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[Clinical manifestations and effects of IVGG in patients with Kawasaki disease]
1Department of Pediatrics, Kaohsiung Medical College, Kaohsiung City, Taiwan, Republic of China.
Insights
Intravenous immunoglobulin (IVIG) combined with aspirin significantly reduces coronary artery abnormalities in Kawasaki disease patients compared to aspirin alone. Early IVIG treatment is key for better outcomes in pediatric Kawasaki disease.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery abnormalities are a major complication, necessitating effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of different intravenous immunoglobulin (IVIG) regimens combined with aspirin in preventing coronary artery abnormalities in pediatric patients with Kawasaki disease.
Main Methods:
- A retrospective study of 293 Kawasaki disease patients treated between 1984 and 1992.
- Patients were randomized into three groups: aspirin alone, aspirin with low-dose IVIG (400 mg/kg/day for 5 days), and aspirin with high-dose single IVIG (2 gm/kg).
- Prevalence of coronary artery abnormalities was compared across groups.
Main Results:
- Aspirin alone resulted in a 42.7% rate of coronary artery changes.
- Combined aspirin and IVIG (both low-dose and high-dose) significantly decreased coronary artery abnormalities to 22.5% and 21.4%, respectively (p < 0.05).
- High-dose single IVIG rapidly improved clinical symptoms and shortened hospitalization but showed no significant difference in preventing coronary aneurysms compared to multiple doses.
Conclusions:
- Early initiation of IVIG with aspirin is crucial for reducing the prevalence of coronary artery dilatation and aneurysms in Kawasaki disease.
- Both single high-dose and multiple low-dose IVIG regimens are effective when used with aspirin, with single high-dose offering faster symptom relief.
Abstract:
From Jan 1984 till Dec 1992, 293 patients--180 males and 113 females (M:F = 1.5:1)--with Kawasaki disease visited the Pediatric Department of Kaohsiung Medical College Hospital. The mean age from the total cases were 28.5 months (2 months-10 years). Fever was the most common clinical symptom, followed by dry cracked lips (93.5%), pharyngeal injection (92.8%) and conjunctivitis (90.5%). Only 62.6% of the total cases had cervical lymph node swelling of which the prevalence was higher than the previous report of the National Taiwan University Hospital in 1985. Two hundred and ninety-three cases were divided randomly into 3 groups according to the different treatment regimens. The first group of 199 cases whose coronary artery change occurred in 85 cases (42.7%), were treated with aspirin alone. The second group of 80 cases were treated with aspirin and IVGG 400 mg/kg/day for 5 consecutive days. The prevalence of coronary artery abnormalities was 22.5% (18/80). The third group of 14 cases were treated with aspirin and single high dose IVGG (2 gm/kg) for 10-12 hours. Coronary artery abnormalities occurred in 3 cases (21.4%). IVGG, initiated within 10 days of the onset of fever, in conjunction with aspirin decreased the prevalence of coronary artery dilatation and aneurysms significantly in comparison with treatment by the aspirin alone (p < 0.05). However, there was no difference in the prevalence of coronary aneurysm between the groups of single high dose and multiple doses, though the single high dose of IVGG can improve the clinical symptoms quickly and shorten the duration of hospitalization.