnosis was missed earlier) if they have either persistent fever without other explanation 152 or aneurysms and ongoing systemic inflammation, as manifested by elevated ESR or CRP (evidence level C).…”

Role of intravenous immunoglobulin in the treatment of Kawasaki disease

“…Cardiac outcomes were not different. 33 Studies in other population groups have found similar results, 34,35 although one study did find lower rates of coronary ectasia at 1 year in patients treated early. 36 Many experts believe that children who present with complete features before the 5th day of illness have more severe disease.…”

Cardiovascular Lesions of Kawasaki Disease: From Genetic Study to Clinical Management

“…However, it may be associated with an increased need for repeat IVIG treatment. (64,65) In the presence of 4 of 5 classic criteria for KD, US and Japanese experts agree that only 4 days of fever are necessary before initiating treatment with IVIG. (15,66) The efficacy of treating patients using IVIG after 10 days of illness is unknown; therefore, early diagnosis and treatment is desired.…”