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Article ; Online: Diagnosis, Progress, and Treatment Update of Kawasaki Disease

Ho-Chang Kuo

International Journal of Molecular Sciences, Vol 24, Iss 13948, p

2023 Volume 13948

Abstract: Kawasaki disease (KD) is an acute inflammatory disorder that primarily affects children and can lead to coronary artery lesions (CAL) if not diagnosed and treated promptly. The original clinical criteria for diagnosing KD were reported by Dr. Tomisaku ... ...

Abstract	Kawasaki disease (KD) is an acute inflammatory disorder that primarily affects children and can lead to coronary artery lesions (CAL) if not diagnosed and treated promptly. The original clinical criteria for diagnosing KD were reported by Dr. Tomisaku Kawasaki in 1967 and have been used for decades. However, research since then has highlighted the limitations of relying solely on these criteria, as they might lead to underdiagnosis or delayed diagnosis, potentially increasing the risk of coronary artery complications. This review appears to discuss several important aspects related to KD diagnosis and management. The current diagnostic methods for KD might need updates, especially considering cases that do not fit the typical clinical criteria. Recognizing diagnostic pitfalls and distinguishing KD from other conditions that might have similar clinical presentations is essential. The differences and similarities between KD and Multisystem Inflammatory Syndrome in Children (MIS-C), another inflammatory condition that has been associated with COVID-19, were also reviewed. The review explores the potential role of eosinophil count, new biomarkers, microRNA panels, and scoring systems in aiding the diagnosis of KD. Overall, the review article provides a comprehensive overview of the evolving landscape of KD diagnosis and management, incorporating new diagnostic methods, biomarkers, and treatment approaches to improve patient outcomes and reduce the risk of complications.
Keywords	Kawasaki disease ; diagnosis ; biomarkers ; treatment ; eosinophil ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2023-09-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Preventing coronary artery lesions in Kawasaki disease

Ho-Chang Kuo

Biomedical Journal, Vol 40, Iss 3, Pp 141-

2017 Volume 146

Abstract: A form of systemic vasculitis that affects mostly small and medium-sized vessels, Kawasaki disease (KD) is most commonly found in children under the age of 5 years old. Though its etiology is unknown, KD has been the most frequent acquired heart disease ... ...

Abstract	A form of systemic vasculitis that affects mostly small and medium-sized vessels, Kawasaki disease (KD) is most commonly found in children under the age of 5 years old. Though its etiology is unknown, KD has been the most frequent acquired heart disease in developing countries. Its incidence has increased over recent decades in many centuries, including Japan, Korea, and China. The most severe complications of KD are coronary artery lesions (CAL), including dilation, fistula, aneurysm, arterial remodeling, stenosis, and occlusion. Aneurysm formation has been observed in 20–25% of KD patients that do not receive intravenous immunoglobulin (IVIG) treatment, and in 3–5% that do receive it. Coronary artery dilation has been found in about 30% of KD patients in the acute stage, although mostly in the transient form. Diminishing the occurrence and regression of CAL is a vital part of treating KD. In this review article, I demonstrate the clinical method to prevent CAL formation used at the Kawasaki Disease Center in Taiwan.
Keywords	Kawasaki disease ; Coronary artery lesion ; Prevention ; Medicine (General) ; R5-920 ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2017-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Effect of breastfeeding for 6 months on disease outcomes in patients with Kawasaki disease.

Mindy Ming-Huey Guo / I-Hsin Tsai / Ho-Chang Kuo

PLoS ONE, Vol 16, Iss 12, p e

2021 Volume 0261156

Abstract: Background Kawasaki disease (KD) is a systematic vasculitis that occurs predominantly in young children, and is the leading cause of acquired heart disease in children younger than five-years-old in developed countries. Although the etiology of KD is ... ...

Abstract	Background Kawasaki disease (KD) is a systematic vasculitis that occurs predominantly in young children, and is the leading cause of acquired heart disease in children younger than five-years-old in developed countries. Although the etiology of KD is unknown, it is believed to be an inflammatory disease resulting from abnormal immune responses to possible environmental or infectious stimuli in genetically predisposed individuals. Breast milk contains numerous anti-inflammatory factors which may protect against allergic and autoimmune diseases. In this study we tried to examine the effect of breastfeeding for 6 months or more on disease outcomes in patients with Kawasaki disease. Methods A retrospective cohort study of 249 KD patients admitted from 1999- 2013 who were older than 6 months at time of diagnosis and had data regarding breastfeeding in the first 6 months of life. Demographic, clinical and laboratory data was collected by chart review. Continuous data was compared using Student's t-test and categorical variables were compared using Chi-square. Stepwise multivariate regression of all demographic factors was performed. Results Breastfeeding for 6 months or more was associated with a shorter total duration of fever (5.980± 1.405 Vs. 6.910 ± 2.573 days, p = 0.001) and a lower risk of developing persistent coronary artery lesions (CALs) (7.8% Vs. 20.2%, p-value = 0.039) on univariate analysis. Multivariate regression of all factors associated with CALs including breastfeeding for 6 months found that only the presence of CALs at baseline (β-coefficient = 0.065, p < 0.001) and white blood count (β-coefficient = 0.065, p = 0.018) remained significant after regression analysis. Conclusions Breastfeeding for 6 months or more was associated with a shorter duration of fever and a lower risk of persistent CAL formation in patients with KD on univariate analysis, although this effect may be modest when other factors such as the presence of CALs at baseline and white blood cell count are also taken into consideration.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Risk Factors for Coronary Artery Lesionsin Kawasaki Disease Independent of Antibiotic Use in Chinese Children

Sixian Lao / Tao Zhou / Ho-Chang Kuo / Guoping Zhong / Weiwei Zeng

Frontiers in Public Health, Vol

2022 Volume 10

Abstract: ObjectivesTo study the impact of antibiotics used in Kawasaki disease (KD) with coronary artery lesions (CAL) and identify independent risk factors.MethodologyThis study reviewed the records of 287 KD patients between the years 2016 and 2020. Patients ... ...

Abstract	ObjectivesTo study the impact of antibiotics used in Kawasaki disease (KD) with coronary artery lesions (CAL) and identify independent risk factors.MethodologyThis study reviewed the records of 287 KD patients between the years 2016 and 2020. Patients were grouped by their outcome, the CAL group, and a no-coronary artery lesions (NCAL) group, and stratified by the use of antibiotics. We collected clinical and laboratory data before the intravenous immunoglobulin (IVIG) treatment.ResultsThe two groups of KD patients with and without CAL were compared. The results showed that there are significant differences between groups which were erythrocyte count (p = 0.045) and hemoglobin (p = 0.005), red blood cell-specific volume (p = 0.001), immature granular cells percentage (p = 0.006), total protein (p = 0.045), albumin (p = 0.041), alkaline phosphatase (p = 0.023), and chlorine (p = 0.006). After multivariate logistic regression, neutrophil granulocyte percentage (odds ratio [OR] = 1.200, 95% confidence interval [CI]: 1.008-1.428, p = 0.040), lymphocyte percentage (p = 0.028, OR = 1.243, 95% CI: 1.024-1.508, p = 0.028) and total protein (OR = 4.414, 95% CI: 1.092-17.846, p = 0.037) were found to be independent risk factors for CAL. After analyzing the cases with a history of antibiotic use, multivariate analysis showed no indicators were considered independent risk factors for CAL.ConclusionNeutrophil granulocyte percentage, Lymphocyte percentage and total protein were independent risks for CAL in KD without antibiotics use history. The use of antibiotics affected physiological indicators of KD patients.
Keywords	Kawasaki disease ; coronary artery lesions ; risk factors ; antibiotics ; children ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Impact of Onset Age on Eosinophils in Kawasaki Disease

Yu-Jhen Chen / Mindy Ming-Huey Guo / Ling-Sai Chang / Ho-Chang Kuo

Biomedicines, Vol 10, Iss 835, p

2022 Volume 835

Abstract: 1) Background: Kawasaki disease (KD) mainly affects children under the age of 5 years and eosinophilia in KD patients might be associated with the development of allergic diseases. We compared the age-adjusted Z-score (Z) of eosinophils and aimed to ... ...

Abstract	(1) Background: Kawasaki disease (KD) mainly affects children under the age of 5 years and eosinophilia in KD patients might be associated with the development of allergic diseases. We compared the age-adjusted Z-score (Z) of eosinophils and aimed to evaluate the impact of onset age on eosinophils in KD patients. (2) Methods: We divided 398 KD patients into seven age subgroups. Laboratory data and the age-adjusted Z-score of eosinophils during the phases of Kawasaki disease were analyzed. (3) Results: The absolute eosinophil count among all age groups showed significant differences in the post-intravenous immunoglobulin (IVIG) phase and throughout the course of KD with Z-score adjusted for age. Further analysis showed persistent elevation of the age-adjusted Z-score of eosinophils (Z-eosinophil) especially in the under six-month-old age subgroup. In addition, we divided the Z-eosinophil into two groups to find the relationship with coronary artery lesions (CALs). Patients with a higher eosinophil count than average age values had a higher risk of developing CALs, while those with a lower eosinophil count than average age values had a lower risk of having CALs. (4) Conclusions: These findings may provide information to clinicians to pay attention to allergic diseases during the follow-up of KD, especially for children who are younger than 6 months old at the onset of KD, and eosinophil count could be a crucial focus in KD.
Keywords	age ; eosinophil ; Kawasaki disease ; Z-score ; coronary artery lesion ; allergy ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: How Did the COVID-19 Pandemic Affect Population Mobility in Taiwan?

Shih-Feng Liu / Hui-Chuan Chang / Jui-Fang Liu / Ho-Chang Kuo

International Journal of Environmental Research and Public Health, Vol 19, Iss 10559, p

2022 Volume 10559

Abstract: Background: Coronavirus disease (COVID-19) impairs the free movement of human beings. The study aims to determine how the COVID-19 pandemic affected population mobility. Methods: The study obtained Google COVID-19 population mobility report and e Taiwan ... ...

Abstract	Background: Coronavirus disease (COVID-19) impairs the free movement of human beings. The study aims to determine how the COVID-19 pandemic affected population mobility. Methods: The study obtained Google COVID-19 population mobility report and e Taiwan COVID-19 pandemic information from Our World in Data. Results: During the Alpha wave, transit decreased the most, with an average difference of >50%, followed by parks, workplaces, groceries, and pharmacies. During the Omicron wave, the average population flow in parks and transit decreased by about 20%. During the pre-existing wave, the average population visits of transit decreased by 10% at the most, followed by parks and workplaces. The peak of daily new confirmed cases per million (7-day rolling average) was 25.02, 6.39, and 0.81 for Alpha, Omicron, and the pre-existing wave, respectively. Daily new confirmed cases per million people correlated with the change in population visits of various places (all p < 0.001). The reproduction rate (7-day rolling average) correlated with the change of population visits of most places, except retail and recreation. We conclude the Alpha variant affected more individuals than Omicron and pre-existing type. Furthermore, changes in population visits in transit were most impacted. This change was consistent with daily new confirmed cases per million people and reproduction rate (7-day rolling average). Conclusion: The Alpha variant affected more individuals than the Omicron and pre-existing types. Furthermore, changes in population visits in transit locations were most impacted. This change was consistent with the daily new number of confirmed cases per million people and the 7-day rolling average reproduction rate.
Keywords	population mobility ; COVID-19 ; pandemic ; Taiwan ; Alpha ; Omicron ; Medicine ; R
Subject code	333
Language	English
Publishing date	2022-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Expression of Eosinophilic Subtype Markers in Patients with Kawasaki Disease

Ling-Sai Chang / Kuang-Den Chen / Ying-Hsien Huang / Ho-Chang Kuo

International Journal of Molecular Sciences, Vol 23, Iss 10093, p

2022 Volume 10093

Abstract: Purpose: Eosinophils may rise to a higher level in the acute phase of Kawasaki disease (KD) both before and after intravenous immunoglobulin (IVIG) therapy. A substantial body of research was carried out on the association between KD and allergic ... ...

Abstract	Purpose: Eosinophils may rise to a higher level in the acute phase of Kawasaki disease (KD) both before and after intravenous immunoglobulin (IVIG) therapy. A substantial body of research was carried out on the association between KD and allergic diseases. Eosinophils play an important role in type 2 inflammation. Recent studies have shown that there are two distinct subtypes of eosinophils. In addition to their role in inflammation, lung-resident eosinophils (rEOS) also regulate homeostasis. Inflammatory eosinophils (iEOS) reflect type 2 inflammation in tissues. iEOS were considered the primary eosinophils in non-severe allergic asthma, while rEOS were thought to be the primary eosinophils in severe non-allergic eosinophilic asthma. This case–control study aimed to investigate the marker expression of eosinophilic subtypes in KD patients. Materials and Methods: The marker expressions of eosinophilic subtypes in the leukocytes of patients with KD were evaluated by the recently established KDmarkers online tool, a web server including gene expression data. Finally, the results were validated with a quantitative reverse transcriptase polymerase chain reaction (RT-PCR). We analyzed the mRNA expression levels of SELL and IL10RA in leukocytes from KD patients and febrile children. Results: Included in our screening tools were transcriptome arrays, which provided clues showing the importance of rEOS, whose role was identified by three genes (lower IL10RA , higher SELL, and SERPINB1 than controls). In contrast, the iEOS representative gene CD101 was not elevated in KD. It was found that the gene IL10RA , a marker of inflammatory eosinophilic leukocytes, was more highly expressed in the leukocytes of KD patients ( n = 43) than febrile controls ( n = 32), especially those without coronary artery lesions (CAL) ( n = 26). Before treatment, SELL expression was higher in leukocytes of CAL patients (CAL, 1.33 ± 0.18, n = 39; non-CAL, 0.87 ± 0.12, n = 55; p = 0.012). SELL was significantly higher after half a year compared to ...
Keywords	allergic diseases ; coronary artery lesions ; eosinophils ; IVIG ; Kawasaki disease ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2022-09-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Comparison of the Characteristics and Outcomes of Coronavirus Disease 2019 in Different Types of Family Infections in Taiwan

Shih-Feng Liu / Nai-Ying Kuo / Ho-Chang Kuo

Journal of Clinical Medicine ; Volume 9 ; Issue 5

2020

Abstract: Background: There were some family infections of coronavirus disease 2019 (COVID-19) in Taiwan to date. This study aimed to investigate the clinical characteristics and outcomes of different types of family infections with COVID-19 and to share Taiwan’ ...

Abstract	Background: There were some family infections of coronavirus disease 2019 (COVID-19) in Taiwan to date. This study aimed to investigate the clinical characteristics and outcomes of different types of family infections with COVID-19 and to share Taiwan’ s experience. Material and methods: We collected cases of family infections of COVID-19 from 21 January 2020 to 16 March 2020. The data were collected from a series of press conference contents by Taiwan’ s Central Epidemic Command Center (CECC). Results: During this period, there were six family infections in Taiwan, including two couple infections, one imported family cluster infection, and three domestic family cluster infections. Compared to the former two, the starters (cases 19, 24, and 27) of domestic family cluster infections showed longer symptom-onset to diagnosis (p = 0.02) longer symptom-onset to quarantine or isolation (p = 0.01) higher first-generation reproduction number (p = 0.03) and more critical presentation (endotracheal tube insertion and intensive care unit (ICU) care) (p < 0.01). In addition, compared to the former two, the starters of the latter were older, had no history of travel, and had more underlying diseases and more mortality. There are more contacts of domestic family cluster infections, making epidemiological investigations more difficult and expensive. However, the second-generation reproduction number of the above three families was zero. Conclusion: Domestic family cluster infections of COVID-19 have different characteristics and outcomes from couple infection and imported family cluster infections in this study.
Keywords	coronavirus disease 2019 ; imported family infections ; domestic family infections ; couple infections ; covid19
Subject code	610
Language	English
Publishing date	2020-05-19
Publisher	Multidisciplinary Digital Publishing Institute
Publishing country	ch
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Comparison of the Characteristics and Outcomes of Coronavirus Disease 2019 in Different Types of Family Infections in Taiwan

Shih-Feng Liu / Nai-Ying Kuo / Ho-Chang Kuo

Journal of Clinical Medicine, Vol 9, Iss 1527, p

2020 Volume 1527

Abstract	Background: There were some family infections of coronavirus disease 2019 (COVID-19) in Taiwan to date. This study aimed to investigate the clinical characteristics and outcomes of different types of family infections with COVID-19 and to share Taiwan’s experience. Material and methods: We collected cases of family infections of COVID-19 from 21 January 2020 to 16 March 2020. The data were collected from a series of press conference contents by Taiwan’s Central Epidemic Command Center (CECC). Results: During this period, there were six family infections in Taiwan, including two couple infections, one imported family cluster infection, and three domestic family cluster infections. Compared to the former two, the starters (cases 19, 24, and 27) of domestic family cluster infections showed longer symptom-onset to diagnosis ( p = 0.02); longer symptom-onset to quarantine or isolation ( p = 0.01); higher first-generation reproduction number ( p = 0.03); and more critical presentation (endotracheal tube insertion and intensive care unit (ICU) care) ( p < 0.01). In addition, compared to the former two, the starters of the latter were older, had no history of travel, and had more underlying diseases and more mortality. There are more contacts of domestic family cluster infections, making epidemiological investigations more difficult and expensive. However, the second-generation reproduction number of the above three families was zero. Conclusion: Domestic family cluster infections of COVID-19 have different characteristics and outcomes from couple infection and imported family cluster infections in this study.
Keywords	coronavirus disease 2019 ; imported family infections ; domestic family infections ; couple infections ; Medicine ; R ; covid19
Subject code	610
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cognitive development of children with Kawasaki disease and the parenting stress of their caregivers in Taiwan

Liang-Jen Wang / Ho-Chang Kuo / Zi-Yu Tsai / Ling-Sai Chang

BMJ Open, Vol 11, Iss

a case–control study

2021 Volume 6

Abstract: Objective Kawasaki disease (KD) is an acute form of febrile vasculitis that occurs in early childhood. The multisystemic vasculitis common in patients with KD may influence blood perfusion in the brain, and thus caregivers of children with KD may feel ... ...

Abstract	Objective Kawasaki disease (KD) is an acute form of febrile vasculitis that occurs in early childhood. The multisystemic vasculitis common in patients with KD may influence blood perfusion in the brain, and thus caregivers of children with KD may feel stress with regard to caring for them. Intravenous immunoglobulin (IVIG) infusion is the standard treatment for acute KD, and the most serious complication of KD is coronary artery aneurysms (coronary artery lesion (CAL)). This study aimed to investigate the relationships between KD heterogeneity and the risk of patients’ cognitive impairment or caregivers’ parenting stress.Design A case–control study with consecutive sampling.Setting A medical centre (Kaohsiung Chang Gung Memorial Hospital, Taiwan).Participants This study consisted of 176 patients with KD (mean age: 5.5 years, 60.8% boys) and 85 healthy children (mean age: 6.4 years, 54.1% boys).Primary and secondary outcome measures Based on the children’s age, each patient with KD and control subject was administered an assessment using the Mullen Scales of Early Learning or the Wechsler Intelligence Scale, and parenting function of their caregivers was assessed using the Parenting Stress Index (PSI)-Short Form.Results We observed no significant differences in any developmental index, cognitive function or parenting stress between patients with KD and controls. Among the children with KD, IVIG administration nor CAL was associated with children’s cognitive scores. However, the caregivers of patients who had CAL suffered from greater PSI total scores than those of patients without CAL. Furthermore, the caregivers who had education levels of a master’s degree or above showed less parenting stress than those who had an education level of college or lower.Conclusion Caregivers’ education is associated to parenting stress, and caregivers of patients with KD who developed CAL may feel stress about the unpredictable sequela caused by CAL for their children. Such caregivers may require support to fulfil their parenting ...
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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