Prospective study of Kawasaki disease complications: review of 115 cases

Alves, Natália Ribeiro de Magalhães; Magalhães, Cristina Medeiros Ribeiro de; Almeida, Roseane de Fátima R.; Santos, Rosa Maria Nascimento dos; Gandolfi, Lenora; Pratesi, Riccardo

doi:10.1016/s0104-4230(11)70062-8

Cited by 75 publications

(71 citation statements)

References 37 publications

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“…99 Profound sensorineural hearing loss is a rare but serious complication. 100,101 Common gastrointestinal findings include hepatitis, diarrhea, vomiting, abdominal pain, and gallbladder hydrops; pancreatitis and jaundice are less common. Genitourinary findings include urethritis, which is common, and hydrocele and phimosis, which are less common.…”

Section: Other Clinical and Laboratory Findingsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,749

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Other Clinical and Laboratory Findingsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,749

4,124

View full text Add to dashboard Cite

show abstract

“…The current standard of therapy during the acute phase of Kawasaki disease is 2 g/kg/dose IVIG therapy. A recent study regarding the patients who received this therapy showed that the prevalence of ophthalmologic complications including uveitis, papilledema, and conjunctival hemorrhage was 13.2 %, and that these complications were not present in the second ophthalmologic assessment 30 days later [15]. This study also suggested that full dose IVIG infusion of 2 g/kg body weight/dose was effective in older children for the treatment of ophthalmologic complications in the acute phase of Kawasaki disease.…”

Section: Ivig Therapymentioning

confidence: 74%

Blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease: a mini-review

Nakad¹

2016

IOSRPHR

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: Ocular involvement in the acute phase of Kawasaki disease typically involves the anterior segment of the eye, and its associated treatment outcomes are generally excellent. However, there are rare reports of posterior segment involvement, and these are associated with poorer outcomes. This study reviewed six patients with recently reported blindness and/or ocular posterior segment involvement in the acute phase of Kawasaki disease. The median age of these patients was 8.5 years old (range: 6-12 years old). The ocular symptoms were photophobia, reduction of vision, blindness, and ocular pain. Five patients exhibited optic disc involvement and three patients showed retinal vessel involvement. All patients received intravenous immunoglobulin therapy and two patients received systemic corticosteroid administration. The visual acuity outcomes of treatment were excellent in five of the patients. However, in one patient there was still no light perception in the affected eye at two months after the initial onset of the disease. This was associated with the possible obstruction of the ophthalmic artery due to vasculitis. Older children may have a higher associated risk of blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease.

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“…In addition to the diagnostic criteria, a broad range of nonspecific clinical features can also manifest including irritability, uveitis, aseptic meningitis, cough, vomiting, diarrhea, abdominal pain, gallbladder hydrops, urethritis, arthralgia, arthritis, hypoalbuminemia, liver function impairment, anemia, and heart failure [2]. Anemia is not an infrequent finding in patients with KD and is associated with a more prolonged duration of active inflammation [3][4][5][6]. Severe hemolytic anemia requiring transfusions is rare and may be related to intravenous immunoglobulin (IVIG) infusion [4,5,7].…”

mentioning

confidence: 99%

Inflammation-Induced Hepcidin is Associated with the Development of Anemia and Coronary Artery Lesions in Kawasaki Disease

Kuo

Yang

Chuang³

et al. 2012

J Clin Immunol

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Prospective study of Kawasaki disease complications: review of 115 cases

Cited by 75 publications

References 37 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease: a mini-review

Inflammation-Induced Hepcidin is Associated with the Development of Anemia and Coronary Artery Lesions in Kawasaki Disease

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