Table 1.
Review of English language reports of KD in siblings
| S. No. | Authors, year of publication [reference] | Country or region of origin | No. of pairs | Duration between disease onset; age of siblings (I, S) | Infectious trigger | Clinical features | Treatment and response |
|---|---|---|---|---|---|---|---|
| 1. | Lyen et al. 1978 [6] | Jamaica | 1 |
1 day I: 2 years S: 4.5 years |
ND | S had a milder clinical course than I who developed pericarditis and hematuria. Echocardiography was normal. | Both children received supportive therapy only; improved. |
| 2. | Elamin A, 1979 [7] | Zambia | 1 |
1 month I: 7 years S: 1 year |
ND | I had myocarditis, S had no cardiac involvement. Echocardiography was normal. | I received crystalline penicillin and prednisolone with anti-failure treatment, S treated with hydrocortisone. Both improved on treatment. |
| 3. | Fink HW, 1984 [8] | USA | 1 |
Same day I, S: 10 months |
ND | Both twins had been operated for pyloric stenosis in the 2nd month of life. | ND |
| 4. | Harada et al. 1986 [9] | Japan | 23 | Usually < 2 weeks | ND | These include 15 pairs of twins. | ND |
| 5. | Yanagawa et al. 1988 [10] | Japan | At least 183 | In all less than a week | ND | Nationwide Japanese survey 1985–1986. Number of siblings affected calculated from the data provided. | ND |
| 6. | Fujita et al. 1989 [11] | Japan | 20 | Median: 4.5 days | ND | 4 pairs of siblings developed KD on the same day, among which twin pairs 3 of 4. Coronary involvement in 22%. Significant illness in siblings. | ND |
| 7. | Elamin A, 1993 [12] | Sudan | 1 |
27 days I: 5 years S: 3 years |
ND | Normal echocardiography in both siblings at 3 months of follow-up. | I treated with aspirin and phenoxymethyl penicillin; S treated with aspirin only; uneventful recovery in both. |
| 8. | Anderson et al. 1995 [13] | Australia | 1 |
1 week I: 12 years S: 10 years |
Streptococcal infection in both. I developed impetigo on the face, cellulitis of the left external ear, and left suppurative lymphadenitis. Both had ↑ASO and anti-DNase B titers. | Coronary arteries normal in both siblings. | Both received intravenous gammaglobulin and flucloxacillin; recovered uneventfully. |
| 9. | Kaneko et al. 1995 [14] | Japan | 1 |
4 days I, S: 1 year |
No specific organism implicated. However, throat swab showed Haemophilus influenzae. | Japanese dizygotic twins, no coronary artery involvement on follow-up at 1 month. | High-dose IVIg was given to both; recovered. |
| 10. | Dergun et al. 2005 [15] | USA | 2 pairs (including 1 pair of twins) | 22 days and 7 days (in twin pair) respectively. Age of twins was 5.6 months. In other pair: I: 10 years, S: 2.5 years | ND | North American study. Both pairs did not have coronary involvement. |
In the twin pair, I received 1 dose of IVIg, whereas S received 2 doses. In the other pair, I receive 1 dose of IVIg, and S did not receive IVIg. |
| 11. | Türel et al. 2011 [16] | Turkey | 1 |
4 days I, S: 7 months |
ND | RCA and LCA dilatation in I. I had improving CAAs at 1 month of follow-up. | Rapid response to treatment with IVIg. |
| 12. | Kottek A, 2011 [17] | USA | 1 |
2 days I, S: 1.5 years |
ND | Monozygotic twin pair from the USA. I had dilated coronary arteries; S had fever for 2 days only and fulfilled 2 of 5 AHA 2004 KD criteria. On evaluation ↑ ESR, CRP, and ALT; aortic root dilatation. Both had normal echocardiography at 1 year of follow-up. | I treated with infliximab and IVIg, and S treated with IVIg alone. |
| 5 | Within 10 days | ND | Review performed by Kottek et al. on monozygotic twins with KD: 3 English and 6 Japanese language reports. Incomplete KD was seen in 2 out of 5. | ND | |||
| 13. | Zhang et al. 2013 [18] | China | 1 |
Same time I, S: 71 days |
ND | Chinese report on two monozygotic twins. Incomplete KD in both. Dilated RCA in both (elder twin on day 24 of illness, younger twin on day 20 of illness). Normal echocardiography on follow-up for both twins starting from 1 month of illness onset. | Both treated with IVIg. |
| 14. | Fukuda et al. 2017 [19] | Japan | 1 |
4 days I, S: 4 years |
Adenoviral infection in both. | Japanese monozygotic twins. S was diagnosed as incomplete KD on admission; LCX dilated on day 10 of illness but resolved by 3 months. | I treated with IVIg; however, S did not receive IVIg due to spontaneous defervescence of fever. |
| 15. | Maggio et al. 2019 [20] | Italy | 1 |
Same time I: 7 years S: 9 months |
Parvovirus infection | S was diagnosed first. I developed KDSS on day 8. S developed CAAs on day 26 (RCA, LCA). Coronary arteries normalized after 2 months of follow-up. | S developed CAAs despite IVIg treatment. Additional treatment with 3 pulse doses of intravenous methylprednisolone was given followed by anakinra. I treated with steroids, inotropes, and diuretics. |
| 16. | Namita et al. 2019 [21] | India | 1 |
Same time I, S: 4 years |
ND | Indian report on identical twins. Incomplete KD was seen in S who also had LCA dilatation. | Both twins responded briskly to IVIg therapy. |
| 17. | Fink HW, 1985 [22] | USA | 1 | Simultaneous | ND | Identical twins. The full text could not be retrieved. | ND |
S. No. serial number, I index child, S sibling, ND not documented, ASO anti-streptolysin O, DNase B deoxyribonuclease B, IVIg intravenous immunoglobulin, RCA right coronary artery, LCA left coronary artery, CAAs coronary artery abnormalities, AHA American Heart Association; ESR erythrocyte sedimentation rate, CRP C-reactive protein, ALT alanine aminotransferase, LCX left circumflex artery, KDSS KD shock syndrome, ↑ increase in