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.

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

Coronary artery abnormalities are the most important complications in children with Kawasaki disease(KD).Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD.However,it has inherent limitations with regard to evaluation of mid and distal coronary arteries and,left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group.Catheter angiography(CA)is invasive,has high radiation exposure and fails to demonstrate abnormalities beyond lumen.The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems.In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children.Computed tomography coronary angiography(CTCA)can be performed during acute as well as convalescent phases of KD.It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.

Kawasaki disease with peritonsillar abscess as the first symptom:A case report

BACKGROUND Kawasaki disease(KD),also known as mucocutaneous lymph node syndrome,is an acute,self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications,with a 25%incidence of coronary artery aneurysms.Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever,difficulty in opening his mouth,and neck pain and was originally treated for throat infection without improvement.On the basis of laboratory tests,ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck,the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy.On the fifth day of admission,the child developed conjunctival congestion,prune tongue,perianal congestion and desquamation,and slightly stiff and swollen bunions on both feet.A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.CONCLUSION Children with neck pain,lymph node enlargement,or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics.Clinicians should not rush invasive operations such as neck puncture,incision,and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.

Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease

BACKGROUND There is evolving role of computed tomography coronary angiography(CTCA)in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease(KD).Despite this,there is lack of data on radiation dose in this group of children undergoing CTCA.AIM To audit the radiation dose of CTCA in children with KD.METHODS Study(December 2013-February 2018)was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering.The dose length product(DLP in milligray-centimeters-mGy.cm)was recorded.Effective radiation dose(millisieverts-mSv)was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection.Radiation dose was compared across the groups(0-1,1-5,5-10,and>10 years).RESULTS Eighty-five children(71 boys,14 girls)with KD underwent CTCA.The median age was 5 years(range,2 mo-11 years).Median DLP and effective dose was 21 mGy.cm,interquartile ranges(IQR)=15(13,28)and 0.83 mSv,IQR=0.33(0.68,1.01)respectively.Mean DLP increased significantly across the age groups.Mean effective dose in infants(0.63 mSv)was significantly lower than the other age groups(1-5 years 0.85 mSv,5-10 years 1.04 mSv,and>10 years 1.38 mSv)(P<0.05).There was no significant difference in the effective dose between the other groups of children.All the CTCA studies were of diagnostic quality.No child required a repeat examination.CONCLUSION CTCA is feasible with submillisievert radiation dose in most children with KD.Thus,CTCA has the potential to be an important adjunctive imaging modality in children with KD.

Adipocytokine profile in children with Kawasaki disease

This letter to editor discusses on the publication on adipocytokine profile in children with Kawasaki disease.Concerns on confounding factors are raised and discussed.

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.

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.

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.

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.

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.

Serum brain natriuretic peptide in children with Kawasaki disease

BACKGROUND： Kawasaki disease （KD） is a common cause of acquired heart disease in children. Recent studies have focused on the biochemical markers of the myocardium, their high sensitivity and specificity and significance in the diagnosis of KD. This study aimed to determine the serum level of brain natriuretic peptide （BNP） and its relation with the heart function of children with KD and to explore its clinical value in diagnosis of KD.METHODS： Forty-three KD children, aged from 5 months to 8 years （mean 2.3±0.6 years ）, were admitted to Qingdao Children＇s Hospital from February 2007 to April 2009. Among them 27 were male, and 16 female. The 43 patients served as a KD group. Patients with myocarditis, cardiomyopathy, congenital heart disease and other primary heart diseases were excluded. Thirty healthy children, aged from 3 months to 15 years （mean 2.5±0.8 years） or 17 males and 13 females served as a control group. There were no significant differences in age and gender between the two groups （P〉0.05）. In the KD group, ELISAwas used to measure the levels of serum BNP in acute and convalescent stages; and in the control group, the levels of serum BNP were measured once randomly. Left ventricular ejection fraction （LVEF）, left ventricular shorten fraction （LVSF）, cardiac index （CI） and left ventricular inflow velocity through the mitral annulus （including E-velocity and A-velocity） were measured by two- dimensional echocardiography in the acute and convalescent stages in the KD group. All data were expressed as mean±SD. The methods of analysis included Student＇s t test and the linear regression analysis test. P〈0.05 was considered statistically significant.RESULTS： The level of serum BNP in the acute stage （517.26±213.40） ng/ml was significantly higher than that in the convalescent stage （91.56±47.97） ng/ml in the control group （37.55±7.56） ng/ ml （P〈0.01）. The levels of LVEF, LVSF and CI in the acute stage were significantly lower than those in the convalescent stage （P〈0.05）, but the E/A level was not significantly different between the acute and convalescent stages （P〉0.05）. Linear regression analysis showed that the BNP level was negatively correlated with the levels of LVEF, LVSF and C1（r=-0.63, -0.52, -0.53, P〈0.05） , but not significantly correlated with the E/A level （r=-0.18, P〉0.05）.CONCLUSION： The levels of serum BNP are significantly increased in KD patients, and are negatively correlated with the levels of LVEF, LVSF, and CI. The detection of serum BNP level is of clinical significance in the diagnosis of KD.

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.

Multi-System Inflammatory Syndrome in Children (MIS-C), Kawasaki Disease and Toxic Shock Syndrome so Different and Similar

Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may result in the Multisystem Inflammatory Syndrome in Children (MIS-C). The most common presentations of MIS are fever, gastrointestinal (diarrhea, vomiting, abdominal pain), cardiovascular, mucocutaneous (rash, mucus membrane changes, conjunctival injection), respiratory (including sore throat), headache, limb and periorbital edema, and elevated inflammation markers. Some clinical and laboratory features of MIS-C are similar to other systemic diseases of childhood as Kawasaki disease and Toxic Shock Syndrome. Here are reported three cases in children with MIS-C, Kawasaki disease and Toxic Shock Syndrome to highlight the similarities and differences of these diseases.

Adipocytokine profile in children with Kawasaki disease at a mean follow-up period of 5.5 years: A study from North India

BACKGROUND Kawasaki disease(KD)is an acute self-limited vasculitis with a predilection for coronary arteries.Children with KD may have altered lipid metabolism and abnormal lipid profiles that may last for prolonged periods.However,there is a paucity of literature on the role of adipocytokines in KD.AIM To estimate the levels of adipocytokines(adiponectin,leptin and resistin)during the convalescent phase of KD.METHODS Twenty children,who had KD at least three years earlier,were enrolled in this study.In addition,20 healthy controls were also enrolled.Clinical and laboratory profiles of patients were obtained from hospital records.Serum adiponectin,leptin and resistin levels were estimated by enzyme-linked immunosorbent assay.RESULTS Mean age of the patients in the study group was 10.15±3 years and the male:female ratio was 1.5:1.Median serum resistin levels in patients with KD(27.77 ng/mL;[IQR:18.66,48.90])were decreased compared to controls(21.20 ng/mL;[IQR:14.80,27.00])(P=0.04).Median serum leptin levels in cases and controls were 1.83 ng/mL;(IQR:1.13,3.80),and 1.10 ng/mL;(IQR:0.41,2.88),respectively(P=0.09).Median serum adiponectin levels were similar in both cases(12.20μg/mL;[IQR:9.76,17.97])and controls(13.95μg/mL;[IQR:11.17,22.58]);(P=0.18).There was no significant difference in all 3 adipocytokines between children with(4/20)and without coronary artery abnormalities(16/20).CONCLUSION Serum resistin levels were significantly elevated in patients with KD during the convalescent phase compared to controls.Serum leptin levels appeared to be higher in patients with KD,although the difference was not statistically significant.Adiponectin levels were similar in both cases and controls.Raised resistin and leptin levels may partially explain lipid perturbations observed during the convalescent phase of KD.

Reevaluation of the Efficacy of Intravenous Gammaglobulin in the Prevention and Treatment of Coronary Artery Lesion in Kawasaki Disease

In order to objectively evaluate the efficacy of intravenous gammaglobulin (IVIG) in the prevention and treatment of coronary artery lesion (CAL) in Kawasaki disease (KD) and the related factors influencing the IVIG efficacy, 314 children with KD were reviewed retrospectively and comparatively and were divided into IVIG plus aspirin group and ASA group. The occurrence and restoration of CAL in these two groups as well as many laboratory and clinical indexes including average hospital stay (days), total fever duration, defervescence time, platelet count, erythrocyte sedimentation rate, C reactive protein etc. were observed. The incidence of CAL was 39.5 % in the children with KD. In the IVIG+ASA group, the incidence of CAL was 34.3 % and 56.0 % in ASA group respectively (P<0.001). The incidence of CAL was reduced in the group in which 2.0 g/kg or 1.0 g/kg IVIG was administered as compared with the group in which IVIG was administered at a dose ≤0.6 g/kg or ≥3.0 g/kg (P<0.05). CAL occurred less frequently when IVIG was administered at 3-10 days of the course than that when IVIG was administered ≤3 days or >10 days (P<0.05). About 13.4 % of the CAL treated with IVIG was not recovered at the 12 th month of the course, mostly in the groups in which only ASA was administered and IVIG treatment was started 10 days later. The hospital stay (days), defervescence time, total fever duration, platelet count, erythrocyte sedimentation rate and C reactive protein were significantly reduced in IVIG+ASA group as compared with those in the ASA group (P<0.05). IVIG treatment can remarkably shorten the course of patients with KD and decrease the incidence of CAL, but the efficacy of IVIG in the prevention and treatment of KD disease is not as expected by people, therefore, reevaluation of the practical efficacy of IVIG is required.