DOI QR코드

DOI QR Code

Cardiac Function in Kawasaki Disease Patients with Respiratory Symptoms

  • Lee, Seul Bee (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Choi, Han Seul (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Son, Sejung (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Hong, Young Mi (Department of Pediatrics, Ewha Womans University School of Medicine)
  • Received : 2015.01.13
  • Accepted : 2015.04.14
  • Published : 2015.07.30

Abstract

Background and Objectives: Respiratory symptoms are often observed in children with Kawasaki disease (KD) during the acute phase. The association of respiratory viruses in children with KD was investigated using multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) and tissue Doppler echocardiography. Subjects and Methods: 138 KD patients were included from January 2010 to June 2013. We compared 3 groups (group 1: n=94, KD without respiratory symptoms; group 2: n=44, KD with respiratory symptoms; and group 3: n=50, febrile patients with respiratory symptoms). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide (NT-proBNP). Echocardiographic measurements were compared between group 1 and group 2. RT-PCR was performed using nasopharyngeal secretion to screen for the presence of 14 viruses in groups 2 and 3. Results: The incidence of KD with respiratory symptoms was 31.8%. The duration of fever was significantly longer, and coronary artery diameter was larger in group 2 than in group 1. Tei index was significantly higher and coronary artery diameter larger in group 2 than group 1. Coronary artery diameter, C-reactive protein levels, platelet count, alanine aminotransferase levels, and NT-pro BNP levels were significantly higher and albumin levels lower in group 2 compared with group 3. Conclusion: NT-pro BNP was a valuable diagnostic tool in differentiating KD from other febrile viral respiratory infections. Some viruses were more frequently observed in KD patients than in febrile controls. Tei index using tissue Doppler imaging was increased in KD patients with respiratory symptoms.

Keywords

References

  1. Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 1974;54:271-6.
  2. Burns JC, Glode MP. Kawasaki syndrome. Lancet 2004;364:533-44. https://doi.org/10.1016/S0140-6736(04)16814-1
  3. Wood LE, Tulloh RM. Kawasaki disease in children. Heart 2009;95:787-92. https://doi.org/10.1136/hrt.2008.143669
  4. Kim GB, Park S, Kwon BS, Han JW, Park YW, Hong YM. Evaluation of the temporal association between Kawasaki disease and viral infections in South Korea. Korean Circ J 2014;44:250-4. https://doi.org/10.4070/kcj.2014.44.4.250
  5. Chang LY, Lu CY, Shao PL, et al. Viral infections associated with Kawasaki disease. J Formos Med Assoc 2014;113:148-54. https://doi.org/10.1016/j.jfma.2013.12.008
  6. Rowley AH, Shulman ST. Kawasaki syndrome. PediatrClin North Am 1999;46:313-29. https://doi.org/10.1016/S0031-3955(05)70120-6
  7. Yanagawa H, Nakamura Y, Yashiro M, et al. Results of the nationwide epidemiologic survey of Kawasaki disease in 1995 and 1996 in Japan. Pediatrics 1998;102:e65. https://doi.org/10.1542/peds.102.6.e65
  8. Green MS. The male predominance in the incidence of infectious disease in children: a postulated explanation for disparities in the literature. Int J Epidemiol 1992;21:381-6. https://doi.org/10.1093/ije/21.2.381
  9. Brogan PA, Bose A, Burgner D, et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 2002;86:286-90. https://doi.org/10.1136/adc.86.4.286
  10. Jaggi P, Kajon AE, Mejias A, Ramilo O, Leber A. Human adenovirus infection in Kawasaki disease: a confounding bystander? Clin Infect Dis 2013;56:58-64. https://doi.org/10.1093/cid/cis807
  11. Treadwell TA, Maddox RA, Holman RC, et al. Investigation of Kawasaki syndrome risk factors in Colorado. Pediatr Infect Dis J 2002;21:976-8. https://doi.org/10.1097/00006454-200210000-00018
  12. Jordan-Villegas A, Chang ML, Ramilo O, Mejias A. Concomitant respiratory viral infections in children with Kawasaki disease. Pediatr Infec Dis J 2010;29:770-2. https://doi.org/10.1097/INF.0b013e3181dba70b
  13. Kim JH, Yu JJ, Lee J, et al. Detection rate and clinical impact of respiratory viruses in children with Kawasaki disease. Korean J Pediatr 2012;55:470-3. https://doi.org/10.3345/kjp.2012.55.12.470
  14. Sanchez Mejia AA, Simpson KE, Hildebolt CF, et al. Tissue Doppler septal Tei index indicates severity of illness in pediatric patients with congestive heart failure. Pediatr Cardiol 2014;35:411-8. https://doi.org/10.1007/s00246-013-0794-1
  15. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association. Pediatrics 2004;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  16. Park YW, Han JW, Hong YM, et al. Epidemiological features of Kawasaki disease in Korea, 2006-2008. Pediatr Int 2011;53:36-9. https://doi.org/10.1111/j.1442-200X.2010.03178.x
  17. Melish ME. Kawasaki syndrome. Pediatr Rev 1996;17:153-62. https://doi.org/10.1542/pir.17-5-153
  18. Burns JC, Herzog L, Fabri O, et al. Seasonality of Kawasaki disease: a global perspective. PLoS One 2013;8:e74529. https://doi.org/10.1371/journal.pone.0074529
  19. Tsai HC, Chang LY, Lu CY, et al. Transmission of acute infectious illness among cases of Kawasaki disease and their household members. J Formos Med Assoc 2015;114:72-6. https://doi.org/10.1016/j.jfma.2014.07.005
  20. Principi N, Rigante D, Esposito S. The role of infection in Kawasaki syndrome. J Infect 2013;67:1-10. https://doi.org/10.1016/j.jinf.2013.04.004
  21. Burgner D, Harnden A. Kawasaki disease: what is the epidemiology telling us about the etiology? Int J Infect Dis 2005;9:185-94. https://doi.org/10.1016/j.ijid.2005.03.002
  22. Chang LY, Chang IS, Lu CY, et al. Epidemiological features of Kawasaki disease in Taiwan, 1996-2002. Pediatrics 2004;114:e678-82. https://doi.org/10.1542/peds.2004-0726
  23. Nakamura Y, Yanagawa I, Kawasaki T. Temporal and geographical clustering of Kawasaki disease in Japan. Prog Clin Biol Res 1987;250:19-32.
  24. Ye Q, Shao WX, Shang SQ, Zhou MM. Value of the N-terminal of prohormone brain natriuretic peptide in diagnosis of Kawasaki disease. Int J Cardiol 2015;178:5-7. https://doi.org/10.1016/j.ijcard.2014.10.095
  25. Dahdah N, Siles A, Fournier A, et al. Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol 2009;30:810-7. https://doi.org/10.1007/s00246-009-9441-2
  26. Bae HK, Lee do K, Kwon JH, Kim HS, Sohn S, Hong YM. Clinical characteristics and serum N-terminal pro-brain natriuretic peptide as a diagnostic marker of Kawasaki disease in infants younger than 3 months of age. Korean J Pediatr 2014;57:357-62. https://doi.org/10.3345/kjp.2014.57.8.357
  27. Vijayan AP, Dinesh KB, Nath KR. Coronary artery dilatation in incomplete Kawasaki disease. Indian Pediatr 2009;46:607-9.
  28. Bruch C, Schmermund A, Marin D, et al. Tei-index in patients with mildto- moderate congestive heart failure. Eur Heart J 2000;21:1888-95. https://doi.org/10.1053/euhj.2000.2246
  29. Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996;9:838-47. https://doi.org/10.1016/S0894-7317(96)90476-9
  30. Ajami G, Borzouee M, Amoozgar H, et al. Evaluation of myocardial function using the Tei index in patients with Kawasaki disease. Cardiol Young 2010;20:44-8.

Cited by

  1. Comparison of Clinical Manifestation and Laboratory Findings between Adenoviral Infection with or without Kawasaki Disease vol.41, pp.3, 2015, https://doi.org/10.12771/emj.2018.41.3.45
  2. Age-related differences in clinical characteristics of Kawasaki disease vol.54, pp.3, 2021, https://doi.org/10.1590/1414-431x202010281