Kawasaki disease (strawberry tongue) associated with very low vitamin D

Created May 2015

Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities?

Clinical Rheumatology, May 2015 https://doi.org/10.1007/s10067-015-2970-6

Stefano Stagi, Donato Rigante, Gemma Lepri, Marco Matucci Cerinic, Fernanda Falcini falcini@unifi.it

Chart in the study

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Twenty-five-hydroxyvitamin D (25(OH)-vitamin D) is crucial in the regulation of immunologic processes, but—although its deficiency has been reported in patients with different rheumatological disorders—no data are available for Kawasaki disease (KD). The goals of this study were to assess the serum levels of 25(OH)-vitamin D in children with KD and evaluate the relationship with the eventual occurrence of KD-related vascular abnormalities. We evaluated serum 25(OH)-vitamin D levels in 79 children with KD (21 females, 58 males, median age 4.9 years, range 1.4–7.5 years) in comparison with healthy sex-/age-matched controls. A significantly higher percentage of KD patients (98.7 %) were shown to have reduced 25(OH)-vitamin D levels (<30 ng/mL) in comparison with controls (78.6 %, p < 0.0001). Furthermore, KD patients had severely low levels of 25(OH)-vitamin D than controls (9.17 ± 4.94 vs 23.3 ± 10.6 ng/mL, p < 0.0001), especially the subgroup who developed coronary artery abnormalities (4.92 ± 1.36 vs 9.41 ± 4.95 ng/mL, p < 0.0001).

In addition, serum 25(OH)-vitamin D levels correlated not only with

  • erythrosedimentation rate (p < 0.0001),

  • C-reactive protein (p < 0.0001),

  • hemoglobin level at KD diagnosis (p < 0.0001) but also with both

  • coronary artery aneurysms (p = 0.005) and

  • non-aneurysmatic cardiovascular lesions (p < 0.05).

Low serum concentrations of 25(OH)-vitamin D might have a contributive role in the development of coronary artery complications observed in children with KD.

PDF is available free at Sci-Hub   10.1007/s10067-015-2970-6

First 2 pages given by publisher a free preview - image only - no translation possible

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📄 Download the KD 2014 PDF from VitaminDWiki - noticed nothing about Vitamin D

KD has had a recent seasonal cycle

which has gotten worse as vitamin D levels have been dropping

Note: the KD season is now in Winter-Spring - when vitamin D levels are the lowest

Note: very little connection between the winds(mentioned below) and KD before vitamin D levels became very low

chart from http://www.nature.com/news/infectious-disease-blowing-in-the-wind-1.10374

image

KD is the red line

Wonder if the winds cause such pollution that Japanese the children stay indoors and thus get less vitamin D?

VitaminDWiki reasons to suspect that KD can be prevented with Vitamin D supplementation

  1. KD increases during the season which has the lowest vitamin D levels

  2. KD affects those with dark skins more (dark skin carries a high risk of being vitamin D deficient when away from the tropics)

  3. KD is an autoimmune disease - many of which can be prevented or treated by Vitamin D

  4. KD has increased 2X in a decade - like 30 other diseases associated with low vitamin D

See also Criteria to associate a health problem with low vitamin D

Snips from Wikipedia entry – with VitaminDWiki comments

  • Autoimmune inflammation of lymph nodes

  • Without treatment, mortality may approach 1%

  • It is difficult to establish the diagnosis, especially early in the course of the illness,

    • and frequently children are not diagnosed until they have seen several healthcare providers

  • May be associated with liver inflammation (which can be the cause of low vitamin D)

  • Kawasaki disease affects boys more than girls,

    • with people of Asian ethnicity, particularly Japanese and Korean people, most susceptible,
    • as well as people of Afro-Caribbean ethnicity. (darker skin ==> lower vitamin D)
  • The disease was rare in Caucasians until the last few decades,
    • (perhaps increase with recent lower levels of vitamin D) and incidence rate fluctuates from country to country

  • more than one in 150 children in Japan will develop Kawasaki disease during their lifetimes.

  • 80% of patients younger than five years of age

  • US incidence of the disease doubled from 1991 to 2000

  • it appears to have replaced acute rheumatic fever as the most common cause of acquired heart disease in children

    • More cases in winter in spring (times when vitamin D levels are the lowest)

    (Note by VitaminDWiki: KD appears to be an orphan disease in US (but not in Japan 1 in 150)

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VitaminDWiki pages with KAWASAKI in title (3 as of July 2022)

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Tags: Autoimmune Infant-Child