SCORING SYSTEM FOR PREDICTING INTRAVENOUS IMMUNOGLOBULIN (IVIG) RESISTANCE WHILE TREATING KAWASAKI DISEASE: A REVIEW

Anuja Oli and Lu Hongzhu*

ABSTRACT

Kawasaki disease (KD) is an acute self-limiting inflammatory disorder, associated with vasculitis, affecting predominantly medium sized arteries, particularly the coronary arteries. This disease predominantly affects children below 5 years old and seen in developed countries. Etiology of this disease is poorly understood but genetic susceptibility has been found in some studies. Coronary artery aneurysm (CAA) is one of the most serious complication of Kawasaki disease. Diagnosis is done clinically based on the guidelines. Intravascular immunoglobulin (IVIG) is considered to be the gold standard of the treatment along with anti-inflammatory like aspirin and steroids as in more serious cases. IVIG relieves acute inflammation and has been shown to reduce the rate of coronary aneurysms from greater than 25% in untreated patients to 1-5% in treated patients. Maximal benefits are seen when IVIG is given within the first 10 days of the illness. When fever is not settled after 36 hours of initiation of IVIG then it is considered as IVIG resistance Kawasaki disease. In such case next dose of IVIG given and other medications may also be given according to severity. This prolongs illness and causing more susceptible to coronary complications. To predict the occurrence of IVIG resistance scoring system has been prepared by Kobayashi, Egami and Sano. These are simple scoring system mostly based on laboratory findings and day of initiation of treatment. With the use of these system we can categorize â€Å¾high risk‟ patient so it will be helpful in managing the illness.

Keywords: Intravenous Immunoglobulin (IVIG) Resistance, Predicting Scoring, Kawasaki Disease.