J Korean Med Sci.  2004 Aug;19(4):501-504. 10.3346/jkms.2004.19.4.501.

Inflammatory Processes in Kawasaki Disease Reach their Peak at the Sixth Day of Fever Onset: Laboratory Profiles According to Duration of Fever

Affiliations
  • 1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. leekyungyil@catholic.ac.kr

Abstract

We evaluated the inflammatory indices according to the fever duration in children with Kawasaki disease (KD), and determined duration when the inflammatory processes in KD reach their peak. Children with KD (n=152) were classified into 7 groups according to fever duration: at the third day or earlier (n=20), fourth (n=33), fifth (n=46), sixth (n=15), seventh (n=15), eighth (n=9), and at the ninth day or later after fever onset (n= 14). The levels of various laboratory indices were determined 3 times: before, 24 hr and 7 days after intravenous immunoglobulin administration (2 g/kg). WBC and neutrophil counts, and C-reactive protein level were the highest at the sixth day. Levels of hemoglobin, albumin, and high density lipoprotein cholestrol were the lowest at the sixth day. Although these indices were not significant statistically between groups, the indices showed either bell-shaped or U-shaped distribution of which peak or trench were at the sixth day. These findiugs showed that the inflammatory processes in KD reach peak on the sixth day of fever onset. This finding is important because a higher single-dose intravenous immunoglobulin treatment before the peak day may help reduce the coronary artery lesions in KD.

Keyword

Mucocutaneous Lymph Node Syndrome; Kawasaki Disease; Immunoglobulins Intravenous; Inflammation; C-Reactive Protein; Leukocytes

MeSH Terms

Child, Preschool
Coronary Vessels/pathology
Female
*Fever/blood
Humans
Immunoglobulins, Intravenous/therapeutic use
Infant
*Inflammation/blood/immunology
Male
*Mucocutaneous Lymph Node Syndrome/blood/immunology/pathology/therapy
Time Factors

Cited by  1 articles

Kawasaki Disease: Laboratory Findings and an Immunopathogenesis on the Premise of a "Protein Homeostasis System"
Kyung-Yil Lee, Jung-Woo Rhim, Jin-Han Kang
Yonsei Med J. 2012;53(2):262-275.    doi: 10.3349/ymj.2012.53.2.262.


Reference

1. Kawasaki T. Acute, febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967. 16:178–222.
2. Sundel RP, Newberger JW. Kawasaki disease. Curr Opin Infect Dis. 1992. 5:664–669.
Article
3. Rowley AH, Gonzalez-Crussi F, Shulman ST. Kawasaki syndrome. Rev Infect Dis. 1988. 10:1–15.
Article
4. Abe J, Kotzin BL, Jujo K, Melish ME, Glode MP, Kohsaka T, Leung DY. Selective expansion of T cells expressing T-cell receptor variable regions Vβ2 and Vβ8 in Kawasaki disease. Proc Natl Acad Sci USA. 1992. 89:4066–4070.
5. Lee KY, Lee HS, Hong JH, Han JW, Lee JS, Whang KT. High-dose intravenous immunoglobulin down-regulates the activated levels of inflammatory indices except erythrocyte sedimentation rate in acute stage of Kawasaki disease. J Trop Pediatr. 2004. in press.
Article
6. Furusho K, Kamiya T, Nakano H, Kiyosawa N, Shinomiya K, Hayashidera T, Tamura T, Hirose O, Manabe Y, Yokoyama T. High dose intravenous gamma globulin for Kawasaki disease. Lancet. 1984. 2:1055–1058.
7. Newburger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ, Colan SD, Duffy CE, Fulton DR, Glode MP. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of Kawasaki syndrome. N Engl J Med. 1991. 324:1633–1639.
8. Hicks RV, Melish ME. Kawasaki syndrome; Rheumatic complains and analysis of salicylate therapy. Arthritis Rheum. 1979. 22:621–622.
9. Japan Kawasaki Disease Research Committee. Diagnostic guidelines of Kawasaki disease. 1984. 4th ed. Tokyo: Japan Kawasaki Disease Research Committee.
10. Kushner I. C-reactive protein and the acute-phase response. Hosp Pract. 1990. 25:21–28.
11. Sammalkorpi K, Valtonen V, Kerttula Y, Nikkila E, Taskinen MR. Changes in serum lipoprotein pattern induced by acute infection. Metabolism. 1988. 37:859–865.
12. Newburger JW, Burns JC, Beiser AS, Loscalzo J. Altered lipid profile after Kawasaki syndrome. Circulation. 1991. 84:625–631.
Article
13. Nomura Y, Masuda K, Yoshinaga M, Sameshima K, Miyata K. Patients diagnosed with Kawasaki disease before the fifth day of illness have a high risk of coronary artery aneurysm. Pediatr Int. 2002. 44:353–357.
14. Tse SML, Silverman ED, McCrindle BW, Yeung RSM. Early treatment with intravenous immunoglobulin in patients with Kawasaki disease. J Pediatr. 2002. 140:450–455.
Article
15. Koren G, Lavi S, Rose V, Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr. 1986. 108:388–392.
Article
16. Beiser AS, Takahashi M, Baker AL, Sundel RP, Newburger JW. A predictive instrument for coronary artery aneurysms in Kawasaki disease. Am J Cardiol. 1998. 81:1116–1120.
17. Koyanagi H, Nakamura Y, Yanagawa H. Lower level of serum potassium and higher level of C-reactive protein as an independent risk factor for giant aneurysms in Kawasaki disease. Acta Paediatr. 1998. 87:32–36.
Article
18. Lee KY, Han JW, Lee JS, Whang KT. Alteration of biochemical profiles after high-dose intravenous immunoglobulin administration in Kawasaki disease. Acta Paediatr. 2002. 91:164–167.
Article
19. Lee GB, Lee JW, Lee KY. Prediction of intravenous immunoglobulin non-responders in patients with Kawasaki disease. Korean J Pediatr. 2004. 47:90–94.
20. Lee KY, Han JW, Lee HS, Hong JH, Hahn SH, Lee JS, Whang KT. Epidemiologic study of Kawasaki disease at a single hospital in Daejeon, Korea (1987 through 2000). Pediatr Infect Dis J. 2004. 23:52–55.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr