Article information
Resumen
La enfermedad de Kawasaki es una vasculitis sistémica de etiología desconocida que afecta principalmente a niños menores de 5 años. Es actualmente la primera causa de cardiopatía adquirida en la infancia en los países desarrollados, lo que la convierte en una enfermedad de suma trascendencia en el momento actual. No se conoce su etiología, aunque existen fuertes sospechas de que sea infecciosa. El diagnóstico se realiza por criterios clínicos de fiebre persistente de al menos 5 días de duración y 4 de 5 criterios clínicos: cambios en extremidades, exantemas polimorfos, inyección conjuntival no exudativa, cambios en los labios y la mucosa oral y adenopatías>1,5cm, habitualmente unilateral. La complicación más frecuente es la dilatación y los aneurismas de las arterias coronarias, la cual ocurre en el 20-25% de los niños no tratados. El tratamiento estándar de la enfermedad es con gammaglobulina intravenosa en dosis de 2g/kg, antes de los 10 días del comienzo de la enfermedad, más ácido acetilsalicílico oral en dosis antiinflamatorias. El riesgo de lesión coronaria en los niños tratados es del 3-5%.
Palabras clave:
Enfermedad de Kawasaki
Gammaglobulina
Aneurisma
Abstract
Kawasaki disease is a systemic vasculitis of unknow etiology that occurs predominantly in children under the age of 5 years. Kawasaki disease is the most common cause of acquired heart disease in children in the developed world. The exact cause has not yet been established but there is considerable support for it to be due to an infectious agent. The diagnosis of Kawasaki disease is based in clinical criteria: fever persisting at least 5 days and the presence of at least 4 principal features: changes of extremities, polymorphous exanthem, bilateral bulbar conjunctival injection without exudate, changes in lips and oral cavity and cervical lymphadenopathy>1.5cm, usually unilateral. The most common complication is coronary arterial aneurysm and coronay arterial dilatation that occurs in 20-25% untreated children. Standard treatment for Kawasaki disease include intravenous immunoglobulin as a single 2g/kg dose within the first 10 days and oral acetilsalycilic acid. The risk of coronary damage in treated patient is 3-5%.
Key words:
Kawasaki disease
Immunoglobulin
Coronary aneurysm
Full text is only aviable in PDF
Bibliografía
[1.]
T. Kawasaki.
Acute febrile mucocutaneous syndrome with lymphoid involvement with specific descamation of fingers and toes.
Jpn J Allerg, 16 (1967), pp. 178-222
[2.]
J.C. Burns, H.I. Kushner, J.F. Bastian, et al.
Kawasaki disease: a brief history.
Pediatrics, 106 (2000), pp. e27
[3.]
T. Kawasaki, F. Kosaki, Okawa, et al.
A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan.
Pediatrics, 54 (1974), pp. 271-276
[4.]
B.H. Landing, E.J. Larson.
Are infantile periarteritis nodosa with coronary artery involvement and fatal mucocutaneous lynph node syndrome the same? Comparison of 20 patients from North America with patients with Hawaii and Japan.
Pediatrics, 59 (1977), pp. 651-662
[5.]
J. De Inocencio Arocena, F. Del Castillo Martín.
La enfermedad de Kawasaki. Actualización en 14 preguntas.
Rev Esp Pediatr, 59 (2003), pp. 315-324
[6.]
F. Esper, E.D. Shapiro, C. Weibel, et al.
Association between a novel human Coronavirus and Kawasaki disease.
J Infect Dis, 191 (2005), pp. 499-502
[7.]
C. Shimizu, H. Shike, S.C. Baker, et al.
Human Coronavirus NL63 is not detected in the respiratory tracts of children with acute Kawasaki disease.
J Infect Dis, 192 (2005), pp. 1767-1771
[8.]
L.Y. Chang, B.L. Chiang, C.L. Kao, et al.
Lack of association between infection with a novel human Coronavirus (HCoV), HCoV-NH, and Kawasaki disease in Taiwan.
J Infect Dis, 193 (2006), pp. 283-286
[9.]
P.M. Schlievert.
Role of superantigens in human disease.
J Infect Dis, 167 (1993), pp. 997-1002
[11.]
J. Abe, B.L. Kotzin, K.C. Jujo, et al.
Selective expansion of T cells expresing T-cell receptor variable region Vb2 and Vb8 in Kawasaki disease.
Proc Natl Acad Sci USA, 89 (1992), pp. 4066-4070
[12.]
J. Abe, B.L. Kotzin, C. Meissner, et al.
Characterization of T cell repertoire changes in acute Kawasaki disease.
J Exp Med, 177 (1993), pp. 791-796
[13.]
D.Y.M. Leung, H.C. Meissner, D.R. Fulton, et al.
Toxic shock syndrome toxin-secreting Staphylococcus aureus in Kawasaki syndrome.
Lancet, 342 (1993), pp. 1385-1387
[14.]
B.A. Pietra, J. De Inocencio, E.H. Giannini, et al.
T cell receptor Vß family repertoire and T cell activation markers in Kawasaki disease.
J Immunol, 153 (1994), pp. 1881-1888
[15.]
M.E. Melish, J. Parsonett, N. Marchette.
Kawasaki syndrome (KS) is not caused by toxic shock syndrome toxin-1 (TSST-1)+Staphylococci.
Pediatr Res, 35 (1994), pp. A187
[16.]
L. Mancia, J. Wahlström, B. Schiller.
Characterization of the T-cell receptor V-ß repertoire in Kawasaki disease.
Scand J Immunol, 48 (1998), pp. 443-449
[17.]
A.H. Rowley, C.A. Eckerley, H.M. Jäck, et al.
IgA plasma cells in vascular tissue of patients with Kawasaki syndrome.
J Immunol, 159 (1997), pp. 5946-5955
[18.]
A.H. Rowley, S.T. Shulman, B.T. Spike, et al.
Oligonal IgA response in vascular wall in acute Kawasaki syndrome.
J Immunol, 166 (2001), pp. 1334-1343
[19.]
A.H. Rowley, S.C. Baker, S.T. Shulman, et al.
Cytoplasmic inclusion bodies are detected by synthetic antibody in ciliated bronchial epithelium during acete Kawasaki disease.
J Infect Dis, 192 (2005), pp. 1757-1766
[20.]
T. Yoshioka, T. Matsutani, T. Toyosaki-Maeda, et al.
Relation of streptococcal pyrogenic exotoxin C as a causative superantigen for Kawasaki disease.
Pediatr Res, 53 (2003), pp. 403-410
[21.]
A.H. Rowley.
The etiology of Kawasaki disease: superantigen or conventional antigen?.
Pediatr Infect Dis J, 18 (1999), pp. 69-70
[22.]
M. Takahashi.
The endothelium in Kawasaki disease: the next frontier.
J Pediatr, 133 (1998), pp. 177-179
[23.]
C.E. Canter, R.J. Bower, A.W. Strauss.
Atipical Kawasaki disease with aortic aneurysm.
Pediatrics, 68 (1981), pp. 885-887
[24.]
S. Tomita, K. Chug, M. Mas, et al.
Peripherical gangrene associated with Kawasaki disease.
Clin Infect Dis, 14 (1992), pp. 121-126
[25.]
F. Del Castillo Martín.
Enfermedad de Kawasaki.
Urgencias y tratamiento del niño grave, pp. 421-426
[26.]
J.C. Burn, M.P. Glodé.
Kawasaki syndrome.
Lancet, 364 (2004), pp. 533-544
[27.]
H. Fujiwara, Y. Hamashima.
Pathology of Kawasaki disease.
Pediatrics, 61 (1978), pp. 100-107
[28.]
Y. Sasaguri, H. Kato.
Regression of aneurysms in Kawasaki disease: a pathological study.
J Pediatr, 100 (1982), pp. 225-231
[29.]
H. Kato.
Long-term consequences of Kawasaki disease: pediatrics to adults.
Proceedings of the 5th International Kawasaki disease symposium. Fukuoka, Japón, 1995, pp. 557-566
[30.]
H. Yanagawa, Y. Nakamura, M. Yashiro, et al.
Results of the nationwide epidemiologic survey of Kawasaki disease in 1995 and 1996 in Japan.
Pediatrics, 102 (1998), pp. e65
[31.]
K.S. Barron, S.T. Shulman, A. Rowley, et al.
Report of the National Institutes of Health workshop on Kawasaki disease.
J Rheumatol, 26 (1999), pp. 170-190
[32.]
H. Yanagawa, Y. Nakamura, M. Yashiro, et al.
Incidence survey of Kawasaki disease in 1997 and 1998 in Japan.
Pediatrics, 107 (2001), pp. e3
[33.]
R.R. Chang.
Epidemiologic charasteristics of children hospitalized for Kawasaki disease in California.
Pediatr Infect Dis J, 21 (2002), pp. 1150-1155
[34.]
A. Harnden, B. Alves, A. Sheikh.
Rising incidence of Kawasaki disease in England: analysis of hospital admission data.
BMJ, 324 (2002), pp. 1424-1425
[35.]
D. De Sotto Esteban, F. Del Castillo Martín, M.I. Martín Delgado, et al.
Enfermedad de Kawasaki en España: revisión de la literatura nacional.
Pediatrika, 19 (1999), pp. 42-48
[36.]
M. Martínez Ruiz, F. Del Castillo Martín, C. Borque Andrés, et al.
Incidencia y características clínicas de la enfermedad de Kawasaki.
An Pediatr (Barc), 59 (2003), pp. 323-327
[37.]
C. Calvo Rey, C. Borque Andrés, F. Del Castillo Martín, et al.
Enfermedad de Kawasaki: complicaciones y evolución. A propósito de 38 casos.
An Esp Pediatr, 39 (1993), pp. 423-427
[38.]
A.H. Rowley.
Kawasaki syndrome.
Krugman's infectious disease of children, 11.a ed., pp. 323-335
[39.]
J.W. Newburger, M. Takahashi, M.A. Gerber, et al.
Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professional from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, council on cardiovascular disease in young, American Heart Association.
Pediatrics, 114 (2004), pp. 1708-1733
[40.]
F. Del Castillo Martín.
Síndrome de Kawasaki.
Pediatr Integral, 5 (2000), pp. 153-162
[41.]
M.K. Makhene, P.S. Diaz.
Clinical presentations and complications of suspected measles in hospitalized children.
Pediat Infect Dis J, 12 (1993), pp. 863-940
[42.]
M.E. Melish.
Kawasaki syndrome.
Pediatr Rew, 17 (1996), pp. 153-162
[43.]
J. Guerrero Vázquez, A. Garcés Ramos, S. Olmedo San Laureano.
Erupción del área del pañal en la enfermedad de Kawasaki.
An Esp Pediatr, 32 (1990), pp. 246-248
[44.]
J.C. Burns, W.H. Mason, M.P. Glode, et al.
Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease.
J Pediatr, 118 (1991), pp. 680-686
[45.]
J.K. Stamos, K. Corydon, J. Donaldson, et al.
Lymphadenitis as the dominant manifestation of Kawasaki disease.
Pediatrics, 93 (1994), pp. 525-528
[46.]
S.T. Shulman, J. De Inocencio, R. Hirsch.
Kawasaki disease.
Pediatr Clin North Am, 42 (1995), pp. 1205-1222
[47.]
J.C. Burns, J.W. Wiggins, W.T. Toews, et al.
Clinical spectrum of Kawasaki disease in infants younger than months of age.
J Pediatr, 109 (1986), pp. 759-763
[48.]
A.H. Rowley.
Incomplete (atypical) Kawasaki disease.
Pediatr Infect Dis J, 21 (2002), pp. 563-565
[50.]
W.H. Mason, M. Takahashi.
Kawasaki syndrome.
Clin Infect Dis, 28 (1999), pp. 169-187
[51.]
R.C. Hansen.
Staphylococcal scalded skin syndrome, toxic shock syndrome, and Kawasaki disease.
Pediatr Clin North Am, 30 (1983), pp. 533-544
[52.]
I.K. Maconochie.
Kawasaki disease.
Arch Dis Child Educ Prac Ed, 89 (2004), pp. ep3-ep8
[53.]
D. Whitby, J.G. Hoad, E.J. Tizard, et al.
Isolation of measles virus from child with Kawasaki disease.
Lancet, 338 (1991), pp. 1215
[54.]
M.K. Makhene, P.S. Diaz.
Clinical presentations and complications of suspected meadles in hospitalized children.
Pediatr Infect Dis J, 12 (1993), pp. 836-840
[55.]
A. Dajani, K.A. Taubert, M.A. Gerber, et al.
Diagnosis and therapy of with Kawasaki disease in children.
Circulation, 87 (1993), pp. 1776-1780
[56.]
B.A. Binstadt, J.C. Levine, P.A. Nigrovic, et al.
Coronary artery dilatation among patients presenting with systemic-onset juvenile idiopathic arthritis.
Pediatrics, 116 (2005), pp. e89-e93
[57.]
A.H. Rowley, S.T. Shulman.
Kawasaki syndrome.
Pediatr Cardiol, 46 (1999), pp. 313-329
[58.]
H.D. Davies, V. Kirk, T. Jadavji, et al.
Simultaneous presentation of Kawasaki disease and toxic shock syndome in an adolescent male.
Pediatr Infect Dis J, 15 (1996), pp. 1136-1138
[59.]
H. Kato, E. Ichinose, T. Kawasaki.
Myocardial infarction in Kawasaki disease: Clinical analyses in 195 cases.
J Pediatr, 108 (1986), pp. 923-927
[60.]
A. Dajani, K.A. Taubert, M. Takahashi, et al.
Guidelines for long-term management of patients with Kawasaki disease.
Circulation, 89 (1994), pp. 916-922
[61.]
H. Kato, T. Sugimura, T. Akagi, et al.
Long-term consequences of Kawasaki disease. A 10- to 21- year follow-up study of 594 patients.
Circulation, 94 (1996), pp. 1379-1385
[62.]
J.C. Burn, H. Shike, J.B. Gordon, et al.
Sequelae of Kawasaki disease in adolescents and young adults.
J Am Coll Cardiol, 28 (1996), pp. 253-257
[63.]
N. Noto, T. Okada, M. Yamasuge, et al.
Noninvasive assessment of the early progression of atherosclerosis in adolescents with Kawaski disease and coronary artery lesions.
Pediatrics, 107 (2001), pp. 1095-1099
[64.]
S. Mercer, B. Carpenter.
Surgical complications of Kawasaki disease.
J Pediatr Surg, 16 (1981), pp. 444-448
[65.]
R. Yamakawa, M. Ishii, T. Sugimura, et al.
Coronary endothelial disfunction after Kawasaki disease: evaluation by intracoronary injection of acetylcholine.
J Am Coll Cardiol, 31 (1998), pp. 1074-1080
[66.]
H. Furuyama, Y. Odagawa, C. Katoh, et al.
Assessment of coronary function in children with a history of Kawasaki disea-se using (15) O-warwe positron emission tomography.
Circulation, 105 (2002), pp. 2878-2884
[67.]
Y.B. Deng, T.L. Li, H.J. Xiang, et al.
Impaired andothelial function in the brachial artery after Kawasaki disease and the effects of intravenous administration of vitamin C.
Pediatr Infect Dis. J, 22 (2003), pp. 34-39
[68.]
H. Furuyama, Y. Odagawa, C. Katoh, et al.
Altered myocardial flow reserve and endotelial function late after Kawasaki disease.
J Pediatr, 142 (2003), pp. 149-154
[69.]
H.C. Meissner, D.Y.M. Leung.
Kawasaki syndrome: where are the answers?.
Pediatrics, 112 (2003), pp. 672-675
[70.]
S.M.L. Tse, E.D. Silverman, B.W. McCrindle, et al.
Early treatment with intravenous immunoglobulin in patients with Kawasaki disease.
J Pediatr, 140 (2002), pp. 450-455
[71.]
H. Muta, M. Ishii, K. Egami, et al.
Early intravenous gammaglobulin treatment for Kawasaki disease: the Nationwide Surveys in Japan.
J Pediatr, 144 (2004), pp. 496-499
[72.]
K. Durongpisitkul, V.J. Gururaj, J.M. Park, et al.
The prevention of coronary artery aneurysm in Kawasaki disease: a metaanalysis on the efficacy of aspirin and immunoglobulin treatment.
Pediatrics, 96 (1995), pp. 1057-1061
[73.]
M. Terai, S.T. Shulman.
Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gammaglobulin dose but independent of salicylate dose.
J Pediatr, 131 (1997), pp. 888-893
[74.]
H. Kato, S. Koike, T. Yokoyama.
Kawasaki disease: effect of treatment on coronary involvement.
Pediatrics, 63 (1979), pp. 175-179
[75.]
D.A. Wright, J.W. Newburger, A. Baker, et al.
Treatment of immune globulin-resistant Kawasaki disease with pulse doses of corticosteroids.
J Pediatr, 128 (1996), pp. 146-149
[76.]
A.C. Wooditch, S.C. Aronoff.
Effect of initial corticosteroid therapy on coronary artery aneurysm formation in Kawasaki disease: a meta-analysis of 862 children.
Pediatrics, 116 (2005), pp. 989-995
Copyright © 2006. Sociedad Española de Reumatología