Bacille Calmette-Guérin inoculation site changes and cardiac complications in patients with Kawasaki disease

2020 ◽  
pp. archdischild-2020-319543
Author(s):  
Haruki Takikawa ◽  
Ryusuke Ae ◽  
Yuri Matsubara ◽  
Daisuke Matsubara ◽  
Nobuko Makino ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Ivig Treatment ◽  
Cardiac Complications ◽  
Independent Factor ◽  
Bacille Calmette Guerin ◽  
Treatment And Prevention ◽  
Inoculation Site ◽  
Paediatric Department ◽  
Using Data ◽  
Adjusted Model

ObjectiveTo investigate whether redness and crusting at the bacille Calmette-Guérin inoculation site (BCGitis), identified during acute illness owing to Kawasaki disease (KD), is an independent risk factor for development of cardiac complications.DesignRetrospective cohort study using data from the nationwide KD survey in Japan.SettingSurvey respondents included hospitals specialising in paediatrics and hospitals with ≥100 beds and a paediatric department throughout Japan.PatientsWe included 17 181 patients with KD across Japan during 2005–2006.Main outcome measuresBCGitis and cardiac complications resulting from KD.ResultsBCGitis was identified in 7549 (44%) patients with KD. Compared with patients without BCGitis, those with BCGitis were younger, more likely to be male, less likely to have recurrent status and visited a hospital and underwent initial intravenous immunoglobulin (IVIG) treatment earlier after KD onset. In the unadjusted model, patients with BCGitis were significantly less likely to have cardiac complications (crude OR 0.81, 95% CI 0.71 to 0.92). However, after including treatment factors (days of illness at initial IVIG and treatment responsiveness) in the adjusted model, the association was no longer significant (adjusted OR 0.89, 95% CI 0.77 to 1.03), indicating that BCGitis was not an independent factor associated with cardiac complication and might be confounded by treatment factors.ConclusionsBCGitis was identified in comparatively early illness stages of KD. Our findings indicated that BCGitis was not an independent factor associated with developing cardiac complications but was confounded by prompt initial IVIG administration, which might result in successful treatment and prevention of cardiac complications.

scholarly journals Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

2018 ◽  
Vol 104 (7) ◽  
pp. 640-646 ◽  
Author(s):  
Robert M R Tulloh ◽  
Richard Mayon-White ◽  
Anthony Harnden ◽  
Athimalaipet V Ramanan ◽  
E Jane Tizard ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Rural Areas ◽  
Primary Treatment ◽  
Ivig Treatment ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Seasonal Incidence ◽  
Female Ratio ◽  
Black African ◽  
The Uk

ObjectiveKawasaki disease (KD) is an increasingly common vasculitis with risk of coronary artery aneurysms (CAAs). The last UK survey was in 1990, whereas current epidemiology, treatment patterns and complication rates are unknown. The aim of this study was to address this knowledge gap.MethodsA British Paediatric Surveillance Unit survey in the UK and Ireland from 1 January 2013 to 28 February 2015 ascertained demographics, ethnicity, seasonal incidence, treatment and complication rates.Results553 cases were notified: 389 had complete KD, 46 had atypical KD and 116 had incomplete KD; 2 were diagnosed at postmortem with an incidence of 4.55/100 000 children under 5 years, with a male to female ratio of 1.5:1 and a median age of 2.7 years (2.5 months–15 years). Presentation was highest in January and in rural areas. Most were white (64%), and Chinese and Japanese Asians were over-represented as were black African or African mixed-race children. 94% received intravenous immunoglobulin (IVIG). The overall CAA rate was 19%, and all-cardiac complications affected 28%. Those with CAA received IVIG later than in those without (median 10 days vs 7 days). Those under 1 year had fewer symptoms, but the highest CAA rate (39%). Overall 8 of 512 cases (1.6%) had giant CAA, and 4 of 86 cases (5%) under 1 year of age developed giant CAA. Mortality from KD was 0.36%.ConclusionsThe UK and Ireland incidence of KD has increased and is more frequently seen in winter and rural areas. Delayed IVIG treatment is associated with CAA, suggesting earlier and adjunctive primary treatment might reduce complications to prevent CAA, particularly in the very young.

scholarly journals 1261Epidemiology of Kawasaki disease in Japan, 2017–2018: results from the nationwide survey

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Ryusuke Ae ◽  
Nobuko Makino ◽  
Koki Kosami ◽  
Yuri Matsubara ◽  
Yosikazu Nakamura
Keyword(s):  
Kawasaki Disease ◽  
Large Scale ◽  
Nationwide Survey ◽  
Developed Countries ◽  
Annual Number ◽  
Cardiac Complications ◽  
Large Scale Data ◽  
Number Of Patients ◽  
Using Data ◽  
Epidemiologic Characteristics

Abstract Background Kawasaki disease (KD) is the most common cause of acquired pediatric heart disease in developed countries. The study aimed to summarize the epidemiologic characteristics, treatments, and cardiac complications of KD, using data from the nationwide survey in Japan. Methods The nationwide survey in Japan has been conducted biennially since 1970. The survey respondents were hospitals specializing in pediatrics and those with ≥100 beds and a pediatric department throughout Japan, where KD patients were eventually hospitalized. The most recent survey was completed in 2019, obtaining information for patients who developed KD during 2017–2018. Results The survey identified 32528 KD patients, which comprised 15164 (47%) in 2017 and 17364 (53%) in 2018. The highest annual incidence rate was recorded in 2018 (359 per 100,000 children aged 0–4 years). After 1982, patients with ≤4 principal KD signs increased, resulting in 6847 (21%) patients diagnosed during 2017–2018. Among 30784 patients who received initial intravenous immunoglobulin administration, 6061 (20%) did not respond. Within 30 days of KD onset, 9.0% of patients were diagnosed with cardiac complications, and consequently, 2.6% of patients developed cardiac sequelae after the acute illness. Conclusions The annual number of patients developing KD in Japan increased from 1970 through 2018, while the proportion of KD patients with cardiac complications decreased. Recent advances in KD treatments might have contributed to preventing the development of cardiac complications. Key messages We analyzed large-scale data and summarized the epidemiologic characteristics, treatments, and cardiac complications of KD in Japan.

scholarly journals Diagnosis of Incomplete Kawasaki Disease in Infants Based on an Inflammation at the Bacille Calmette-Guérin Inoculation Site

2012 ◽  
Vol 42 (12) ◽  
pp. 823 ◽  
Author(s):  
Ji Hye Seo ◽  
Jeong Jin Yu ◽  
Hong Ki Ko ◽  
Hyung Soon Choi ◽  
Young-Hwue Kim ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Incomplete Kawasaki Disease ◽  
Bacille Calmette Guerin ◽  
Inoculation Site

Kawasaki Disease Patients With Redness or Crust Formation at the Bacille Calmette-Guérin Inoculation Site

2010 ◽  
Vol 29 (5) ◽  
pp. 430-433 ◽  
Author(s):  
Ritei Uehara ◽  
Hiroshi Igarashi ◽  
Mayumi Yashiro ◽  
Yosikazu Nakamura ◽  
Hiroshi Yanagawa
Keyword(s):  
Kawasaki Disease ◽  
Crust Formation ◽  
Bacille Calmette Guerin ◽  
Inoculation Site

Abstract 200: Afebrile Kawasaki Disease Beyond Diagnostic Guideline Evolving Coronary Artery Complication

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Sun Hwa Lee ◽  
Na Yeon Kim
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Diagnostic Algorithm ◽  
Clinical Feature ◽  
Z Score ◽  
Bacille Calmette Guerin ◽  
Inoculation Site ◽  
Diagnostic Guideline ◽  
Specific Finding

Kawasaki disease (KD) is diagnosed with clinical features. Presence of at least five days of fever is major criteria. Herein we report a 7 month -old boy diagnosed as afebrile kawasaki disease who initially presented with inflammation at the Bacille Calmette-Guerin (BCG) inoculation site (BCGitis) with multiple erythematous papular rash, followed by desquamation of finger tips at 11 day of illness. Laboratory test showed elevated ALT (110 U/L) and otherwise showed no specific finding. Clinical feature disappeared spontaneously except BCGitis. The patient did not fulfill the diagnostic criteria but progressive coronary arterial dilatation was noticed. Left coronary artery (LMCA) was dilated from Z-score 1.6 (3 day of illness) to 2.8 (11 day of illness). After treated with intravenous immunoglobulin (2g/kg), BCGitis disappeared and follow up echocardiogram showed normalized LMCA lesion (Z-score 1.0 at 17 day of illness). BCGitis was considered to be pathognomonic feature of this patient. Diagnostic algorithm and guidelines are useful tool for the incomplete KD patients but clinicians should also be cautious for the patient with BCGitis even they are excluded by diagnostic guideline.

Abstract 125: Steroid Treatment in the Acute Phase of Kawasaki Disease in Mexican Children. Are they Useful?

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Miguel Garcia-Dominguez ◽  
Luis M Garrido-Garcia
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Initial Treatment ◽  
Ivig Treatment ◽  
Cardiac Complications ◽  
Primary Therapy ◽  
Coronary Artery Aneurysms ◽  
Steroid Group ◽  
Increased Risk

Background: Intravenous immunoglobulin (IVIG) and aspirin is the standard initial therapy in the treatment of Kawasaki disease (KD), which is proven to decrease the incidence of coronary artery aneurysms from 25% to less than 5%. There is increasing evidence for steroid therapy as adjunctive primary therapy with IVIG especially in those patients who are at increased risk of coronary artery aneurysms and in patients with risk of IVIG resistance. However, clinical trials evaluating the use of corticosteroids plus IVIG have produced confusing results. Objective: To evaluate the clinical efficacy and safety of steroids plus intravenous immunoglobulin (IVIG) combination therapy (IVIG+S) for the initial treatment of patients with KD to prevent coronary artery aneurysms (CAA) compared with the standard treatment with intravenous immunoglobulin plus aspirin (IVIG+A) in a Children’s Hospital in Mexico City. Material and Methods: An observational, comparative, retrospective and case-control study of all patients treated with IVIG for KD in our Institution from August 1995 to May 2014. The clinical presentation, laboratory results and coronary artery abnormalities in the IVIG+S and the IVIG+A groups were analyzed and compared. Results: We studied 295 patients with KD treated with IVIG, 136 (46.1%) received IVIG+A treatment and 159 (53.9%) received IVIG+S treatment. We didn’t found adverse reactions in the patients treated with steroids. The IVIG+S group were older 43.25 ± 43.04 than the non-steroid group 32.07 ± 24.51 (p < 0.008). Steroids were commonly use in incomplete cases (p < 0.059) and in patients with cardiac complications at diagnosis: pericardial effusion (p < 0.056) and pericarditis (p < 0.013). The steroid group has slightly more days of fever after the IVIG treatment 1.27 ± 1.51 days vs. 0.93 ± 0.924 days (p < 0.028). We found no difference in the development of CAA in both groups. (p = 0.221) Conclusions: There were no differences in the development of CAA with the use of steroids in the initial treatment of KD. Nevertheless steroids were used more commonly in incomplete forms of KD and in more severely affected patients, which could reflect the lack of difference in the development of CAA in both groups.

scholarly journals Analysis of factors associated with development of Bacille Calmette–Guérin inoculation site change in patients with Kawasaki disease

2018 ◽  
Vol 46 (4) ◽  
pp. 1640-1648 ◽  
Author(s):  
Tooru Araki ◽  
Aya Kodera ◽  
Kunimi Kitada ◽  
Michimasa Fujiwara ◽  
Michiko Muraoka ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Severity ◽  
Bacille Calmette Guerin ◽  
Bcg Vaccination ◽  
Factors Associated ◽  
Patient Demographics ◽  
Site Change ◽  
Inoculation Site ◽  
Group A ◽  
Echocardiographic Findings

Objective The present study was performed to identify factors associated with a Bacille Calmette–Guérin (BCG) inoculation site change in patients with Kawasaki disease (KD). Methods Among patients who had received BCG vaccination and treatment for KD at our hospital from 2005 through 2016, 177 patients born in 2005 through 2016 were enrolled. The patients were divided into those with (n = 83, change group) and without (n = 94, no-change group) a BCG site change, and the patient demographics, clinical severity, blood examination results, and echocardiographic findings were compared between the two groups. Results The change group was younger at onset and had a shorter interval from vaccination to onset. A BCG site change was observed in patients who developed the onset of KD symptoms from 31 to 806 days after BCG vaccination. Multivariate analysis showed that the interval from vaccination was closely and positively associated with the BCG site change (hazard ratio = 0.995, 95% confidence interval = 0.993–0.997). Conclusion A BCG site change in patients with KD is most closely associated with the interval from BCG vaccination to onset.

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