Aggiornamento monografico
La gestione del bambino con malattia di Kawasaki: un approccio basato sull’evidenza
MANAGEMENT OF KAWASAKI DISEASE: AN EVIDENCE-BASED APPROACH
GIUSEPPE ORSO, RENATO VITIELLO, GIOVANNI NOCERINO E LUCIANO DE SETA
Unità Operativa Complessa, Servizio di Cardiologia Pediatrica, IV Pediatria, Ospedale SS. Annunziata, ASL Napoli 1
Aprile 2002 - pagg. 222 -229
Abstract
The aetiology of Kawasaki disease is unknown. The highest incidence is in children aged
less than 5 years. Its typical forms are diagnosed on the basis of criteria which include, in
addition to fever lasting more than 5 days, the presence of 4 additional signs (bilateral
conjunctivitis, laterocervical lymphadenomegaly, rash, mucositis, alterations of fingers and
toes). Atypical forms are relatively common and should always be taken into account in case
of persisting fever. Two atypical cases are reported. The assessment of coronary risk is
based on clinical and laboratory data. Treatment with immunoglobulins (2 g/kg) reduce
the risk of coronary aneurysms. In case of lack of response (10-20% of cases), a new dose
of immunoglobulins should be administered. The use of steroids in non-responders has recently
been proposed.
Parole chiave
Classificazione MeSH
Bibliografia
1. Rowley AH, Shulman ST. Kawasaki syndrome.
Pediatr Clin North Am 1999;46:313-9.
2. Tamburlini G, Strinati R, Cadorini S, et al. A two-year survey of mucocutaneous lymph node syndrome in northeastern Italy. Epidemiological and clinical findings. Helv Paediatr Acta 1984;39(4):319-29.
3. Hirata S, Nakamura Y, Yanagawa H. Incidence rate of recurrent Kawasaki disease and related risk factors: from the results of nationwide surveys of Kawasaki disease in Japan. Acta Paediatr 2001;90(1):40-4.
4. Yanagawa H, Yashiro M, Nakamura Y. Results of 12 nationwide epidemiological incidence surweys of Kawasaki disease in Japan. Arch Pediatr Adolesc Med 1995;149:779-83.
5. Nakamura Y, Yanagawa H, Harada K, et al. Mortality among persons with a history of Kawasaki disease in Japan: existence of cardiac sequelae elevated the mortality. J Epidemiol 2000;10(6):372-5.
6. Takahashi M. Kawasaki disease. Current Opinion in Pediatrics 1997;9:523-9.
7. Curtis N. Kawasaki disease. Early recognition is vital to prevent cardiac complication. BMJ 1997;315:322-3.
8. Fukushige J, Takahashi N, Ueda Y, Ueda K. Incidence and clinical features of incomplete Kawasaki disease. Acta Paediatr 1994;83(10): 1057-60.
9. Bodiou AC, Fraisse A, Dubus JC, Unal D. Maladie de Kawasaki: difficultés diagnostiques et indications therapeutiques chez le jeune nourrison. Arch Ped 1999;6(3):339-40.
10. Burns JC, Wiggins JW JR, Toews WH, et al. Clinical spectrum of Kawasaki disease in infants younger than 6 months of age. J Pediatr 1986;109(5):759-63.
11. Vitiello R, Arcieri G. Caso atipico di Kawasaki. Quaderni ACP. In corso di stampa.
12. Committee on Infectious Disease. American Academy of Pediatrics. Malattia di Kawasaki. Red Book (Ed. Italiana) 1997; pp 311-14.
13. Beiser AS, Takahashi M, Baker A. A predictive instrument for coronary artery aneurysm in Kawasaki disease. Am J Cardiol 1998; 81:1116-20.
14. Dajani AS, Taubert KA, Takahashi M, et al. Guidelines for long-term management of patients with Kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1994;89(2): 916-22.
15. Furusho K, Kamiya T, Nakano H, et al. High- dose intravenous gammaglobulin for Kawasaki disease. Lancet 1984;10;2(8411): 1055-8.
16. Kato H, Ichinose E, Yoshioka F, et al. Fate of coronary aneurysms in Kawasaki disease: serial coronary angiography and long-term follow- up study. Am J Cardiol 1982;49(7):1758- 66.
17. Kato H, Sugimura T, Akagi T, et al. Longterm consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996 Sep 15;94(6):1379-85.
18. Suzuki A, Kamiya T, Kuwahara N, et al. Coronary arterial lesions of Kawasaki disease: cardiac catheterization findings of 1100 cases. Pediatr Cardiol 1986;7(1):3-9.
19. Nienaber CA, Spielmann RP, Hausdorf G. Dipyridamole-thallium-201 tomography documenting improved myocardial perfusion with therapy in Kawasaki disease. Am Heart J 1988c;116(6 Pt 1):1575-9.
20. Prabhua AS, Singh TP, Morrow R. Safety and efficacy of intravenous adenosine for pharmacologic stress testing in children with aortic valve disease or Kawasaki disease. Am J Cardiol 1999;82:284-6.
21. Kim C, Kwok YS, Heagerty P, et al. Pharmacologic stress testing for coronary disease diagnosis: A meta-analysis. Am Heart J 2001; 142(6):934-44.
22. Silva AA, Maeno Y, Hashmi A, et al. Cardiovascular risk factors after Kawasaki disease: a case-control study. J Pediatr 2001;138(3): 400-5.
23. Newburger JW, Takahashi M, Beise AS. A single intravenous infusion of gammaglobulin as compared with four infusion in the treatment of acute Kawasaki syndrome. N Engl J Med 1991;324:1633-9.
24. Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986;7;315(6):341-7.
25. Moran AM, Newburger JW, Sanders SP, et al. Abnormal myocardial mechanics in Kawasaki disease: rapid response to gammaglobulin. Am Heart J 2000b;139(2 Pt 1):217-23.
26. Marasini M, Pongiglione G, Gazzolo D, et al. Late intravenous gamma globulin treatment in infants and children with Kawasaki disease and coronary artery abnormalities. Am J Cardiol 1991;15;68(8):796-7.
27. Rowley AH, Shulman ST. Current therapy for acute Kawasaki syndrome. J Pediatr 1991; 118(6):987-91.
28. Curtis N, Levine M. Kawasaki disease thirthy years on. Current Opinion in Pediatrics 1998;10:24-3.
29. Terai M, Shulman ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gammaglobulin dose but indipendent of salicylate dose. J Pediatr 1997;131:883-93.
30. Newburger JW. Treatment of Kawasaki disease. Lancet 1996;347:1128.
31. Matsubara T, Mason W, Kashani IA, et al. Gastrointestinal hemorrhage complicating aspirin therapy in acute Kawasaki disease. J Pediatr 1996;128(5 Pt 1):701-3.
32. Saphyakhajon P, Greene GR. Do we need high-dose acetylsalicylic acid (ASA) in Kawasaki disease. J Pediatr (letter)1998;July 167.
33. Han RK, Silverman ED, Newman A, Mc- Crindle BW. Management and outcome of persistent or recurrent fever after initial intravenous gamma globulin therapy in acute Kawasaki disease. Arch Pediatr Adolesc Med 2000;154(7):694-9.
34. Burns JC, Capparelli EV, Brown JA. Intravenous gammaglobulin treatment and retreatment in Kawasaki disease. Pediatr Inf Dis J 1998;17:1144-8.
35. Sundel RP, Burns JC, Baker A, Beiser AS, Newburger JW. Gamma globulin re-treatment in Kawasaki disease. J Pediatr 1993 Oct; 123(4):657-9.
36. Kato H, Koike S, Yokoyama T. Kawasaki disease: effect of treatment on coronary artery involvement. Pediatrics 1979 Feb;63(2):175-9.
37. Sone K, Tomomasa T, Morikawa A. Corticosteroids in the treatment of the acute phase of Kawasaki disease. J Pediatr 1999 Oct; 135(4):465-9.
38. Dale RC, Saleem MA, Daw S, Dillon MJ. Treatment of severe complicated Kawasaki disease with oral prednisolone and aspirin. J Pediatr 2000 Nov;137(5):723-6.
39. Wright DA, Newburger JW, Baker A, et al. Treatment of immunoglobulin resistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr 1996;128:146-9.
2. Tamburlini G, Strinati R, Cadorini S, et al. A two-year survey of mucocutaneous lymph node syndrome in northeastern Italy. Epidemiological and clinical findings. Helv Paediatr Acta 1984;39(4):319-29.
3. Hirata S, Nakamura Y, Yanagawa H. Incidence rate of recurrent Kawasaki disease and related risk factors: from the results of nationwide surveys of Kawasaki disease in Japan. Acta Paediatr 2001;90(1):40-4.
4. Yanagawa H, Yashiro M, Nakamura Y. Results of 12 nationwide epidemiological incidence surweys of Kawasaki disease in Japan. Arch Pediatr Adolesc Med 1995;149:779-83.
5. Nakamura Y, Yanagawa H, Harada K, et al. Mortality among persons with a history of Kawasaki disease in Japan: existence of cardiac sequelae elevated the mortality. J Epidemiol 2000;10(6):372-5.
6. Takahashi M. Kawasaki disease. Current Opinion in Pediatrics 1997;9:523-9.
7. Curtis N. Kawasaki disease. Early recognition is vital to prevent cardiac complication. BMJ 1997;315:322-3.
8. Fukushige J, Takahashi N, Ueda Y, Ueda K. Incidence and clinical features of incomplete Kawasaki disease. Acta Paediatr 1994;83(10): 1057-60.
9. Bodiou AC, Fraisse A, Dubus JC, Unal D. Maladie de Kawasaki: difficultés diagnostiques et indications therapeutiques chez le jeune nourrison. Arch Ped 1999;6(3):339-40.
10. Burns JC, Wiggins JW JR, Toews WH, et al. Clinical spectrum of Kawasaki disease in infants younger than 6 months of age. J Pediatr 1986;109(5):759-63.
11. Vitiello R, Arcieri G. Caso atipico di Kawasaki. Quaderni ACP. In corso di stampa.
12. Committee on Infectious Disease. American Academy of Pediatrics. Malattia di Kawasaki. Red Book (Ed. Italiana) 1997; pp 311-14.
13. Beiser AS, Takahashi M, Baker A. A predictive instrument for coronary artery aneurysm in Kawasaki disease. Am J Cardiol 1998; 81:1116-20.
14. Dajani AS, Taubert KA, Takahashi M, et al. Guidelines for long-term management of patients with Kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1994;89(2): 916-22.
15. Furusho K, Kamiya T, Nakano H, et al. High- dose intravenous gammaglobulin for Kawasaki disease. Lancet 1984;10;2(8411): 1055-8.
16. Kato H, Ichinose E, Yoshioka F, et al. Fate of coronary aneurysms in Kawasaki disease: serial coronary angiography and long-term follow- up study. Am J Cardiol 1982;49(7):1758- 66.
17. Kato H, Sugimura T, Akagi T, et al. Longterm consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996 Sep 15;94(6):1379-85.
18. Suzuki A, Kamiya T, Kuwahara N, et al. Coronary arterial lesions of Kawasaki disease: cardiac catheterization findings of 1100 cases. Pediatr Cardiol 1986;7(1):3-9.
19. Nienaber CA, Spielmann RP, Hausdorf G. Dipyridamole-thallium-201 tomography documenting improved myocardial perfusion with therapy in Kawasaki disease. Am Heart J 1988c;116(6 Pt 1):1575-9.
20. Prabhua AS, Singh TP, Morrow R. Safety and efficacy of intravenous adenosine for pharmacologic stress testing in children with aortic valve disease or Kawasaki disease. Am J Cardiol 1999;82:284-6.
21. Kim C, Kwok YS, Heagerty P, et al. Pharmacologic stress testing for coronary disease diagnosis: A meta-analysis. Am Heart J 2001; 142(6):934-44.
22. Silva AA, Maeno Y, Hashmi A, et al. Cardiovascular risk factors after Kawasaki disease: a case-control study. J Pediatr 2001;138(3): 400-5.
23. Newburger JW, Takahashi M, Beise AS. A single intravenous infusion of gammaglobulin as compared with four infusion in the treatment of acute Kawasaki syndrome. N Engl J Med 1991;324:1633-9.
24. Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986;7;315(6):341-7.
25. Moran AM, Newburger JW, Sanders SP, et al. Abnormal myocardial mechanics in Kawasaki disease: rapid response to gammaglobulin. Am Heart J 2000b;139(2 Pt 1):217-23.
26. Marasini M, Pongiglione G, Gazzolo D, et al. Late intravenous gamma globulin treatment in infants and children with Kawasaki disease and coronary artery abnormalities. Am J Cardiol 1991;15;68(8):796-7.
27. Rowley AH, Shulman ST. Current therapy for acute Kawasaki syndrome. J Pediatr 1991; 118(6):987-91.
28. Curtis N, Levine M. Kawasaki disease thirthy years on. Current Opinion in Pediatrics 1998;10:24-3.
29. Terai M, Shulman ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gammaglobulin dose but indipendent of salicylate dose. J Pediatr 1997;131:883-93.
30. Newburger JW. Treatment of Kawasaki disease. Lancet 1996;347:1128.
31. Matsubara T, Mason W, Kashani IA, et al. Gastrointestinal hemorrhage complicating aspirin therapy in acute Kawasaki disease. J Pediatr 1996;128(5 Pt 1):701-3.
32. Saphyakhajon P, Greene GR. Do we need high-dose acetylsalicylic acid (ASA) in Kawasaki disease. J Pediatr (letter)1998;July 167.
33. Han RK, Silverman ED, Newman A, Mc- Crindle BW. Management and outcome of persistent or recurrent fever after initial intravenous gamma globulin therapy in acute Kawasaki disease. Arch Pediatr Adolesc Med 2000;154(7):694-9.
34. Burns JC, Capparelli EV, Brown JA. Intravenous gammaglobulin treatment and retreatment in Kawasaki disease. Pediatr Inf Dis J 1998;17:1144-8.
35. Sundel RP, Burns JC, Baker A, Beiser AS, Newburger JW. Gamma globulin re-treatment in Kawasaki disease. J Pediatr 1993 Oct; 123(4):657-9.
36. Kato H, Koike S, Yokoyama T. Kawasaki disease: effect of treatment on coronary artery involvement. Pediatrics 1979 Feb;63(2):175-9.
37. Sone K, Tomomasa T, Morikawa A. Corticosteroids in the treatment of the acute phase of Kawasaki disease. J Pediatr 1999 Oct; 135(4):465-9.
38. Dale RC, Saleem MA, Daw S, Dillon MJ. Treatment of severe complicated Kawasaki disease with oral prednisolone and aspirin. J Pediatr 2000 Nov;137(5):723-6.
39. Wright DA, Newburger JW, Baker A, et al. Treatment of immunoglobulin resistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr 1996;128:146-9.