Kawasaki Hastalığında Güncel Gelişmeler

Year 2017, , 77 - 85, 01.05.2017

Hayrettin Hakan Aykan Süheyla Özkutlu

https://doi.org/10.5505/abantmedj.2017.49379

Abstract

Kawasaki hastalığı, daha önceleri mukokütanöz lenf nodu hastalığı veya infantil poliarteritis nodoza olarak da bilinen çocuklarda görülen akut febril bir hastalıktır. Hastalık, nedeni tam olarak bilinmeyen sistemik bir vaskülit olarak orta çaplı damar tutulumu ile seyreder ve çoğunlukla 5 yaş altı çocuklarda görülür. Kan damarları, cilt, muköz membranlar ve lenf nodları başta olmak üzere birçok organ sistemi etkilenir. En Nadir fakat en önemli etkilerinden biri kalp üzerinedir, tedavi edilmeyen çocuklarda fatal koroner arter anevrizmalarına neden olabilmektedir. Bu nedenle tanının erken konması, tedavinin zamanında ve uygun bir şekilde planlanması oldukça önemlidir. Bu derlemede ülkemizde de önemli bir morbidite nedeni olan Kawasaki hastalığının tanı, tedavi süreçleri ve prognostik özellikleri tartışılmıştır.

Keywords

Kawasaki, mukokutanöz lenf nodu hastalığı, tedavi

Recent Advances in Kawasaki Disease

Abstract

Kawasaki disease is an acute febrile disease inchildren formerly known as mucocutaneous lymphnode disease or infantilepolyarteritis nodosa. The disease, a systemic vasculitis of unknown etiology, in which the medium-sized blood vessels are affected, is frequently seen in children under five years of age. Organ systems, mainly the blood vessels, skin, mucous membranes, and lymph nodes are involved. The rarest but the most serious effect of the disease is on the heart, where it can cause fatal coronary artery aneurysms in untreated children. Therefore, early diagnosis, timely and appropriate treatment approach is very important. In this review, diagnosis, treatment processes and prognostic features of Kawasaki disease, also an important cause of morbidity in our country, were discussed.

Keywords

Kawasaki, Mucocutenous lymph node syndrome, treatment

References

• 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. Scuccimarri R. Kawasaki disease. Pediatr Clin North Am, 2012; 59:425-45.
• 3. Lin YT, Manlhiot C, Ching JC, Han RK, Nield LE, Dillenburg R, Pepelassis D, Lai LS, Smythe JF, Chahal N, Yeung RS, McCrindle BW. Repeated systematic surveillance of Kawasaki disease in Ontario from 1995 to 2006. Pediatr Int, 2010; 52:699-706.
• 4. Ozen S, Bakkaloglu A, Dusunsel R, Soylemezoglu O, Ozaltin F, Poyrazoglu H, Kasapcopur O, Ozkaya O, Yalcinkaya F, Balat A, Kural N, Donmez O, Alpay H, Anarat A, Mir S, GurGuven A, Sonmez F, Gok F. Childhood vasculitides in Turkey: a nationwide survey. Clin Rheumatol, 2007; 26:196-200.
• 5. Gulhan B, Kesici S, Beken S, Cilsal E, Kale G, Alehan D, Kara A, Ozen S. Varying clinical features of Turkish Kawasaki disease patients. Turk J Pediatr, 2012; 54:1-6.
• 6. Makino N, Nakamura Y, Yashiro M, Ae R, Tsuboi S, Aoyama Y, Kojo T, Uehara R, Kotani K, Yanagawa H. Descriptive epidemiology of Kawasaki disease in Japan, 2011-2012: from the results of the 22nd nationwide survey. J Epidemiol, 2015; 25:239-45.
• 7. Fujita Y, Nakamura Y, Sakata K, Hara N, Kobayashi M, Nagai M, Yanagawa H, Kawasaki T. Kawasaki disease in families. Pediatrics, 1989; 84:666-9.
• 8. De Ferranti SD, Newburger JW. Kawasaki disease (Mucocutaneous lymph node syndrome). In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (eds). Moss and Adams heart disease in infants, children, and adolescents: including the fetus and young adult (8th ed). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.
• 9. Son MBF, Newburger JW. Kawasaki disease. In: Kliegman R, Stanton BF, St Geme JW, Schor NF (eds). Nelson textbook of pediatrics (20th ed). Philadelphia: Saunders, 2016.
• 10. Barron K, DeCunto C, Montalvo J, Orson F, Lewis D. Abnormalities of immunoregulation in Kawasaki syndrome. J Rheumatol, 1988; 15:1243-9.
• 11. Onouchi Y, Gunji T, Burns JC, Shimizu C, Newburger JW, Yashiro M, Nakamura Y, Yanagawa H, Wakui K, Fukushima Y, Kishi F, Hamamoto K, Terai M, Sato Y, Ouchi K, Saji T, Nariai A, Kaburagi Y, Yoshikawa T, Suzuki K, Tanaka T, Nagai T, Cho H, Fujino A, Sekine A, Nakamichi R, Tsunoda T, Kawasaki T, Hata A. ITPKC functional polymorphism associated with Kawasaki disease susceptibility and formation of coronary artery aneurysms. Nat Genet, 2008; 40:35-42.
• 12. Fujiwara H, Hamashima Y. Pathology of the heart in Kawasaki disease. Pediatrics, 1978; 61:100-7.
• 13. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA. Diagnosis, treatment, and longterm management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation, 2004; 110:2747-71.
• 14. Printz BF, Sleeper LA, Newburger JW, Minich LL, Bradley T, Cohen MS, Frank D, Li JS, Margossian R, Shirali G, Takahashi M, Colan SD. Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inflammatory markers in acute Kawasaki disease. J Am Coll Cardiol, 2011; 57:86-92.
• 15. Tatara K, Kusakawa S. Long-term prognosis of giant coronary aneurysm in Kawasaki disease: an angiographic study. J Pediatr, 1987; 111:705-10.
• 16. Harada K. Intravenous gamma-globulin treatment in Kawasaki disease. Acta Paediatr Jpn, 1991; 33:805-10.
• 17. Baer AZ, Rubin LG, Shapiro CA, Sood SK, Rajan S, Shapir Y, Romano A, Bierman FZ. Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome. Arch Pediatr Adolesc Med, 2006; 160:686-90.
• 18. Newburger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ, Colan SD, Duffy CE, Fulton DR, Glode MP, et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med, 1991; 324:1633-9.
• 19. Wright DA, Newburger JW, Baker A, Sundel RP. Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr, 1996; 128:146-9.
• 20. Terai M, Shulman ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr, 1997; 131:888-93.
• 21. Ishii M, Ueno T, Akagi T, Baba K, Harada K, Hamaoka K, Kato H, Tsuda E, Uemura S, Saji T, Ogawa S, Echigo S, Yamaguchi T. Guidelines for catheter intervention in coronary artery lesion in Kawasaki disease. Pediatr Int, 2001; 43:558-62.
• 22. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, Kazue T, Eto G, Yamakawa R. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation, 1996; 94:1379-85.