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Indian Pediatr 2011;48:
330-331 |
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High Sensitivity C-Reactive Protein in
Classical Kawasaki Disease |
Ayush Agarwal, Nutan Kamath and Shrikala Baliga*
Departments of Pediatrics and *Microbiology, Kasturba
Medical College, Manipal University, Mangalore, India.
Email: [email protected]
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We recruited 20 children of classical Kawasaki disease (KD) in follow up
of atleast six months since diagnosis, from the pediatric rheumatology
clinic at our hospital in August and September 2007. Twenty healthy age
and sex matched children served as controls. Venous blood for the
measurement of serum high sensitivity C-reactive protein (hs-CRP)
concentrations was collected after an overnight fast and measured with a
particle enhanced immuno-turbidometric assay consisting of an anti-mono-clonal
antibody coupled to latex microparticles (Quantia CRP-US). The presence of
hs-CRP resulted in an insoluble complex formation giving rise to
turbidity, which was measured at wavelength between 505-578 nm and had a
functional sensitivity of 0.015 mg/dL. The institutional ethics committee
approved the study. Written informed consent was taken from either of the
parent.
There were 13 boys with mean age of 4.5 years (range
1-12) and 7 girls with mean age of 2 years (range 0.5-3). Cardiac
involvement (coronary dilatation-2, coronary aneurysm-3) was seen in 25%
children in the acute phase which resolved on follow up. Intravenous
immunoglobulin was received by 75% of the children and all received
aspirin. Mean CRP values during acute phase of disease were 90.85 (range
7.4- 384 mg/dL; SD - 80.20); hs-CRP in patients ranged from 0.019- 0.510;
SD- 0.226. After 6 months of disease onset, mean hs-CRP value in patients
was significantly higher than controls (0.275 mg/dL and 0.085 mg/dL,
respectively, P=0.002). There was no significant difference
comparing the hs-CRP in boys and girls; children with and without history
of cardiac involvement; and with and without immunoglobulin therapy in the
acute phase of illness.
Increased CRP is characteristic during the acute phase
of KD. Persistent elevation after the convalescent phase of KD validates
the possibility of smouldering vasculitis playing a part in altering
arterial function [1,2]. Mitani, et al. [3] observed that levels of
CRP was elevated in KD patients with coronary artery lesions (CAL)
compared to controls and other KD groups with normal coronary arteries or
with regressed aneurysms. In our limited study, hs-CRP values were not
different in the small number of patients with cardiac involvement in the
acute phase as compared to those without. We did not have a case with
residual CAL. There was no correlation between the CRP in the acute phase
and hs-CRP in the follow up. Suppression of this chronic inflammatory
process may be a new target for intervention, to improve arterial
function. Significant reduction in serum hs-CRP levels after short-term
statin treatment has been demonstrated [4].
Contributors: NK: conceived and designed the study,
diagnosed and treated the involved subjects; and supervised the manuscript
for important intellectual content and will act as guarantor of the study;
AA: collected data, analyzed and drafted the paper; SB: performed the hs-CRP
test and helped in the design and conduct of the study. The final
manuscript was approved by all the authors.
Funding: Indian Council of Medical Research as
short term student grant 2008 (No.21/127/ 08-BMS).
Competing interests: None stated.
References
1. Cheung YF, Ho MH, Tam SC, Yung TC. Increased high
sensitivity C reactive protein concentrations and increased arterial
stiffness in children with a history of Kawasaki disease. Heart. 2004;90:1281-5.
2. Kato H, Sugimura T, Akagi T, Sato N, Hashino
K, Maeno Y, et al. Long term consequences of Kawasaki disease: a 10
to 21 year follow up study of 594 patients. Circulation. 1996;94:1379-85.
3. Mitani Y, Sawada H, Hayakawa H, Aoki K, Ohashi H,
Matsumura M, et al. Elevated levels of high-sensitivity
C-reactive protein and serum amyloid-a late after Kawasaki
disease-association between inflammation and late coronary sequelae in
Kawasaki disease. Circulation. 2005;111;38-43.
4. Huang SM, Weng KP, Chang JS, Lee WY, Huang SH, Hsieh
KS. Effects of statin therapy in children complicated with coronary
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J. 2008;72:1583-7.
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