Kawasaki disease shock syndrome: clinical characteristics and possible use of IL-6, IL-10 and IFN-γ as biomarkers for early recognition

Li, Yandie; Zheng, Qi; Zou, Lixia; Wu, Jianqiang; Guo, Li; Teng, Liping; Zheng, Rongjun; Jung, Lawrence; Lu, Meiping

doi:10.1186/s12969-018-0303-4

Cited by 121 publications

(165 citation statements)

References 61 publications

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“…Indeed, KDSS was previously found associated with high levels of IL-6, CRP and PCT. 9 In our series, we observed very high levels of PCT, 8-fold higher than those recently reported in 27 KDSS patients. 9 CRP and IL-6 levels were also high.…”

Section: Kdss Pathophysiology Remains Unclear a High Level Ofcontrasting

confidence: 45%

Outbreak of Kawasaki disease in children during COVID-19 pandemic: a prospective observational study in Paris, France

Toubiana

Poirault

Corsia

et al. 2020

Preprint

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Background: Acute clinical manifestations of SARS-CoV-2 infection are less frequent and less severe in children than in adults. However, recent observations raised concerns about potential post-viral severe inflammatory reactions in children infected with SARS-CoV-2. Methods: We describe an outbreak of cases of Kawasaki disease (KD) admitted between April 27 and May 7, 2020, in the general paediatrics department of a university hospital in Paris, France. All children prospectively underwent nasopharyngeal swabs for SARS-CoV-2 RT-PCR, SARS-CoV-2 IgG serology testing, and echocardiography. The number of admissions for KD during the study period was compared to that observed since January 1, 2018, based on discharge codes, using Poisson regression. Results: A total of 17 children were admitted for KD over an 11-day period, in contrast with a mean of 1.0 case per 2-week period over 2018-2019 (Poisson incidence rate ratio: 13.2 [95% confidence interval: 7.3-24.1], p <0.001). Their median age was 7.5 (range, 3.7-16.6) years, and 59% of patients originated from sub-Saharan Africa or Caribbean islands. Eleven patients presented with KD shock syndrome (KDSS) requiring intensive care support, and 12 had myocarditis. All children had marked gastrointestinal symptoms at the early stage of illness and high levels of inflammatory markers. Fourteen patients (82%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR 7/17, positive IgG antibody detection 14/16). All patients received immunoglobulins and some received corticosteroids (5/17). The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 cases (29%) during hospitalisation. Conclusions: The ongoing outbreak of KD in the Paris might be related to SARS-CoV2, and shows an unusually high proportion of children with gastrointestinal involvement, KDSS and African ancestry.

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Section: Kdss Pathophysiology Remains Unclear a High Level Ofcontrasting

confidence: 45%

Outbreak of Kawasaki disease in children during COVID-19 pandemic: a prospective observational study in Paris, France

Toubiana

Poirault

Corsia

et al. 2020

Preprint

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“…Moreover, IL-6, IL-10, and IFN-γ were considered to facilitate the early recognition of KD shock syndrome (KSS) in patients with KD. KSS is a severe manifestation of KD, with systolic hypotension or clinical signs of poor perfusion (43). In addition, IL-1, IL-6, and IL-18 cytokines were recognized to play an important role in innate immunity with regard to the pathogenesis of SoJIA (13,44).…”

Section: Discussionmentioning

confidence: 99%

Severe Recurrent Fever Episodes With Clinical Diagnosis of Hemophagocytic Lymphohistiocytosis, Incomplete Kawasaki Disease and Systemic-Onset Juvenile Idiopathic Arthritis: A Case Report and Literature Review

Jiang

Yang

2020

Front. Pediatr.

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The pathogeneses of recurrent fever are quite complicated when excluding repeated infections. Recurrent fever is a common symptom for autoinflammatory diseases, relapse of Systemic-onset juvenile idiopathic arthritis (SoJIA) and recurrent Kawasaki disease (KD). There are no specific diagnostic laboratory tests for the diseases. Some studies showed that KD was the precursor of hemophagocytic lymphohistiocytosis (HLH). Macrophage activation syndrome (MAS) is another form of HLH in SoJIA. Cytokine disturbances are considered to be involved in the pathogenesis of the diseases. We describe a Chinese female toddler that developed three separate fever episodes with eventual diagnose of SoJIA within about 10 months. The first episode was diagnosed as IKD, immunoglobulin nonresponsive KD, and HLH. The second and third episodes were diagnosed as IKD and SoJIA, respectively. The fever was hard to be relieved by antipyretics, and the peak axillary temperature was above 40 • C. For every fever episode, infections were excluded. For the first episode, trends over time of hemoglobin, platelets, fibrinogen, and triglycerides indicated HLH, which was finally diagnosed and treated according to the HLH-2004 protocol. For the second episode 6 months later, after excluding an HLH relapse and infections, IKD was finally diagnosed. Oral aspirin was administered, and the HLH treatment was ceased. The third episode occurred 3 months later, and SoJIA was finally diagnosed. For each episode, except for relative tests, we only tested for cytokines interleukin-1β, interleukin-6, and interferon-γ, due to limited laboratory test availability. These cytokines were elevated during remission and rose much higher in the fever phases. The case showed the difficulty to differentiating the recurrent fever in clinical practice. Surveillance of routine laboratory parameters over time might reveal a trend that indicates possible disease, even when parameter values Jiang and Yang Severe Recurrent Fever Episodes do not meet diagnostic criteria. Changes in cytokine profiles are promising markers for differentiating recurrent fever diseases in future. An unknown immunological defect for the case may contribute to the recurrent immunological insults, and we are following up the recurrence of fever episode.

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“…This may lead to the assumption that the possible cause of PIMS might be the aberrant delayed immune response triggered by COVID-19 infection ( Cheung et al, 2020 ; Whittaker et al, 2020 ). Also, that IL-6, IL-10 and interferon-gamma that are elevated in KD as well as in COVID-19, where these are shown to exert an inflammatory-mediated lung injury ( Li et al, 2019 ; Cheung et al, 2020 ).…”

Section: Pediatric Inflammatory Multisystem Syndrome In Childrenmentioning

confidence: 99%

Pathophysiology of Cardiovascular Complications in COVID-19

Petrović

Radenković

et al. 2020

Front. Physiol.

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Numerous recent studies have shown that patients with underlying cardiovascular disease (CVD) are at increased risk of more severe clinical course as well as mortality of COVID-19. Also, the available data suggests that COVID-19 is related to numerous de novo cardiovascular complications especially in the older population and those with pre-existing chronic cardiometabolic conditions. SARS-CoV-2 virus can cause acute cardiovascular injury, as well as increase the risk of chronic cardiovascular damage. As CVD seem to be the major comorbidity in critically unwell patients with COVID-19 and patients often die of cardiovascular complications, we review the literature and discuss the possible pathophysiology and molecular pathways driving these disease processes: cytokine release syndrome, RAAS system dysregulation, plaque destabilization and coagulation disorders with the aim to identify novel treatment targets. In addition, we review the pediatric population, the major cause of the cardiovascular complications is pediatric inflammatory multisystem syndrome that is believed to be associated with COVID-19 infection. Due to the increasingly recognized CVD damage in COVID-19, there is a need to establish clear clinical and follow-up protocols and to identify and treat possible comorbidities that may be risk factors for the development of cardiovascular complications.

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Kawasaki disease shock syndrome: clinical characteristics and possible use of IL-6, IL-10 and IFN-γ as biomarkers for early recognition

Cited by 121 publications

References 61 publications

Outbreak of Kawasaki disease in children during COVID-19 pandemic: a prospective observational study in Paris, France

Outbreak of Kawasaki disease in children during COVID-19 pandemic: a prospective observational study in Paris, France

Severe Recurrent Fever Episodes With Clinical Diagnosis of Hemophagocytic Lymphohistiocytosis, Incomplete Kawasaki Disease and Systemic-Onset Juvenile Idiopathic Arthritis: A Case Report and Literature Review

Pathophysiology of Cardiovascular Complications in COVID-19

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