Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-25T08:17:56.407Z Has data issue: false hasContentIssue false

Controversies in the medical management of Kawasaki disease

Published online by Cambridge University Press:  19 August 2008

Elfriede Pahl*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh
William H. Neches
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh
José A. Ettedgui
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh
*
Dr. Elfriede Pahl, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA

Summary

Summary Mucocutaneous lymph node syndrome, now called Kawasaki disease, affects children of all ages and races. The cause of this systemic vasculitis is unknown, thus the diagnosis is based solely on clinical criteria. Coronary arteritis and the formation of coronary arterial aneurysms are the most serious early cardiac complications, while long term sequels, such as coronary stenosis and myocardial infarction, may occur. Current medical therapy is aimed solely at preventing or decreasing the occurrence of these cardiovascular complications in patients with this disease. Past treatment included antibiotics, steroids, and nonsteroidal anti-inflammatory agents. Aspirin remains the most widely used drug, although the use of intravenous gammaglobulin has also become common. When used in combination, these two agents may reduce the incidence of coronary arterial aneurysms. The optimal dosage and duration of treatment has not yet been determined.

Type
The World Forum for Pediatric Cardiology Symposium on Kawasaki Disease
Copyright
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kawasaki, T, Kusaki, F. Febrile occulo-oro-curaneo acrodesquamatous syndrome with or without acute nonsup purative cervical lymphadenitis in infancy and children. Clinical Observations of 50 Cases. Jpn J Allergy 1967; 16: 178222.Google ScholarPubMed
2.Mcllray, MA, Fisher, EJ, Saravolatz, LD, Hardwicke, MWilson, FM. Aseptic meningitis complicating adult Kawasaki disease: case report and review of the literature. Am J Med 1989; 87: 106110.CrossRefGoogle Scholar
3.Neches, WH. Kawasaki Disease. In: Moller, JH and Neal, WA eds. Fetal, Neonatal and Infant Heart Disease. Appleton and Lange, Norwalk, Connecticut, 1990, pp 887896.Google Scholar
4.Pahl, E, Ettedgui, JA, Neches, WH, Park, SC. The value of angiography in the follow-up of coronary involvement in mucocutaneous lymph node syndrome (Kawasaki disease). J Am Coil Cardiol 1989; 14: 13181325.CrossRefGoogle ScholarPubMed
5.Newburger, JW, Burns, JC. Kawasaki syndrome. Cardiol Clin 1989; 2: 453465.CrossRefGoogle Scholar
6.Fujiwara, H, Hamashina, Y. Pathology ofthe heart in Kawasaki disease. Pediatrics 1978; 61: 100107.Google Scholar
7.Kato, H, Ichinose, E, Yoshioka, F, Takechi, T, Matsunaga, S, Suzuki, K, Rikitake, N. Fate ofcoronaryaneurysms in Kawasaki disease: Serial coronary angiography and long term follow-up study. Am J Cardiol 1982; 49: 17581766.Google ScholarPubMed
8.Takahashi, M, Mason, W, Lewis, AB. Regression of coronary aneurysms in patient with Kawasaki syndrome. Circulation 1987; 75: 387394.CrossRefGoogle ScholarPubMed
9.Kato, H, Ichinose, E, Kawasaki, T. Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases. J Pediatr 1986; 108: 923927.CrossRefGoogle ScholarPubMed
10.Yanagisawa, M, Kobayashi, N, Matsya, S. Myocardial infarction due to coronary thromboarteritis following acute febrile mu cocutaneous lymph node syndrome in an infant. Pediatrics 1974; 54: 277283.CrossRefGoogle Scholar
11.Nakano, H, Nojima, K, Saito, A, Ueda, K. High incidence of aortic regurgitation following Kawasaki disease. J Pediatr 1985; 107: 5963.CrossRefGoogle ScholarPubMed
12.Gidding, SS, Shulman, ST, Ilbawi, M, Crussi, F, Duffy, CE. Mucocutaneous lymph node syndrome (Kawasaki disease): Delayed aortic and mitral insufficiency secondary to active valvulitis. J Am Coil Cardiol 1986; 7: 894897.CrossRefGoogle ScholarPubMed
13.Yutani, C, Go, S, Kamiya, T, Hirose, o, Misawa, H, Maeda, H, Kozuka, T, Onishi, S. Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 1981; 105: 470473.Google ScholarPubMed
14.Fujiwara, T, Fujiwara, H, Nakano, H. Pathological features of coronary arteries in children with Kawasaki disease in which coronary arterial aneurysm was absent at autopsy. Circulation 1988; 78: 345350.CrossRefGoogle ScholarPubMed
15.Asai, T. Evaluation method for degree ofseriousness in Kawasaki disease. Act Pediatr Jpn 1983; 25: 170175. [Overseas ed].CrossRefGoogle Scholar
16.Nakano, H, Ueda, K, Saito, A, Tsuchitani, Y, Kawamori, J, Miyabe, T, Yoshida, . Scoring method for identifying patients with Kawasaki disease at high risk of coronary artery aneu rysms. Am J Cardiol 1986; 58: 749753.CrossRefGoogle Scholar
17.Burns, JC, Glode, MP, Clarke, SH, Wiggins, JHathaway, WE. Coagulopathy and platelet activation in Kawasaki syndrome; identification of patients at high risk for development of coronary artery aneurysms. J Pediatr 1984; 105: 206211.CrossRefGoogle ScholarPubMed
18.Benson, LN, Rowe, RD. Predictors ofcoronary risk in Kawasaki disease. Prog Clin Biol Res 1987; 250: 299304.Google Scholar
19.Kato, H, Koike, S, Tokoyama, TK. Kawasaki disease: effective treatment of coronary artery involvement. Pediatrics 1979; 63: 174179.CrossRefGoogle ScholarPubMed
20.Cremer, H. Presented at the Third International Kawasaki Disease Symposium,Tokyo, Japan,November, 1988.Google Scholar
21.Ichida, F, Fatica, NS, Engle, MA, O'Loughlin, JE, Klein, AA, Snyder, MS, Ehlers, KH, Leven, AR. Coronary artery involvement in Kawasaki syndrome in Manhattan, New York: Risk factors and role of aspirin. Pediatrics 1987; 6: 828835.Google Scholar
22.Kusakawa, S, Tatra, K. Efficacies and risks of aspirin in the treatment of the Kawasaki disease. Prog Clin Biol Res 1987; 250: 401413.Google ScholarPubMed
23.Yanagawa, H, Kawasaki, T, Shigenatsy, I. Nationwide survey on Kawasaki disease in Japan. Pediatrics 1987; 75: 5862.CrossRefGoogle Scholar
24.Takahashi, M, Kato, H. Can consensus be reached in cardiac management of Kawasaki syndrome? Review of a survey among Japanese and U.S. pediatric cardiologists. Prog Clin Biol Res 1987; 250: 493508.Google ScholarPubMed
25.Koren, G, MacLeod, SM. Difficulty in achieving therapeutic serum concentrations of salicylate in Kawasaki disease. J Pediatr 1984; 105: 991995.CrossRefGoogle ScholarPubMed
26.Furosho, K, Kamiya, T, Nakano, H, Kiyosawa, N, Shinomiya, K, Hayashidera, T, Tamura, T, Hirose, O, Manabe, Y, Yokoyama, T, Kawarano, M. High-dose intravenous gamma globulin for Kawasaki disease. Lancet 1984; 2: 10551058.CrossRefGoogle Scholar
27.Newburger, JW, Takahashi, M, Burns, JC, Beiser, AS, Chung, KJ, Duffy, CE, Glode, MP, Mason, WH, Reddy, V, Sanders, SP, Shulman, ST, Wiggins, JW, Hicks, RV, Fulton, DR, Lewis, AB, Leung, DYM, Colton, T, Rosen, FS, Melish, ME. The treatment of Kawasaki syndrome with intravenous gamma globulin. New EngJ Med 1986; 315: 341347.CrossRefGoogle ScholarPubMed
28.Nagashima, M, Matsushima, M, Matsuoka, H, Ogawa, A. The treatment of Kawasaki syndrome with intravenous gamma globulin. New Eng J Med 1986; 315: 341347.Google Scholar
28.Nagashima, M, Matsushima, M, Matsuoka, H, Okumura, N. High-dose gamma globulin therapy for Kawasaki disease. J Pediatr 1987; 110: 710712.Google Scholar
29.Rowley, AH, Duffy, CE, Shulman, ST. Prevention of giant coronary artery aneurysms in Kawasaki disease by intravenous gamma globulin therapy. J Pediatr 1988; 113: 290294.CrossRefGoogle ScholarPubMed
30.Shulman, S (ed). Management of Kawasaki syndrome: a consensus statement prepared by North American participants of the Third International Kawasaki Disease Symposium,Tokyo, Japan,December, 1988. Pediatr Infect Dis J 1989; 10: 663665.Google Scholar
31.Barron, KS, Murphy, DJ, Silverman, ED, Rurtenbeerg, HD, Wright, GB, Franklin, W, Goldberty, SJ, Higashino, SM, Cox, DG, Lee, M. Treatment of Kawasaki syndrome: A comparison oftwo dosage regimens ofintravenously administered immune globulin. J Pediatr 1990; 117: 638644.CrossRefGoogle Scholar
32.Kawasaki, T. Presented at the American Heart Association 62nd Annual Scientific Sessions,New Orleans, Louisiana,November, 1989.Google Scholar
33.Arjunan, K, Daniels, SR, Meyer, RA, Schwartz, DC, Barron, H, Kaplan, S. Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: An echocardiographic and angiographic study. J Am Coil Cardiol 1986; 8: 11191124.CrossRefGoogle ScholarPubMed
34.Fitzgerald, GA. Dipyridamole. N Eng J Med 1987; 316:12471257.Google ScholarPubMed
35.Terai, M, Ogata, M, Sugomoto, K, Nagai, Y, Toba, T, Tamai, K, Nakajima, H. Coronary arterial thrombi in Kawasaki disease. J of Ped 1985; 1:7678.CrossRefGoogle Scholar
36.Burtt, DM, Pollack, P, Bianco, JA. Intravenous streptokinase in an infant with Kawasaki disease complicated by acute myo cardial infarction. Pediatr Cardiol 1986; 6: 307311.Google Scholar
37.Kato, H, Ichinose, E, Inoue, O. Intracoronary thrombolytic therapy in Kawasaki disease: Treatment and prevention of acute myocardial infarction. Prog Clin Biol Res 1987; 250:445454.Google ScholarPubMed