Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Relationship between Kawasaki disease and abdominal pain

This editorial presents an analysis of an article recently published in the World Journal of Clinical Cases.Kawasaki disease(KD)is a well-known pediatric vasculitis characterized by fever,rash,conjunctivitis,oral mucosal changes,and swelling of the extremities.This editorial aims to delve into the intricate relationship between KD and abdominal pain,drawing insights from recent research findings to provide a comprehensive understanding and potential avenues for future investigation.

Application of artificial intelligence in the diagnosis and treatment of Kawasaki disease

This editorial provides commentary on an article titled"Potential and limitationsof ChatGPT and generative artificial intelligence(AI)in medical safety education"recently published in the World Journal of Clinical Cases.AI has enormous potentialfor various applications in the field of Kawasaki disease(KD).One is machinelearning(ML)to assist in the diagnosis of KD,and clinical prediction models havebeen constructed worldwide using ML;the second is using a gene signalcalculation toolbox to identify KD,which can be used to monitor key clinicalfeatures and laboratory parameters of disease severity;and the third is using deeplearning(DL)to assist in cardiac ultrasound detection.The performance of the DLalgorithm is similar to that of experienced cardiac experts in detecting coronaryartery lesions to promoting the diagnosis of KD.To effectively utilize AI in thediagnosis and treatment process of KD,it is crucial to improve the accuracy of AIdecision-making using more medical data,while addressing issues related topatient personal information protection and AI decision-making responsibility.AIprogress is expected to provide patients with accurate and effective medicalservices that will positively impact the diagnosis and treatment of KD in thefuture.

Rethinking Kawasaki disease diagnosis:Continuing the search for new biomarkers

Recent findings by Yamashita et al report a Kawasaki disease(KD)case with normal biomarker levels,challenging traditional diagnostic paradigms.This editorial explores the implications of such atypical KD presentations,emphasizing the need for novel biomarkers and revised diagnostic guidelines.The case underscores the limitations of current biomarkers,the importance of clinical judgment,and the necessity for comprehensive research to identify new diagnostic tools.Emerging technologies in proteomics and genomics offer potential avenues for discovering reliable biomarkers.Revisiting clinical guidelines to incorporate flexibility for atypical presentations is crucial.Ensuring timely and accurate KD diagnosis,even without elevated traditional biomarkers,prevents severe complications.Future advancements should focus on novel biomarkers to improve patient outcomes.

Application of Echocardiography Combined with Blood SAA, IL-6, PCT, and CRP Detection in the Diagnosis and Treatment of Kawasaki Disease in Children

Objective: To understand the application of echocardiography combined with blood SAA, IL-6, PCT, and CRP detection in the diagnosis and treatment of Kawasaki disease in children. Methods: 56 children with Kawasaki disease were selected as the study subjects as the treatment group, and 54 children with other diseases during the same period were selected as the control group. Echocardiography, blood SAA, IL-6, PCT and CRP were detected before and after treatment to observe the results of the two groups. A database was established to compare the changes of various indicators between the two groups, as well as the application value of each indicator in the clinical diagnosis and treatment of Kawasaki disease, and the pros and cons of the application of each indicator in the diagnosis and treatment of children with Kawasaki disease were analyzed, so as to provide a clearer early warning mechanism for the clinical diagnosis and treatment of children with Kawasaki disease. Results: There was no significant difference in the results of related imaging indexes in the control group before and after treatment (P > 0.05). There was no significant difference in the results of relevant imaging indicators in the treatment group before and after treatment (P > 0.05), except for LMCA (P < 0.05). The comparison of imaging related indicators before and after treatment between the two groups showed that except for no statistically significant difference in LMCA and RMCA before treatment (P > 0.05), all other indicators had statistical significance (P < 0.05). The results of relevant laboratory indexes in control group before and after treatment were statistically significant (P < 0.05). The results of relevant laboratory indexes before and after treatment in the treatment group were statistically significant (P < 0.05). The results of relevant laboratory indicators were compared between the two groups, except for the results of SAA, IL-6 and PCT before treatment, which were not statistically significant (P > 0.05), the differences in all other indicators were statistically significant (P Conclusion: The combination of echocardiography with blood SAA, IL-6, PCT, and CRP detection can establish the optimal evaluation plan for accurate and effective diagnosis, treatment, and prognosis of Kawasaki disease in children, providing more accurate and reliable diagnostic and treatment methods and laboratory data for clinical practice, and thus providing strong protection for children’s health.

Employing a random forest model to forecast the likelihood of coronary artery lesions in Kawasaki disease: a study centered on four biomarkers

Background:Kawasaki disease is an acute immune vasculitis,which is more common in children under 5 years old.Kawasaki disease mainly affects the cardiovascular system,especially the coronary arteries.Once coronary artery damage occurs,it can significantly impact the patient’s prognosis.Therefore,in some countries and regions,Kawasaki disease has become a common acquired heart disease.Methods:First,univariate analysis was conducted on each predictive factor.Then,Least Absolute Shrinkage and Selection Operator and random forest algorithms were used to screen all predictive factors,and the prediction model was evaluated using receiver operating characteristic curve,calibration curve,and Decision Curve Analysis.Results:This study,based on data from 228 Kawasaki disease patients,utilized a random forest model to identify four predictive factors:white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count.These factors were used to construct a prediction model,which achieved an area under the curve of 0.743.Conclusions:We developed a forest plot based on white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count to effectively predict the occurrence of coronary artery lesions in Kawasaki disease.

Hospital Discharge Plan in Family Caregivers of Children with Coronary Artery Aneurysm in Kawasaki Disease: A Review

Objective:The study reviews status,main time nodes and hospital discharge services for family caregivers of children with Kawasaki disease complicated by coronary artery aneurysm to provide references for the development of hospital discharge preparation services for medical personnel and patients.Background:CAL of Kawasaki disease is the main cause of acquired heart disease in children,but there is not enough research on the readiness for hospital discharge.Design:Systematic review of observational and interventional studies.

A Meta-analysis of the Biomarkers Associated with Coronary Artery Lesions Secondary to Kawasaki Disease in Chinese Children

The biomarkers associated with coronary artery lesions （CAL） secondary to Kawasaki disease （KD） in Chinese children were investigated by using Meta-analysis. We searched documents published from January 1997 to December 2009 from medical electronic databases. According to inclusion and exclusion criteria, eligible full-text papers were identified. We conducted a comprehensive quantitative analysis by using Stata10.0 statistical software package to assess the heterogeneity among the documents, calculated the summary effect and analyze publication bias and sensitivity. A total of 92 documents and 16 biomarkers were identified. All documents were case-control studies, and included 2398 patients in CAL group and 5932 patients in non-CAL （NCAL） group. The Meta-analysis showed that the levels of platelet count, platelet hematocrit （PCT）, neutrophils count, platelet distribution width （PDW）, mean platelet volume （MPV）, erythrocyte sedimentation rate （ESR）, cardiac troponin Ⅰ （cTnI）, and endothelin-1 （ET-1） in CAL group were significantly higher than those in NCAL group, and serum albumin （Alb） and hemoglobin （Hb） levels were significantly lower in CAL group （all P〈0.05）. White blood cell （WBC） count, serum sodium, matrix metalloproteinase 9 （MMP-9）, total cholesterol （TC）, hematocrit （HCT） and CD3＋T lymphocytes percentage had no statistically significant difference between the two groups. In conclusion, our results indicated that the 10 biomarkers including platelet count, neutrophils count, PCT, PDW, MPV, ESR, cTnI, ET-1, Alb and Hb were associated with CAL, and may be involved in the pathogenesis of CAL. The biomarkers of WBC count, serum sodium, MMP-9, TC, HCT, and CD3＋T lymphocytes percentage bore no relationship with the development of CAL among Chinese children with KD.

Controversies in diagnosis and management of Kawasaki disease

Kawasaki disease(KD) is a common medium vessel systemic vasculitis that usually occurs in small children. It has a predilection for the coronary arteries, but other medium sized arteries can also be involved. The etiology of this disorder remains a mystery. Though typical presentation of KD is quite characteristic, it may also present as incomplete or atypical disease in which case the diagnosis can be very challenging. As both incomplete and atypical forms of KD can be associated with serious coronary artery complications, the pediatrician can ill afford to miss these diagnoses. The American Heart Association has enunciated consensus guidelines to facilitate the clinical diagnosis and treatment of this condition. However, there are still several issues that remain controversial. Intravenous immunoglobulin remains the cornerstone of management but several other treatment modalities, especially glucocorticoids, are increasingly finding favour. We review here some of the contemporary issues, and the controversies thereon, pertaining to management of KD.

Out-of-hospital cardiac arrest in a young adult survivor with sequelae of childhood Kawasaki disease: A case report

BACKGROUND Kawasaki disease(KD)is an acute type of systemic vasculitis involving small to medium-sized muscular arteries and outbreaks during childhood.KD can cause myocardial ischemia,infarction,and sudden cardiac arrest.We present a case of a young adult survivor of out-of-hospital cardiac arrest as late KD sequelae.CASE SUMMARY A 29-year-old man with presumed acute KD history at the age of 5 suddenly lost consciousness while jogging and was diagnosed a sudden cardiac arrest by an emergency doctor.After about 10 min cardiopulmonary resuscitation,return of spontaneous circulation was achieved,and the patient was transferred to our hospital.A coronary computed tomography angiogram and coronary angiography revealed extensive calcifications of left anterior descending and right coronary artery aneurysms.The patient was an active individual who took exercise regularly and claimed no previous symptoms of chest pain or shortness of breath on exertion.The most possible cause of his sudden cardiac arrest could be presumed as a thrombus within the coronary artery aneurysms.After that,a thromboembolism induced extensive ischemia,and this ischemia-induced arrhythmia led to a cardiac arrest.CONCLUSION Few patients who suffer a late sequela of KD can survive from out-of-hospital cardiac arrest.Medications,surgical intervention,and active follow-up are extremely important for this patient to prevent occurrence of adverse events in the future.

Clinical features of acute kidney injury in patients with Kawasaki disease

Although acute kidney injury(AKI)is a common complication in hospitalized children,AKI has rarely been reported in patients with Kawasaki disease(KD).Herein,we review the clinical trajectories of AKI in patients with KD.A total of 39 patients with KD who developed AKI have been reported in 28 publications as case reports.The causes of AKI include prerenal AKI associated with acute heart failure(AHF),intrinsic AKI caused by tubulointerstitial nephritis(TIN),acute nephritic syndrome(ANS),hemolytic uremic syndrome(HUS),immune complexmediated nephropathy,rhabdomyolysis,and KD shock syndrome(KDSS).Six of the 39 patients(15.4%)underwent renal replacement therapy.While AHF and multiple organ dysfunction syndrome developed in41%and 68%of KD patients with AKI,respectively,all patients recovered without any renal sequelae.Although the precise pathogenic mechanism underlying the development of AKI in patients with KD is unknown,several possible mechanisms have been proposed,including T-cell-mediated immunologic abnormalities for TIN,renal and glomerular endothelial injury resulting from vasculitis for HUS,immune complex-mediated kidney injury for immune complex-mediated nephropathy and ASN,and capillary leak and an increased release of cytokines with myocardial dysfunction for KDSS.

Pyuria in patients with Kawasaki disease

Kawasaki disease(KD) is an acute, febrile vasculitis that predominantly develops in children ≤ 5 years of age and can lead to multiple organ injuries including the kidneys. Of these injuries, pyuria is a common feature of patients with KD, occurring in 30%-80% of patients. Sterile pyuria is most common in KD patients ≤ 1 year of age. KD patients with sterile pyuria exhibit more severe inflammatory reactions and may have subclinical renal injuries. Sterile pyuria in KD is associated with mononuclear cells(not neutrophils) in the urine. Although sterile pyuria in KD was at one time thought to be due to urethritis caused by a non-specific vasculitis of the urethra, recent studies suggest that sterile pyuria in KD originates from the urethra, the kidney as a resultof mild and sub-clinical renal injuries, and/or the bladder due to cystitis. Pyuria is not always sterile in KD, but can result from a urinary tract infection(UTI). As causative pathogens, Escherichia coli and Klebsiella oxytoca have been reported. The clinical phenotypes do not differ between those with or without UTI. Because some KD patients with UTIs have urinary tract abnormalities such as vesicoureteral reflux, a complete UTI workup including renal ultrasound, voiding cystourethrogram and/or dimercaptosuccinic acid renal scan recommended in KD patients with UTIs.

Risk of coronary arterial lesions in immunoglobulin resistant Kawasaki disease

Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is aimed to investigate an additional therapy affects the risk for CAL in IVIG resistant KD. Design: The information from 11,510 children with KD was collected by the nationwide survey (2003-2004) in Japan. The secondary therapeutic strategies for IVIG resistant KD were an additional IVIG dose, steroids or both. The incidence of CAL was compared among 4 groups: G1, children responded to initial IVIG;G2, IVIG resistant patients receiving an additional IVIG dose;G3, IVIG resistant patients receiving additional steroids;G4, IVIG resistant patients receiving an additional IVIG dose plus steroids. CAL was assessed at 30th day of illness using ultrasound echocardiography. Results: 2229 patients (19.4%) were resistant to initial IVIG. Incidence of CAL was significantly lower in children responding to initial IVIG than in IVIG resistant patients (1.9% and 11.0%, respectively;odd’s ratio 6.3). The incidences of CAL in an each additional therapy group were as follows: G2: 6.7%, G3: 9.7%, G4: 22.2%. The risk for CAL was significantly higher in G4 as compared with G2 and G3. Giant aneurysmal formation (GA) was more frequently developed in G3 and G4 consisting of the patients receiving steroids (G1: 0.03%, G2: 0.63%, G3: 4.3%, G4: 3.7%). Conclusion: The incidence of CAL was considerably high in IVIG resistant KD and an additional therapy by steroids may increase the risk for GA.

Effects of Serum of Kawasaki Disease on PDGF Expression in Monocytes and on Endothelial Cell Apoptosis

The effects of serum of patients with Kawasaki disease on the platelet derived growth factor B (PDGF B) chain protein expression in monocytes were studied by immunocytochemical method and the effects of the serum on the endothelial cellular (EC) apoptosis were observed by flow cytometric technique. It was found that the serum of patients with Kawasaki disease induced significantly the expression of PDGF B chain protein. Likewise, EC apoptosis was increased significantly in the experimental group as compared with the control group ( P < 0.01). The results suggest that PDGF in monocytes increase and EC apoptosis play an important role in the development of coronary artery complication in Kawasaki disease.

ST-segment elevation myocardial infarction in Kawasaki disease:A case report and review of literature

BACKGROUND Kawasaki disease(KD)is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm(CAA).CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain.Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram.An aneurysm of the left circumflex(LCX)coronary artery was found with massive thrombi within.A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications.The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7,suggestive of a small aneurysm considering his age,sex,and body surface area.We further present a case series of 19 patients with KD,including the current patient,presenting with acute coronary syndrome(ACS).Notably,none of the cases showed Z scores;only five patients(26%)had been regularly followed up by a physician,and only one patient(5.3%)was being treated with antithrombotic therapy before ACS occurred.CONCLUSION For KD presenting with ACS,regular follow up and medical therapy may be crucial for improved outcomes.

HSP_(60), HSP_(70) in the Pathogenesis of Kawasaki Disease:Implication and Action

HSP(60), HSP(70) in plasma of 11 cases of Kawasaki diseases (KD) and 23 healthy children were determined. The two groups were controlled for age. Determination of HSP(60), HSP(70) was conducted in lymphocytes of 14 cases of KD and 26 healthy children. The results were compared with those of 12 patients with febrile diseases and 10 patients with tuberculosis. Our results showed that except a significant difference in plasma HSP(70) found between acute phase and convalescent phase of KD (P<0. 01), no significant difference was found in HSP(60), HSP(70)among all groups (P>0. 05). The differences in HSP(60), HS(70), in lymphocytes were relatively obvious among all groups. The levels of HSP(60), HSP(70) in acute phase of KD were significantly higher than those in convalescent phase or in healthy controls (P<0. 01). The levels of HSP(60) in KD were significantly higher than those of patients with febrile diseases. HSP(60) of KD children was significantly lower than those of children with tuberculosis (P<0.01). The findings showed that HSP(60), HSP(70) might contribute to the pathogenesis of KD. Determination of HSP(60), HSP(70) in lymphocytes is of help in the diagnosis of KD.

Lymph-node-first presentation of Kawasaki disease in a 12-year-old girl with cervical lymphadenitis caused by Mycoplasma pneumoniae:A case report

BACKGROUND To the best of our knowledge,cases of Kawasaki disease(KD)occurring at the age of 12 are rare,even in Asia where the incidence of KD is high.We report a case of lymph-node-first presentation of KD(NFKD)in a 12-year-old girl with Mycoplasma pneumoniae(M.pneumoniae)infection who presented with prolonged fever and lymphadenitis refractory to macrolide antibiotics.CASE SUMMARY A previously healthy 12-year-old girl presented with fever,myalgia,sore throat,swelling,and tenderness on the right side of the neck.She was initially diagnosed with lymphadenitis caused by M.pneumoniae refractory to macrolide antibiotics.She had elevated brain natriuretic peptide(BNP)levels.Finally,the patient was diagnosed with KD.After receiving intravenous immunoglobulin,the fever resolved,and her symptoms improved.CONCLUSION NFKD should be differentiated from adolescent lymphadenitis presenting with prolonged fever by checking the BNP level early.

Incomplete Kawasaki disease complicated with acute abdomen: A case report

Kawasaki disease(KD)is an acute systemic vasculitis characterized by unknown etiology.CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD.He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy.Ultrasound examination at early onset revealed a giant coronary artery aneurysm.The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest.He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery.After the operation,the cardiac output increased,and the symptoms of heart failure resolved.Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure,and normal growth was obtained.CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm.Nevertheless,some issues still need specific attention.

Use of corticosteroids during acute phase of Kawasaki disease

In spite of initial intravenous immunoglobulin(IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. Three options of using corticosteroids for the treatment of patients during the acute phase of Kawasaki disease, havebeen considered. The first is their use exclusively for patients unresponsive to IVIG treatment. The second is their use in combination with IVIG as the routine first line therapy for all patients. The last is the use in the combination as the first line therapy for selected patients at a high risk being unresponsive to initial IVIG. However, it is uncertain that the corticosteroids as the second line treatment are better than the additional IVIG in patients unresponsive to initial IVIG. The combination of corticosteroids and IVIG as the routine first line therapy also have not enough evidences. The last option of using corticosteroids- the combination of corticosteroids and IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.

Kawasaki disease, <i>Mycoplasma pneumoniae</i>infection and anaplastic large cell lymphoma: An uncommon association

Kawasaki disease (KD) is an acute febrile systemic vasculitis occurring predominantly in young children less than 5 years of age. Although imperfectly known, the aetiopathogenesis of KD would be secondary to immunological abnormalities that could constitute a favourable terrain for neoplasms. We report on a case in a 2-year-old girl who presented clinical manifestations compatible with Kawasaki disease complicated by coronary aneurysm. Aetiopathological investigations revealed M. pneumoniae infection as specific IgM were present in the serum (Elisa). The patient was initially treated by intravenous immunoglobulins (IVIG) and aspirin to anti-inflammatory dose. Following a few days of desquamation, resolution of the symptomatology occurred. Four weeks later she developed disseminated tumorous syndrome. Lymph node biopsy revealed massive infiltration by large cells lymphomatous proliferation. Histologic and immunophenotypic findings were characteristic of ALK-1+ anaplastic large cell lymphoma. Four weeks later, the patient died from a severe nosocomial infection complicated by septic shock. Our observation is the first cases describing the association between anaplastic large cell lymphoma, KD and M. pneumoniae. Immunologic disorder due to KD and M. pneumoniae infection may play probably a central role for malignancy.