Clinical and biochemical characteristics of Kawasaki syndrome in 22 children
Authors:
H. Vyhnánková 1; R. Vyhnánek 2; V. Dvořáková 1; H. Kolářová 1; L. Vitnerová 1; M. Magner 1; H. Houšťková 2; J. Zeman 1; T. Honzík 1
Authors‘ workplace:
Klinika dětského a dorostového lékařství UK 1. LF a VFN, Prahapřednosta prof. MUDr. J. Zeman, DrSc.
1; Pediatrická klinika IPVZ a UK 1. LF, Thomayerova nemocnice, Prahapřednostka doc. MUDr. H. Houšťková, CSc.
2
Published in:
Čes-slov Pediat 2014; 69 (4): 203-212.
Category:
Original Papers
Overview
Kawasaki disease (KD) is an acute vasculitis. The clinical criteria for diagnosis are:
fever lasting for at least 5 days, non-purulent conjunctivitis, mucosal inflammation, cervical lymphadenopathy, skin rash and swelling and redness of the palms and soles with consecutive desquamation of the skin. Coronary arteries aneurysms and death represent the most severe complication. The incidence of KD is rising in many countries, and it is one of the most common causes of acquired heart disease in children in developed countries.
Aims:
To analyze the clinical course and laboratory findings in our group of children, and compare our findings to the literature.
Methods:
Our retrospective study included 22 children between the ages of 2 months and 8 years (32±30 months), hospitalized between January 2001 and December 2013 with KD.
Results:
Specific clinical features of KD like skin rash, conjunctivitis and mucosal inflammation were present in 91% of the children; on the other hand cervical lymphadenopathy was only present in half of the patients. Diarrhea (36.4%) was the most common nonspecific symptom. Seven children (32%) were infants under 12 months of age, among them three were younger than 6 months. 11 children got ill at the age of 1–4 years and four children were older than 5 years. Six children (27.2%), mostly infants, presented as an incomplete form of KD. Except for two children, immunoglobulins were administered on time (within 10 days of fever). Coronary abnormalities developed in one child who was not given immunoglobulins.
Conclusion:
The prognosis of children that are treated on time is good. Children under one year of age with incomplete presentation of KD remain a high-risk group, in which the diagnosis and hence the treatment could be delayed.
Key words:
Kawasaki disease, classic and incomplete form, early onset, coronary aneurysms V.
Sources
1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children (článek v japonštině). Jpn J Allergy (Arerugi) 1967 Mar; 16 (3): 178–222.
2. Dajani AS, Taubert KA, Gerber MA, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993; 87 (5): 1776–1780.
3. Gardner-Medwin JM, Dolezalova P, Cummins C, et al. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002 Oct; 360 (9341): 1197–1202.
4. Taubert KA, Rowley AH, Shulman ST. Nationwide survey of Kawasaki disease and acute rheumatic fever. J Pediatr 1991 Aug; 119 (2): 279–282.
5. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young, american heart association. Pediatrics 2004 Dec; 114 (6): 1708–1733.
6. Harnden A, Alves B, Sheikh A. Rising incidence of Kawasaki disease in England: analysis of hospital admission data. BMJ 2002 Jun; 324 (7351): 1424–1425.
7. Nakamura Y, Yashiro M, Uehara R, et al. Epidemiologic features of Kawasaki disease in Japan: Results of the 2009–2010 Nationwide Survey. J Epidemiol 2012; 22 (3): 216–221.
8. Uehara R, Belay ED. Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol 2012; 22 (2): 79–85.
9. Fischer TK, Holman RC, Yorita KL, et al. Kawasaki syndrome in Denmark. Pediatr Infect Dis J 2007 May; 26 (5): 411–415.
10. Holman RC, Belay ED, Christensen KY, et al. Hospitalizations for Kawasaki syndrome among children in the United States, 1997–2007. Pediatr Infect Dis J 2010 Jun; 29 (6): 483–488.
11. Salo E, Griffiths EP, Farstad T, et al. Incidence of Kawasaki disease in northern European countries. Pediatr Int 2012 Dec; 54 (6): 770–772.
12. Uehara R, Yashiro M, Nakamura Y, Yanagawa H. Kawasaki disease in parents and children. Acta Paediatr 2003; 92 (6): 694–697.
13. Holman RC, Christensen KY, Belay ED, et al. Racial/ /ethnic differences in the incidence of Kawasaki syndrome among children in Hawaii. Hawaii Med J 2010 Aug; 69 (8): 194–197.
14. Fujita Y, Nakamura Y, Sakata K, et al. Kawasaki disease in families. Pediatrics 1989; 84: 666–669.
15. Onouchi Y. Genetics of Kawasaki disease. Circul J 2012; 76: 1581.
16. Burns JC, Cayan DR, Tong G, et al. Seasonality and temporal clustering of Kawasaki syndrome. Epidemiology 2005 Mar; 16 (2): 220–225.
17. Lynch M, Holman RC, Mulligan A, et al. Kawasaki syndrome hospitalizations in Ireland, 1996 through 2000. Pediatr Infect Dis J 2003 Nov; 22 (11): 959–963.
18. Burns JC, Glode MP. Kawasaki syndrome. Lancet 2004; 364: 533–544.
19. Manlhiot C, Yeung RSM, Chahal N, et al. Kawasaki disease at the extremes of the age spectrum. Pediatrics 2009 Sep; 124 (3): e410–415.
20. Holman RC, Curns AT, et al. Kawasaki syndrome in Hawaii. Pediatr Infect Dis J 2005 May; 24 (5): 429–433.
21. Royle J, Williams K, Elliott E. Kawasaki disease in Australia, 1993–95. Arch Dis Child 1998 Jan; 78 (1): 33–39.
22. Huang WC, Huang LM, et al. Epidemiologic features of Kawasaki disease in Taiwan, 2003–2006. Pediatrics 2009 Mar; 123 (3): e401–405.
23. JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008) – digest version. Circ J 2010 Sep; 74 (9): 1989–2020.
24. Rosenfeld EA, Corydon KE, Shulman ST. Kawasaki disease in infants less than one year of age. J Pediatr 1995 Apr; 126 (4): 524–529.
25. Kim GB, Han JW, Hong YM, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009–2011. Pediatr Infect Dis J 2014 Jan; 33 (1): 24–27.
26. Doležalová P, Telekesová P, Němcová D, Hoza J. Incidence of vasculitis in children in the Czech Republic: 2-year prospective epidemiology survey. J Rheumatol 2004 Nov; 31 (11): 2295–2299.
27. U.S. Bureau of the Census. Census 2000 summary file 2 (SF 2)100-percent data. Washington, DC: Census, 2000.
28. Huang WC, Huang LM, Chang IS, et al. Epidemiologic features of Kawasaki disease in Taiwan, 2003–2006. Pediatrics 2009 Mar; 123 (3): 2008–2187.
29. Liu HC, Lo CW, Hwang B, et al. Clinical manifestations vary with different age spectrums in infants with Kawasaki disease. Scientific World Journal 2012; 2012: 210382.
30. Chang FY, Hwang B, Chen SJ, et al. Characteristics of Kawasaki disease in infants younger than six months of age. Pediatr Infect Dis J 2006 Mar; 25 (3): 241–244.
31. Yanagawa H, Nakamura Y, Yashiro M, et al. Results of the nationwide epidemiologic survey of Kawasaki disease in 1995 and 1996 in Japan. Pediatrics 1998 Dec; 102 (6): E65.
32. Park YW, Han JW, Park IS, et al. Epidemiologic study of Kawasaki disease in 6 months old and younger infants. Korean J Pediatr 2008; 51: 1320–1323.
33. Lee EJ, Park YW, Hong YM, et al. Epidemiology of Kawasaki disease in infants 3 months of age and younger. Korean J Pediatr 2012 Jun; 55 (6): 202–205.
34. Burns JC, Wiggins JW Jr, et al. Clinical spectrum of Kawasaki disease in infants younger than 6 months of age. J Pediatr 1986 Nov; 109 (5): 759–763.
35. Chuang CH, Hsiao MH, Chiu CH, et al. Kawasaki disease in infants three months of age or younger. J Microbiol Immunol Infect 2006 Oct; 39 (5): 387–391.
36. Joffe A, Kabrani A, Jadavji T. Atypical and complicated Kawasaki disease in infants. Do we need criteria? West J Med 1995 Apr; 162 (4): 322–327.
37. Manlhiot C, Christie E, McCrindle BW, et al. Complete and incomplete Kawasaki disease: two sides of the same coin. Eur J Pediatr 2012 Apr; 171 (4): 657–662.
38. Tacke CE, Breunis WB, Pereira RR, et al. Five years of Kawasaki disease in the Netherlands: a national surveillance study. Pediatr Infect Dis J 2014 Jan 23.
39. Nakamura Y, Yashiro M, Uehara R, et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2007–2008 nationwide survey. J Epidemiol 2010; 20 (4): 302–307.
40. Kang HJ, Kim GN, Kil HR. Changes of clinical characteristics and outcomes in patients with Kawasaki disease over the past 7 years in a single center study. Korean J Pediatr 2013 Sep; 56 (9): 389–395.
41. Gut J. Kawasakiho choroba (40. výročí první publikace). Čes-slov Pediat 2008; 63 (3): 156–163.
42. Uziel Y, Hashkes P, et al. “Unresolving pneumonia“ as the main manifestation of atypical Kawasaki disease. Arch Dis Child 2003 Oct; 88 (10): 940–942.
43. Amano S, Hazama F. Neural involvement in Kawasaki disease. Acta Pathol Jpn 1980 May; 30 (3): 365–373.
44. McCrindle BW, Li JS, Minich LL, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007 Jul; 116 (2): 174–179.
45. Duronqpisitkul K, Gururaj VJ, Park JM, et al. The prevention of coronary artery aneurysm in Kawasaki disease: a meta-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrics 1995 Dec; 96 (6): 1057–1061.
46. Sano T, Kurotobi S, Matsuzaki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Ped 2007; 166: 131–137.
47. Eleftheriou D, Levin M, Shingadia D, et al. Management of Kawasaki disease. Arch Dis Child 2014; 99: 74–83.
48. Newburger JW, Burns JC, et al. Altered lipid profile after Kawasaki syndrome. Circulation 1991 Aug; 84 (2): 625–631.
49. Huang SM, Weng KP, Chang JS, et al. Effects of statin therapy in children complicated with coronary arterial abnormality late after Kawasaki disease: a pilot study. Circ J 2008 Oct; 72 (10): 1583–1587.
50. Blankier S, McCrindle BW, Ito S, et al. The role of atorvastatin in regulating the immune response leading to vascular damage in a model of Kawasaki disease. Clin Exp Immunol 2011 May; 164 (2): 193–201.
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Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
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