Late Intravenous Immunoglobulin Treatment in Patients With Kawasaki Disease

Matsubara, Hiromi; Ito, Masahiro; Yashiro, Mayumi; Uehara, Ritei; Nakamura, Yosikazu

doi:10.1542/peds.2011-1704

Cited by 58 publications

(48 citation statements)

References 32 publications

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“…Various risk factors for cardiac sequelae of KD have been reported: male gender, 23 – 26 infants, 23 , 27 – 29 older children, 23 , 29 , 30 recurrent cases, 31 late IVIG treatment, 32 and refractoriness to initial IVIG treatment. 28 , 31 , 33 – 36 In the studies that reported that patient age was a risk factor for coronary artery damage in KD, the authors discussed the late start of initial IVIG treatment resulting from a late diagnosis and/or incomplete presentation, as part of their interpretation of the contribution of patient age.…”

Section: Introductionmentioning

confidence: 99%

Epidemiologic Features and Prognostic Factors of Coronary Artery Lesions Associated With Kawasaki Disease Based on a 13-Year Cohort of Consecutive Cases Identified by Complete Enumeration Surveys in Wakayama, Japan

Kitano

Suzuki

Takeuchi

et al. 2014

Journal of Epidemiology

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BackgroundTo clarify the contribution of patient age to the development of coronary artery lesions (CALs) associated with Kawasaki disease (KD), epidemiologic features and prognostic factors were investigated using hospital-based complete enumeration surveys in a specific area.MethodsConsecutive KD cases identified between October 1999 and September 2012 in Wakayama Prefecture, Japan, were analyzed. The primary outcome measure was the presence/absence of CALs (giant aneurysm, mid- or small-sized aneurysm, and dilatation) on echocardiography 1 month after disease onset. Demographics and medical treatment factors were compared between the patients with and without CALs. Odds ratios (ORs) and 95% confidence intervals (CIs) of explanatory variables (age, gender, and factors related to high-dose intravenous immunoglobulin treatment) for the development of CALs were determined.ResultsThe median age of the 1415 patients (796 males, 619 females) was 25 months after excluding 2 children of foreign residents; 2.2% of the patients had a past history of KD, and 1.8% showed incomplete presentation. CALs were observed in 3.3% (4.0% of males, 2.3% of females; P = 0.080). The ORs of CALs among patients <11 months old (3.0, 95% CI 1.4–6.6) and those >48 months old (3.1, 95% CI 1.5–6.6) were significantly higher than values in 11- to 48-month-olds.ConclusionsThe effect of patient age on the development of CALs was found to be U-shaped, with the bottom at ages 11 to 48 months. This finding was based on a 13-year cohort of consecutive KD cases in a specific area with little selection bias and is consistent with previously reported results.

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Section: Introductionmentioning

confidence: 99%

Epidemiologic Features and Prognostic Factors of Coronary Artery Lesions Associated With Kawasaki Disease Based on a 13-Year Cohort of Consecutive Cases Identified by Complete Enumeration Surveys in Wakayama, Japan

Kitano

Suzuki

Takeuchi

et al. 2014

Journal of Epidemiology

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“…However, overall outcomes remained worse, with 27% of patients having coronary artery lesions in the convalescent phase as compared to 1% in the early IVIg group. 32 Among patients who did not have coronary artery lesions before IVIg therapy, the rate of developing lesions in the acute phase was similar regardless of timing of IVIg; however, in the convalescent phase, late IVIg patients still fared worse (5% vs. 1% with coronary artery lesions). 32 In contrast, using the same database, retrospective comparison of KD patients treated before the 5th day of illness to patients treated conventionally between days 5 and 9 demonstrated that early treatment was more likely to result in need for additional IVIg therapy (16% vs. 9%).…”

Section: Timing Of Therapymentioning

confidence: 93%

“…A case-control study using a Japanese national database compared 75 patients treated with IVIg between days 11 and 20 of illness, with pair-matched controls treated between days 4 and 8. 32 Approximately half of the late IVIg group had coronary artery lesions at the time of therapy, and, of these, half normalized in the convalescent phase (> 1 month after onset). However, overall outcomes remained worse, with 27% of patients having coronary artery lesions in the convalescent phase as compared to 1% in the early IVIg group.…”

Section: Timing Of Therapymentioning

confidence: 97%

Role of intravenous immunoglobulin in the treatment of Kawasaki disease

Newburger

2017

Int J of Rheum Dis

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Intravenous immunoglobulin (IVIg) is a purified plasma product that is used for many immune-deficient conditions and autoimmune conditions. Use of IVIg for treatment for Kawasaki disease (KD) is critical for control of inflammation. The American Heart Association (AHA) recommends a single infusion of 2 g/kg preferably given during the first 10 days of illness. In this review, we have discussed the possible mechanisms of action of IVIg in KD and its clinical usage in this condition.

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“…2 IVIG more than 10 days after the onset of fever may be less effective. 3 Atypical clinical features of Kawasaki disease can easily be overlooked or misinterpreted. Here we describe the unusual presentation of Kawaski disease with acute and profound sensorineural hearing loss.…”

Section: Introductionmentioning

confidence: 99%

Kawasaki disease: always straight to the heart?

2012

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Kawasaki disease is an important differential diagnosis when evaluating prolonged fever in childhood. Although the aetiology of this vasculitic disease process remains obscure, prompt recognition and treatment significantly reduces vascular complications such as coronary artery aneurysms. Patients presenting with atypical or incomplete diagnostic features remain a challenge. Here the authors describe the atypical features of Kawasaki disease that led to profound acute hearing loss in a 6-year-old boy with complex congenital heart disease. Coronary changes were not seen on early follow-up, but the patient required bilateral hearing aids. Considering Kawasaki disease early, even in the possibly confusing context of complex congenital heart disease and atypical symptomatology, is crucial to avoid long-term sequelae.

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Late Intravenous Immunoglobulin Treatment in Patients With Kawasaki Disease

Abstract: IVIG treatment ≥10 days after illness onset achieves resolution of inflammation but was found to be insufficient for preventing CALs.

Cited by 58 publications

References 32 publications

Epidemiologic Features and Prognostic Factors of Coronary Artery Lesions Associated With Kawasaki Disease Based on a 13-Year Cohort of Consecutive Cases Identified by Complete Enumeration Surveys in Wakayama, Japan

Epidemiologic Features and Prognostic Factors of Coronary Artery Lesions Associated With Kawasaki Disease Based on a 13-Year Cohort of Consecutive Cases Identified by Complete Enumeration Surveys in Wakayama, Japan

Role of intravenous immunoglobulin in the treatment of Kawasaki disease

Kawasaki disease: always straight to the heart?

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