You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
kawasaki disease ( kd ) is an acute multisystem vasculitis that afflicts mostly young children . since the first report of kd in 1967 ( 1 )
however , the clinical and epidemiologic studies have proposed that kd is closely related to an infectious disease ( 2 , 3 ) .
the acute onset of a self - limited course , the prevalent population ( rare in < 6 months of age and > 5 yr of age ) , the existence of clusters or epidemics with a wave - like spread , all suggest that kd is related to infectious agents , particularly of viral origin . on the other hand , the elevated levels of the inflammatory indices including the white blood cell ( wbc ) and neutrophil count and the c - reactive protein ( crp ) suggest that bacterial agents including superantigens are involved in kd ( 4 ) .
we previously found that the igm and iga levels increased at 1 week and 2 weeks after intravenous immunoglobulin ( ivig ) treatment with a statistical significance ( 5 ) .
many therapeutic modalities have been attempted in order to prevent the coronary artery lesions ( cal ) as the major complication of kd .
ivig therapy is known to decrease the numbers of cal , and is now accepted as standard treatment for kd ( 6 , 7 ) .
the total duration of fever in kd in the era before ivig therapy was reported to be approximately 1 - 2 weeks ( mean 10 days ) regardless of treatments with aspirin or steroids ( 1 , 8) . we evaluated the inflammatory indices including the wbc count and crp according to the onset of fever in children with kd , and postulated that inflammatory processes in kd reach a peak at the sixth day of fever .
the subjects of this study were 152 children who had been diagnosed with kd ( 82 boys and 70 girls ) between july 1999 and december 2002 at the catholic university of korea , daejeon st .
the diagnostic criteria were based on the diagnostic guidelines of kawasaki disease presented by the japan kawasaki disease research committee ( 9 ) .
one hundred nineteen children met the criteria for kd and 33 cases of an incomplete kd were included .
incomplete kd patient was defined as those who do not fulfil the recommended criteria at presentation regardless of echocardiographic findings .
all patients with incomplete presentation who did not show elevated crp ( < 2.0 mg / dl ) , and wbc and neutrophil ( < 10,000/l and < 5,000/l , respectively ) levels with repeated examinations in the earlier days of illness or those who did not show an increased platelet count 7 days after ivig treatment were excluded ( 4 cases ) .
children were treated with ivig ( i.v .- globulin s , green cross , korea : 5% liquid preparation containing only maltose , igg : maltose=1:2 ) at a dose of 2 g / kg over 12 hr and a dose of aspirin ( 30 - 40 mg / kg ) during the febrile period . after obtaining parental consent ,
the serial examinations were performed three times during admission : before ivig administration , and 24 hr and 7days after ivig administration .
cal were defined and classified as follows : ectasia was defined when coronary arterial dilatation with the diameter 4 mm was seen or when the diameter was less than 1.5 times than that of adjacent artery diameter ; aneurysm , when dilatation > 4 mm ectasia with or without , multiple , pyramidal / fusiform aneurysm was present .
twenty - six of the 152 children had cal ( 21 in ectasias and 5 in aneurysms ) .
thirteen children showed a resistance to ivig therapy ( a fever for more than 48 hr after initiating the ivig infusion ) .
the ethics committee on clinical research , the catholic university of korea , approved this study .
the means of all continuous variables were compared using one way anova , fisher 's extact test and chi - square test .
there were no significant differences in terms of age ( mean 28.416.2 months ) and sex distribution ( male to female ratio , 82:70 ) among the groups .
the mean incidence of cal evaluated within 2 - 3 weeks of the onset of fever was 17.1% .
there was a trend for the incidence of cal to be higher in the sixth day ( 40% ) and the ninth day groups ( 42.9% ) than the other groups .
twenty - two percent of cases had fever with less than 4 of the diagnostic criteria for kd at presentation ( incomplete kd ) .
there was a trend for the incidence of incomplete kd to be higher in the third day ( 35% ) , the eighth day ( 33% ) and the ninth day groups ( 43% ) .
wbc and neutrophil counts , crp and creatine phosphokinase ( cpk ) values were the highest in the sixth day group , and the last two indices showed a bell - shaped distribution pattern based on the peak sixth day values .
in contrast , albumin , and hdl - cholesterol values were the lowest in the sixth day group , and they showed a pattern of u - shaped distribution .
the platelet count and total cholesterol value showed a trend for increase with subsequent days of fever . the hemoglobin , esr and ldh values did not change significantly .
the ast and alt values were the highest in the third day group , but were not statistically significant .
the inflammatory processes of an infection progress to a peak stage , then regress to a convalescence by host immune response .
the total duration of fever in most uncomplicated viral infections is approximately 1 week , including measles ( 5 days ) and epstein - barr virus infection ( 6 days ) . on the other hand ,
the duration of fever in an untreated bacterial infection differs according to the causative agent .
however causative disease caused by intracellular organisms such as typhoid fever lasts much longer ( > 2 weeks ) .
early studies revealed that the total duration of kd without ivig therapy was 1 - 2 weeks ( mean 10 days ) ( 1 , 8) .
therefore , it is postulated that the peak inflammatory process in kd is at the fifth to sixth day after the onset of fever .
the results in this study shows that the levels of inflammatory indices reach a peak or nadir on the sixth day of the fever , which agrees with the above postulation .
wbc and neutrophil counts , esr and crp levels are commonly used as indices of severity of inflammation .
crp increases rapidly within 24 hr in various conditions , like bacterial infections , trauma , tissue necrosis , and malignant neoplasm .
the decreased albumin or hdl - cholesterol values have been reported in inflammatory diseases including kd ( 11 , 12 ) .
although , this study could not show difference of statistical significance in any of the indices between groups , the distribution patterns of these indices strongly support our postulation .
ast and alt values appeared to be higher in the early days of the natural course in kd .
the cases with elevated ast and alt above two folds the normal values were also higher in the early days of the fever ( 4 day , 20 of 50 cases ) than in the later days ( 7 days , 5 of 38 cases ) .
a decreased total cholesterol level in the earlier days tends to increase with days of the fever .
the platelet counts also tended to increase by days of fever in the acute stage .
recently , two studies reported the relationship between the initial day of the ivig treatment and the clinical or laboratory outcomes in kd ( 13 , 14 ) .
although the two studies are similar in study design , the results of cal frequency and laboratory findings were not identical .
( 13 ) reported that the group receiving ivig treatment prior to the fifth day of illness showed a higher cal at 1 month , and no differences in the laboratory findings except for alt and ast when compared to those given ivig after the fifth day .
in contrast , tse et al . ( 14 ) reported a case - control study showing that early ivig treatment at day 5 or earlier showed a lower incidence of cal at 1 yr , and some differences in the laboratory findings including higher hemoglobin , alt , and albumin values and lower platelet count .
if our postulation is correct , different results of laboratory study between the two groups might result from differences in the number of patients in each different fever day .
earlier studies have reported that the risk of cal in kd is associated with some demographic or laboratory factors such as the prolonged fever duration , or an increased crp ( 15 - 17 ) .
ivig is quite effective for improving the clinical symptoms as well as the laboratory findings including crp , and for preventing coronary complications ( 6 , 7 ) .
we previously repored that a high dose ivig treatment ( 2 g / kg ) lowered the values of various proteins including albumin and lipoproteins , and also values of the inflammatory indices within 24 hr except esr ( 5 , 18 ) .
in addition , we also found that ivig - resistant patients showed a sustained high values of crp and wbc on 24 hr after ivig with a higher risk of cal ( 19 , 20 ) . if the risk of cal is associated with the intensity of the inflammation reflected by laboratory indices , early treatment prior to the peak stage of inflammation can help prevent cal in kd .
there are some limitations in interpreting our results . because the data had a large number of variables ( seven variables ) and an uneven distribution of the number of variables ,
a diagnosis of kd in patients before 5 days illness could not fulfil the diagnostic criteria and those with incomplete kd were included in this study .
all patients with incomplete kd were selected on the basis of the laboratory findings as described earlier as well as the clinical criteria .
however , there was no significant difference in laboratory values between the incomplete kd group and typical kd group ( data not shown ) . in conclusion , it is very important to determine when the inflammatory processes of kd reach a peak as a self - limiting disease .
as for the coronary complications in kd , it is believed that the more severe inflammatory processes , which are reflected by prolonged fever duration or higher values of the inflammatory indices , have a higher risk .
therefore a higher single - dose ivig treatment before the peak stage of kd may help reduce the intensity of inflammation and the frequency of cal . repeated examination of the inflammatory indices can help decide the timing for appropriate ivig treatment for children with an incomplete presentation in the earlier days , and for evaluating the effects of ivig treatment .
we evaluated the inflammatory indices according to the fever duration in children with kawasaki disease ( kd ) , and determined duration when the inflammatory processes in kd reach their peak . 
 children with kd ( n=152 ) were classified into 7 groups according to fever duration : at the third day or earlier ( n=20 ) , fourth ( n=33 ) , fifth ( n=46 ) , sixth ( n=15 ) , seventh ( n=15 ) , eighth ( n=9 ) , and at the ninth day or later after fever onset ( n= 14 ) . 
 the levels of various laboratory indices were determined 3 times : before , 24 hr and 7 days after intravenous immunoglobulin administration ( 2 g / kg ) . 
 wbc and neutrophil counts , and c - reactive protein level were the highest at the sixth day . 
 levels of hemoglobin , albumin , and high density lipoprotein cholestrol were the lowest at the sixth day . 
 although these indices were not significant statistically between groups , the indices showed either bell - shaped or u - shaped distribution of which peak or trench were at the sixth day . 
 these findiugs showed that the inflammatory processes in kd reach peak on the sixth day of fever onset . 
 this finding is important because a higher single - dose intravenous immunoglobulin treatment before the peak day may help reduce the coronary artery lesions in kd .