33 Epidemiological Patterns and Treatment plan for Kawasaki Disease in Kids
Guided by - Gulnaz Osmonova, Department of Child Diseases, Osh, Kyrgyzstan
Chubastri. B.M, Henna Sabi, Hariraj Megha,Ansari Mohd Hamid,Alam Mahboob
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Abstract
Kawasaki Disease (KD) is a sudden-onset blood vessel problem that usually hits kids under five. It's the main reason kids in rich countries get heart disease after birth. Even after all thistimeresearching, we still don't know exactly what causes it. What we do know is there is a chanceit'sa mix of genes and something in the environment that starts it. KD is happening moreoftenaround the world, mostly in East Asia. One of the main treatments is to give intravenousimmunoglobulin (IVIG) and aspirin early on. This has made a surprising difference inakid'schances of getting artery problems and dealing with death. This article covers what weknowabout who's getting KD, what might cause it, and ways to treat it based on new studies. Introduction
Back in 1967, a doctor in Japan named Tomisaku Kawasaki first told us about KD. It's whenthebody's blood vessels get inflamed, from the small ones to the medium-sized ones. Thisis
especially true for the heart's blood vessels (Kawasaki, 1967). Most kids who get it are little, likeunder five years old .They get a fever that won't go away for five days, red eyes, their mouthandskin get irritated, they get a rash, their glands swell, and their hands and feet change color andpeel. The biggest worry is that their heart's blood vessels can balloon up, called aneurysms. Thishappens in about 25% of kids who don't get treated . Even though treatments have gottenbetter, KD is still a tricky thing to handle since it's happening more often, and we don't really get what'sbehind it. Where It's Happening: Global Trends
KD isn't the same everywhere. Japan has the highest numbers, with over 370 kids out of 100,000getting it before they turn five .For about 40 years, records have shown that KD is slowly goingup, with peaks every few years .Places like South Korea (260–300 per 100,000) and Taiwan (200per
100,000) have similar numbers . But in North America and Europe, the numbers are way lower, like 20–30 per 100,000 kids. Africa and parts of South Asia have even fewer, under 10per
100,000, but that might be because they don't always spot it .
In India, they're getting better at knowing about KD, and hospital studies show that around5to10 out of 100,000 kids get it. In the States, from 2010 to 2020, it stayed pretty steady at about 25per 100,000, and boys get it more than girls do. What this tells us is that KD likes East Asia, but it
also is a disease from everywhere, hitting all types of folks
Interpretation:
This line grap visualize the global incidence of KD from 2010 to 2023 for specified five countries. - Highest in East Asia
- Japan consistently Shows world's highest rate. - India, africa and latin America are seen rising trends due to better diagnosis. Who Gets It: Age, Gender, and Background
KD mostly picks on little ones, around 1.5 to 2 years old. Most cases, like 85%, turn up beforefiveyears old .Boys are a bit more likely to get it than girls, like 1.5 boys for every girl. If you'reakidfrom Japan, Korea, or China, you're more at risk, even if you don't live there. That's a signthat
genes have something to do with it. Studies have found some genes linked to KD, such as ITPKC, CASP3, FCGR2A, and BLK. These genes control how the body handles the immune systemandactivates cells . Babies under six months don't get KD as often, probably because they still have protectionfromtheir moms. Older kids over five might be past the age where their body can get it as easy nowthat they've been exposed to things and built an immunity.
Interpretation :
This stacked bar chart represent the age and sex distribution of Kawasaki diseaseas
-Peak incidence occurs in 1-2 year old children
- males predominate with a male to female ratio ~1.6:1. When It Happens: Seasons and Time
KD tends to show up at certain times of the year. In Japan, Korea, and the US, it spikes inwinter
and early spring, with a smaller bump during the summer . The time of the year may point tosome germ causing it. Also, looking at where the air comes from shows that windsfromNortheast China can cause KD clusters in Japan, hinting that something in the air or environment
triggers it .Over the past 30 years, KD has steadily gone up, because we do a better job spottingit, and maybe the environment has been changing.
Interpretation:
This clustered bar chart represent the seasonal variation of KD across major
countries. -Winter-Spring peaks are see globally, consistent with infections hypotheses. What Causes It: Ideas and How It Works
Even though people have been scratching their heads, we still aren't all the way sure preciselywhat starts KD. Right now, one common thought involves a mix of things that acts as triggersfor
people who are already more at risk to get sick. The germ idea says that something spreadingfrom person to person may be the case here based on when and where it shows up, sowecanthen assume that viruses like adenoviruses, coronaviruses, parvovirus B19 can cause it. Also, bacterial superantigens made by Staphylococcus aureus and Streptococcus pyogenes arealsolikely . With KD, the body's defense system goes wild, attacking blood vessels, causing a stormof
chemicals and widespread problems with the arteries. Inflammatory cytokines like IL-6, IL-1β, TNF-α, and MCP-1 spike during the start of the process . If your immune signaling pathwaysarealready wired a certain way because of your genes, like with ITPKC and FCGR2A, this canmakethat attack happen even stronger, making your blood vessels more likely to get damaged. It may sound like a weird thing, but when kids had Multisystem Inflammatory Syndrome(MIS-C)
during COVID-19, it was similar to KD and just confirmed that viruses could play aroleintriggering hyperinflammation. Studies see high signs of these inflammatory and bloodvessel
problems that are common with KD, so it shows that they share the immune make up . How Bad It Is: Deaths and Health Problems
Before folks turned to IVIG therapies, about 25% of kids with KD turned out to get arteryaneurysms which brings with it long-term heart problems . Currently, the IVIG treatment hastimely decreased the odds of this risk to nearly 5% . Death rates are now less than 0.2%indeveloped countries. In other regions, there are often delays in these diagnosis due to their lackof timely healthcare. Heart issues are a major factor that impact the possibilities of positive results. Giant aneurysmshave a really high chance of causing blood clots and heart attacks. Long-termfollowupsinJapan had patients with severe heart complications that continued to have ischemicheart
disease as adults . Therefore, early detection and management are highly recommended.
Interpretation :
This graph visualize death rate for Kawasaki disease in Specified countries. What We Do: Treatment Plans
Intravenous Immunoglobulin (IVIG)
To make sure that KD risks lower it needs to be handled in the first 10 days of whentheindividual gets sick. Now the method is to administer IVIG treatment. This is where yougivesomeone 2 g/kg infused medication within 10-12 hours . The IVIG treatment will helptheimmune responses by restraining anti-inflammatory cytokines . Clinical trials also showcasehowIVIG therapy decreases the chance of coronary artery aneurysms from25%to about 5%. Although the side outcome is that about 10%/20% of patients have an IVIG resistance becausethey still have a fever of >36 hours in which something more has to bedone.
interpretation:
This dual axis clustered bar chart represents the corona artery complications rate and mortalityrate
- Early 1V1G dramaticall reduces cardiac complications. - Biologic therapies further improve prognosis in resistent cases. Aspirin
Aspirin acts as both Anti-inflammatory and antiplatelet . In acute conditions high-dose aspirinisbeing administered(30mg-50mg/kg per day) until a child does not have a fever for at least 48hours then the dose goes down to a low dose aspirin which lasts around 6-8 weeks . Studieshave suggested that anti-inflammatory traits in Aspirin may assist but may not matter toomuchtowards coronary outcomes when IVIG gets administered quickly . The low does aspirinisanecessity since this helps prevent thrombosis. Corticosteroids
Corticosteroids , such as methylprednisolone are there to assist in IVIG resistant cases or highrisk patients with high CRP OR coronary dilation . RAISE trials highlight that combiningcorticosteroids with IVIG has reduced coronary complications . Biologic and Additional Therapies
For the IVIG Resistant kids , there are biologic agents that target cytokines and have proventobeefficient. One would be Infliximab which is an anti-TNF-alpha monoclonal antibody becauseit
helps reduce the fevers that last and can assist inflammation markers . There are other options, supported by clinical trials, such as Anakinra/ Cyclosprine. Echocardiographic assistance needs to happen to assist diagnosis at the 2 week mark, 6weekmark, and consistent monitoring. Patients who have giant aneurysms may need consistent
antithrombotic with warfarin or low-molecular-weight heparin.
Interpretation:
This graph shows treatment response% and complications rate%
- Effective combination therapy significantly reduces the mortality risks. Keeping It In Check: Public Health
KD could prove to be common if folks don't have the knowledge to identify the disease . Japanand South Korea have national KD registries that assist in this analysis .Awareness hastoberaised with the healthcare providers and especially parents. Research on climate can assist what
causes KD in association to infections . Conclusion
Kawasaki disease is found worldwide in pediatrics.There may be possible sources that causethis to trigger and associate to pathogenesis.There is also a reflection with an increase inAsiabecause of better recognition from diagnosis. To conclude, IVIG and Aspirin treatments, if takenrapidly, decrease complications associated with coronary risks. With the rise of these treatmentsthat are accessible to the public, that has definitely assisted the introduction of biologicstoaidwith resistance of IVIG patients. Continuous global assistance is a possibility and diagnosishasto be there for reducing disease. References
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