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Management of acute and refractory Kawasaki disease

Carline E Tacke1, David Burgner, Irene M Kuipers

  • 1Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, H7-230, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

Expert Review of Anti-Infective Therapy
|December 4, 2012
PubMed

Insights

Kawasaki disease (KD) treatment with IVIG significantly reduces coronary artery aneurysms. Steroids show promise for non-responders, but optimal management for refractory cases remains debated.

Area of Science:

  • Pediatric Cardiology
  • Immunology
  • Rheumatology

Background:

  • Kawasaki disease (KD) is a critical pediatric illness.
  • High-dose intravenous immunoglobulin (IVIG) is the standard treatment for acute KD.
  • IVIG significantly reduces the risk of coronary artery aneurysms.

Purpose of the Study:

  • To review current evidence for acute Kawasaki disease treatment.
  • To discuss management strategies for IVIG-nonresponsive KD patients.

Main Methods:

  • Literature review of studies on Kawasaki disease treatment.
  • Analysis of evidence for IVIG, aspirin, and adjunctive therapies.
  • Discussion of emerging treatments for non-responsive cases.

Main Results:

  • IVIG decreases coronary artery aneurysm incidence from 25% to <5%.
  • Steroid therapy shows potential as adjunctive treatment, particularly in Asian children.
  • 10-30% of patients exhibit resistance to initial IVIG therapy.

Conclusions:

  • Optimal treatment for IVIG-nonresponsive KD is controversial.
  • Management options include additional IVIG, corticosteroids, and other immunomodulatory agents.
  • Further research is needed to establish the best approach for refractory KD.

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