Abstract
Kawasaki disease (KD) has replaced acute rheumatic fever as the most common cause of acquired heart disease in children in the developed world and is increasingly being recognized from several developing countries. It is a systemic vasculitis with a predilection for coronary arteries. The diagnosis is based on a constellation of clinical findings that appear in a temporal sequence. Quite understandably, this can become a problem in situations wherein the clinical features are not typical. In such situations, it can be very difficult, if not impossible, to arrive at a diagnosis. Several biomarkers have been recognized in children with acute KD but none of these has reasonably high sensitivity and specificity in predicting the course of the illness. A line up of inflammatory, proteomic, gene expression and micro-RNA based biomarkers has been studied in association with KD. The commonly used inflammatory markers e.g. erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and total leucocyte counts (TLC) lack specificity for KD. Proteomic studies are based on the identification of specific proteins in serum, plasma and urine by gel electrophoresis. A host of genetic studies have identified genes associated with KD and some of these genes can predict the course and coronary outcomes in the affected individuals. Most of these tests are in the early stages of their development and some of these can predict the course, propensity to develop coronary artery sequelae, intravenous immunoglobulin (IVIg) resistance and the severity of the illness in a patient. Development of clinical criteria based on these tests will improve our diagnostic acumen and aid in early identification and prevention of cardiovascular complications.
Highlights
Kawasaki disease (KD) is a common childhood vasculitis
We have reported a cut-off at 1,025 pg/mL for NT-proBNP levels which has a sensitivity of 88% and specificity of 96% [41] in the acute phase of KD
The need for a robust set of biochemical biomarkers to validate the diagnosis of KD in the clinical setting has become the need of the hour
Summary
Kawasaki disease (KD) is a common childhood vasculitis. The disease was first described in Japanese children in 1967 by a Japanese pediatrician, Dr Tomisaku Kawasaki [1]. The clinical features mimic many self-resolving exanthematous febrile illnesses of childhood (e.g., measles, adenoviral infection, scarlet fever, dengue fever) These illnesses share some common clinical features with KD like fever, rash, mucocutaneous manifestations, lymphadenopathy, and elevated inflammatory parameters. Low mean platelet volume (MPV) [15], platelet distribution width (PDW) [19], and platelet-derived microparticles (PDMP) [20] have been shown to be markers of platelet activation and inflammation in acute stages of KD. Their use as biomarkers for the disease requires replication of results across different populations
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