Features of Kawasaki disease course in infants

Authors

  • O.S. Koreniuk State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”, Dnipro, Ukraine
  • N.N. Kramarenko State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”, Dnipro, Ukraine
  • S.H. Ivanus Municipal Institution “Dnipropetrovsk Children’s City Clinical Hospital 2”, Dnipro, Ukraine

DOI:

https://doi.org/10.22141/2224-0551.14.6.2019.179242

Keywords:

Kawasaki disease, course features, children

Abstract

Background. A large number of clinical masks and also insufficient vigilance of doctors regarding Kawasaki syndrome in a child with long-term fever impede timely diagnosis of Kawasaki syndrome. The purpose of the study was to increase the diagnostic efficiency of Kawasaki disease based on a retrospective analysis of its clinical course and outcomes in children under our supervision. Materials and methods. Case histories were analyzed in 7 children aged from 7 months to 6 years, who were treated in the cardiopulmonary department of Children’s Clinical Hospital 2 in Dnipro. The diagnosis of Kawasaki disease was verified based on diagnostic criteria in accordance with the current clinical protocol. Routine research methods and echocardiography were performed for all patients. Results. The study revealed late diagnosis of Kawasaki disease, already at the stage of formation of coronary artery aneurysms, in 43 % of cases. The complexity of diagnosing Kawasaki syndrome was due to the lack of a full range of typical symptoms. The incomplete presentation was noted mainly in children of the first three years of life and included symptoms such as conjunctivitis, maculopapular rash, and oral lesions in various combinations. Echocardiography revealed coronary artery aneurysms in 57 % of cases, mostly in infants with incomplete presentation of Kawasaki disease. Against the background of therapy (intravenous immunoglobulin and aspirin), we observed a significant regression of coronary artery aneurysms in all patients. Conclusions. Infants most often have incomplete presentation of Kawasaki syndrome, which complicates its diagnosis. In this regard, prolonged fever in combination even with 2–3 typical signs should be an absolute indication for echocardiography with mandatory visualization of the coronary arteries.

References

Shostakovich-Koretskaia LR, Budaeva IV. Kawasaki syndrome as a cause of prolonged fever in children. Aktualʹnaâ Infektologiâ. 2013;(10:104-107. (in Russian).

Lutfullin IYa. Kawasaki syndrome: clinical pathways and the problem of underdiagnosis. Vestnik Sovremennoi Klinicheskoi Mediciny. 2016;9(2):52-60. doi: 10.20969/VSKM.2016.9(2).52-60. (in Russian).

Maidannik VG, Nitiuriaeva-Korneiko IA. Bolezn' Kavasaki v detskom vozraste [Kawasaki disease in childhood]. Kyiv: Logos; 2015. 375 p. (in Russian).

Lyskina GA, Vinogradova OI, Shirinskaia OG, et al. Klinika, diagnostika i lechenie sindroma Kavasaki. Klinicheskie rekomendatsii [Clinic, diagnosis and treatment of Kawasaki syndrome. Clinical guidelines]. Moscow; 2011. 57 p. (in Russian).

Park YW. Epidemiology of Kawasaki disease in Korea. Epidemiology of Kawasaki disease in Korea. Korean J Pediatr. 2008;51(5):452-456.

Lyskina, GA, Tobryak AV. Kawasaki syndrome in children aged five or older at onset: review of literature and case report. Doctor Ru. 2015;(114):39-42. (in Russian).

Rowley AH, Baker SC, Shulman ST, et al. Ultrastructural, immunofluorescence, and RNA evidence support the hypothesis of a "new" virus associated with Kawasaki disease. J Infect Dis. 2011 Apr 1;203(7):1021-30. doi: 10.1093/infdis/jiq136.

Franco A, Shimizu C, Tremoulet AH, Burns JC. Memory T-cells and characterization of peripheral T-cell clones in acute Kawasaki disease. Autoimmunity. 2010 Jun;43(4):317-24. doi: 10.3109/08916930903405891.

Lyskina GA, Shirinskaya OG. Clinical manifestation, diagnostics and treatment of Kawasaki disease: known data and unsolved questions. Voprosy sovremennoi pediatrii. 2013;12(1):63-73. (in Russian).

Bekhtereva MK. Kawasaki syndrome in the practice of a pediatrician and infectionist. Kliniko-laboratornyi konsilium. 2013;(45):43-49. (in Russian).

Sudo D, Monobe Y, Yashiro M, et al. Coronary artery lesions of incomplete Kawasaki disease: a nation wide survey in Japan. Eur J Pediatr. 2012 Apr;171(4):651-6. doi: 10.1007/s00431-011-1630-3.

Published

2019-09-01

Issue

Section

Clinical Pediatrics