Patricia Ferrieri

Diagnosis and therapy of Kawasaki disease in children.

Adnan S. Dajani, MD, Chairman; Kathryn A. Taubert, PhD; Michael A. Gerber, MD; Stanford T. Shulman, MD; Patricia Ferrieri, MD; Michael Freed, MD; Masato Takahashi, MD; Fredrick Z. Bierman, MD; Adolf W. Karchmer, MD; Walter Wilson, MD; Shahbudin H. Rahimtoola, MD; David T. Durack, MD, DPhil, (Liaison, Infectious Diseases Society of America); Georges Peter, MD (Liaison, American Academy of Pediatrics, Committee on Infectious Diseases), Members, Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Guidelines for long-term management of patients with Kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.

Long-term management of patients with Kawasaki disease should be tailored to the degree of coronary arterial involvement. This committee has made recommendations for each risk level about antiplatelet and anticoagulant therapy, physical activity, follow-up assessment by a pediatric cardiologist or primary care physician, and the appropriate diagnostic procedures that may be performed to evaluate cardiac disease. The risk level for a given patient with coronary arterial involvement may change over time because of changes in coronary artery morphology. The recommendations for management presented here are intended as practical interim guidelines until additional prospective or retrospective data are compiled to define more clearly the natural history of Kawasaki disease.

Unique Features of Infective Endocarditis in Childhood

Infective endocarditis (IE) is associated with substantial morbidity and mortality. Although it is relatively rare in children, its incidence may be increasing.1 The present statement focuses on the features that are particularly relevant to infants and children, including important issues for the primary care physician. The epidemiology of heart disease in children has changed during the past 3 to 4 decades. Because of the increased survival rate of children with congenital heart disease (CHD) and the overall decrease in rheumatic valvular heart disease in developed countries, CHD now constitutes the predominant underlying condition for IE in children over the age of 2 years in these countries. The complexities of management of neonatal and pediatric intensive care unit patients have increased the risks of catheter-related IE. In addition, postoperative IE is a long-term risk after correction of complex CHD. Proper use of the diagnostic microbiology laboratory is critical in the diagnosis and management of children with IE. Moreover, newer diagnostic guidelines have improved sensitivity for making the diagnosis of clinically definite IE. Advances in noninvasive techniques, such as 2-dimensional echocardiography, have enhanced our ability to diagnose IE. Newer antibiotics that can be used in children with IE have become available, and home intravenous therapy has become an acceptable approach for stable patients who are at low risk for embolization. In addition, approaches to the prevention of endocarditis recently have been modified and are reviewed in the present statement. IE occurs less often in children than in adults and accounts for ≈1 in 1280 pediatric admissions per year.2 Although the reported hospitalization rates for IE vary considerably among published series, the frequency of endocarditis among children seems to have increased in recent years.3 This is due in part to improved survival among children who are at risk for endocarditis, …