Kawasaki disease (KD) is an acute febrile systemic vasculitis that predominantly occurs in children below five years old (Agarwal, 2017). This means the walls of their blood vessels begin to inflame and swell. This disease is commonly diagnosed by a group of signs and symptoms which can be confirmed by laboratory tests (Agarwal, 2017).
KD begins in an infected site of small-sized arteries,
typically coronary arteries (Agarwal 2017). If this disease is left untreated,
it can lead to further complications related to heart diseases; complications
as coronary artery aneurysm, thrombosis, stenosis, and death (Agarwal 2017).
The most common treatment for KD in the acute phase is
using Intravenous immunoglobin (IVIG) and aspirin which reduces the incidence
of coronary abnormalities to less than 5% (De Rosa 2007). As for aspirin, it is
used in a higher dosage than a normal user, it is used primarily for its
anti-inflammatory properties, and then lower dosage for anti-thrombotic effects
(De Rosa 2007). Specifically, IVIG has been proven to be highly effective in
reducing disease symptoms or at least the severity of coronary artery aneurysms
(De Rosa 2007). These coronary artery aneurysms develop in 15-25% of untreated
children, however, 10-15% of cases develop resistance to this treatment
(Rigante 2010). Intravenous Immunoglobin (IVIG) treatment since is the most
common and successful way to be treated. Slowly more and more cases are
becoming resistant, forcing researchers to find other drugs and treatment
techniques that help children at a young age.
Agarwal
S, Agrawal DK. Kawasaki disease: etiopathogenesis and novel treatment
strategies. Expert Rev Clin Immunol. 2017 Mar;13(3):247-258. doi:
10.1080/1744666X.2017.1232165. Epub 2016 Sep 13. PMID: 27590181; PMCID:
PMC5542821.
De
Rosa G, Pardeo M, Rigante D. Current recommendations for the pharmacologic
therapy in Kawasaki syndrome and management of its cardiovascular
complications. Eur Rev Med Pharmacol Sci. 2007 Sep-Oct;11(5):301-8. PMID:
18074939.
Rigante D, Valentini P, Rizzo D, Leo A,
De Rosa G, Onesimo R, De Nisco A, Angelone DF, Compagnone A, Delogu AB. Responsiveness to intravenous immunoglobulins and occurrence
of coronary artery abnormalities in a single-center cohort of Italian patients
with Kawasaki syndrome. Rheumatol Int. 2010 Apr;30(6):841-6. doi:
10.1007/s00296-009-1337-1. Epub 2010 Jan 5. PMID: 20049445.
This is really interesting Madi! Before reading your post I didn't know anything about Kawasaki disease and know I feel like I know a lot more about it. I did find it disheartening to hear about how more and more cases are becoming resistant to the main form of treatment for this disease: aspirin and IVIG. I was wondering what kinds of other drugs researchers and providers were trying to use in order to successfully treat this disease. I found that researchers are trying other types of drugs such as corticosteroids and biological drugs to treat Kawasaki disease (Marchesi et al., 2018). The corticosteroids act as an anti-inflammatory as well as an immunosuppressive and are used to reduce the inflammation in the blood vessels (Marchesi et al., 2018). Although, these drugs have their own side effects such as hypertension, hyperglycemia, heart issues, heart failure, and many other issues (Marchesi et al., 2018). The biological drugs are good at targeting the issues with inflammation in the immune system, and these drugs are especially good at targeting the molecules that are prominent in Kawasaki disease (Marchesi et al., 2018). Side effects of biological drugs range from headaches, rashes, and gastrointestinal issues to severe allergic reactions, thrombocytopenia, and infections (Marchesi et al., 2018). It seems that there are many drugs that need to be tested and each child with Kawasaki disease needs to be individually evaluated to decide the best course of aciton.
ReplyDeleteMarchesi, A., Tarissi de Jacobis, I., Rigante, D., Rimini, A., Malorni, W., Corsello, G., Bossi, G., Buonuomo, S., Cardinale, F., Cortis, E., De Benedetti, F., De Zorzi, A., Duse, M., Del Principe, D., Dellepiane, R. M., D'Isanto, L., El Hachem, M., Esposito, S., Falcini, F., Giordano, U., … Villani, A. (2018). Kawasaki disease: guidelines of Italian Society of Pediatrics, part II - treatment of resistant forms and cardiovascular complications, follow-up, lifestyle and prevention of cardiovascular risks. Italian journal of pediatrics, 44(1), 103. https://doi-org.dml.regis.edu/10.1186/s13052-018-0529-2
This post is very insightful Madi! I loved how you decided to focus on the treatments of KD and specifically describe each in detail. You briefly mentioned how the disease is diagnosed, which got me thinking about what types of things that doctors look for during those laboratory tests. I found an article from Rheumatology International that discussed the clinical indications for Kawasaki Disease. After an in-depth study of patients’ symptoms and behaviors, researchers found that KD is often associated with high white blood cell count, high platelet count, low hemoglobin, and a longer duration of a fever. These symptoms are also seen with many infectious diseases, but the numbers found in the laboratory tests for those with KD are slightly more extreme. In addition to these tests, doctors also have to analyze patients’ behaviors, which typically includes decreased overall activity and abnormally heightened irritability.
ReplyDeleteLee, D. W., & Choi, H. J. (2022). Clinical indications for Kawasaki disease in febrile infants aged less than three months. Rheumatology International, 42(5), 891–897. https://doi-org.dml.regis.edu/10.1007/s00296-021-05019-7