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CLINICAL REVIEW: Anthony Harnden, Masato Takahashi, and David Burgner Kawasaki disease BMJ 2009; 338: b1514 [Full text]

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Kawasaki Disease and Cooling Measures

Simon J Dean   (14 May 2009)

Corticosteroids in Kawasaki Disease treatment

Andrea Taddio, Loredana Lepore, Alessandro Ventura   (24 May 2009)

Kawasaki Disease and Cooling Measures 14 May 2009
Simon J Dean, GP Park Surgery, Horsham, West Sussex RH12 1BG Send response to journal: Re: Kawasaki Disease and Cooling Measures	Kawasaki disease represents the GP's ultimate diagnostic nightmare - a collection of (albeit) extreme viral signs and symptoms representing a disease which is serious yet treatable. The unique alerting feature for the GP has to be the presentation of an inconsolable child with a persistently high fever for more than 5 days despite adequate cooling measures. Cooling measures are often badly instituted by parents. Proper cooling is important if only to enable the GP to differentiate potential Kawasaki disease cases from the numerous other children with viral induced fevers. Good advice for parents trying to cool their child is hard to find - NHS Direct's website only advises paracetamol and ibuprofen without mentioning undressing. There is a lot more that can be done to lower the temperature in a pyrexial child. A suitable comprehensive leaflet for parents is available from me or from www.parksurgery.com Proper cooling measures are important for more than just symptomatic relief. If properly instituted the lack of response can alert the GP to the need for admission. Competing interests: None declared
Corticosteroids in Kawasaki Disease treatment 24 May 2009
Andrea Taddio, MD Department of Pediatrics, Institute of Child Health, IRCCS Burlo Garofolo, 34100, Trieste, Italy, Loredana Lepore, Alessandro Ventura Send response to journal: Re: Corticosteroids in Kawasaki Disease treatment	Dear Sir, we read with great interest your recent review about Kawasaki Disease (KD) (1); however we don’t agree with authors’ conclusions about the usefulness of corticosteroids in disease treatment. Harnden et al. mentioned a recent multicentre, double blinded, placebo controlled randomised trial (CRT) (2), that apparently reported no difference in coronary artery changes in a subgroup of patients initially treated with intravenous immunoglobulin (IVIG) and aspirin plus methylprednisolone compared with those who received the standard treatment plus placebo. We have already underlined that a more accurate data evaluation revealed that corticosteroids seemed to be effective in reducing the risk of coronary damage in those patients who required a re- treatment with IVIG (3). Considering that failure of initial IVIG treatment still remains the most consistent risk factor of developing coronary abnormalities (4), there are not reasons, at the moment, not to consider beneficial the use of corticosteroids. Stated the importance of clinical reviews and the influence that CRTs exercise on medical progress, we would like to stress the importance of a careful CRT data evaluation, in order to avoid possible reading interpretation mistakes leading to lasting questionable conclusions. References 1.Harnden A, Takahashi M, Burgner D. Kawasaki disease. BMJ 2009;338:b1514. 2.Newburger JW, Sleeper LA, McCrindle BW, et al. Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med 2007;356:663-75. 3.Taddio A, Rosé CD. Treatment of Kawasaki disease. N Engl J Med 2007;356:2747; 4.Hashino K, Ishii M, Iemura M, et al. Re-treatment for immune globulin- resistant Kawasaki disease: a comparative study of additional immune globulin and steroid pulse therapy. Pediatr Int 2001;43:211-7. Competing interests: None declared