Kawasaki Disease in Burirum Hospital Jan. 2001-Apr.2006
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Abstract
Background: Kawasaki Disease is one of the major causes of acquired heart disease in childhood. It is increasingly found especially in Asia. There is an upward trend of this disease in Thailand as well. 15-25% of untreated patients have chance to develop coronary artery aneurysms. Since there has been no specific test to identify affected children, diagnosis can be a problem especially in Burirum province which is the endemic area of many tropical diseases with overlapped clinical features.
Objective: To study the epidemiologic patterns, clinical features, treatment and result of treatment in Kawasaki patients.
Research design: Retrospective descriptive study.
Subjects: From inpatients diagnosed Kawasaki Disease in Burirum Hospital from 1st Jan 2001 to 31st Apr 2006.
Methods: Descriptive statistic (mean, median and percent)
Result: 12 patients (male: female ratio 1.4:1) age ranging from 6 months to 4.5 years (average age 25 months) were found during period of study (mostly in summer). There were more patients received in summer. Six patients (50%) had atypical Kawasaki Disease. One (8.33%) was presented with congestive heart failure. Most cases were treated with Intravenous Immunoglobulin (IVIG) in early phase of disease but two (16.66%) were not due to delayed diagnosis. Most patients became afebrile within 24-48 hours after completion of the initial dose of IVIG. One had prolonged seven days of fever due to incomplete treatment (received only first dose of IVIG). Two patients (16.66%) with recurrent Kawasaki Disease had delayed diagnosis and inappropriate dose of IVIG in previous treatment. Three patients (25.0%) were referred to another hospital because of no clinical improvement. The others were normal on echocardiograms.
Conclusion: Although Kawasaki Disease is not common disease in Thailand, its complications are serious in delayed diagnosed or untreated patients. Physicians should aware of this disease when a child is presented with high fever although the other criteria of disease do not present.
Key word: Kawasaki Disease, Kawasaki Syndrome, Mucocutaneous Lymph Node Syndrome
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References
2. Newburger JW, Taubert KA, Shulman ST et al. Summary and abstracts of the Seventh International Kawasaki Disease Symposium. Pediatr Res. 2003;53:153-7.
3. สุมาลี ศรีวัฒนา, สุวรรณี ตั้งทูลสินธนา, โชติมา บัทมานนท์, ศักดิ์ เตชางาม. โรคคาวาชากิ. แพทยสภาสาร 2519;5:550-7
4. Panamonta M, Chaikitpinyo A, Durongpisitkul K et al. Kawasaki disease in central area of Northeast Thailand. J Med Assoc Thai. 2004;87:887-90.
5. Council on Cardiovascular Disease in the Young, Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, American Heart Association. Diagnostic Guidelines for Kawasaki Disease. Circulation. 2001;103:335-336.
6. Kato H, Sugimura T, Akagi T et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 1996:94:1379-85.
7. Yoshikawa H, Nomura Y, Masuda K et al. Four cases of Kawasaki syndrome complicated with myocarditis. Circ J. 2006;70:202-5.
8. Tsuda E, Arakaki Y, Shimizu T et al. Changes in causes of sudden deaths by decade in patients with coronary arterial lesions due to Kawasaki disease. Cardiol Young. 2005;15:481-8.
9. Newburger JW, Takahashi M, Bums JC et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med. 1986;315:341-7.
10. Peduzzi TL, Pitetti RD. Myocardial infarction and atypical Kawasaki disease in a 3-month-old infant. Pediatr Emerg Care. 2002;18:e16-9.
11. Hsieh YC, Wu MH, Wang JK et al. Clinical features of atypical Kawasaki disease. J Microbiol Immunol Infect. 2002 ; 35:57-60.
12. Tiao MM, Huang LT, Liang CD, Ko SF. Atypical Kawasaki disease presenting as intestinal pseudo¬obstruction. J Formos Med Assoc. 2006;105:252-5.
13. Diana MC, Villa G, Gattomo M et al. Sudden death in an infant revealing atypical Kawasaki disease. Pediatr Emerg Care. 2006;22:35-7.
14. Witt MT, Minich LL, Bohnsack JF, Young PC. Kawasaki disease: more patients are being diagnosed who do not meet American Heart Association criteria. Pediatrics. 1999;104:e10.
15. Pannaraj PS, Turner CL, Bastian JF, Burns JC. Failure to diagnose Kawasaki disease at the extremes of the pediatric age range. Pediatr Infect Dis J. 2004;23:789-91.
16. Anderson MS, Todd JK, Glode MP. Delayed diagnosis of Kawasaki syndrome: an analysis of the problem. Pediatrics. 2005;115:e428-33.
17. Dajani AS, Taubert KA, Gerber MA et al. Diagnosis and therapy of Kawasaki Disease in children. Circulation. 1993;87:1776-80.
18. Guo- Ying Huang, Xiao-Jing Ma, Min Huang et al. Epidemiologic pictures of Kawasaki disease in Shanghai from 1998 through 2002. J Epidemiol 2006;16:9-14.
19. YM Ng, RYT Sung, LY So et al. Kawasaki disease in Hong Kong, 1994 to 2000. Hong Kong Med J 2005;11:331-5.
20. Mason WH, Takahashi M. Kawasaki syndrome. Clin Infect Dis 1999;28:169-85.
21. Brogan PA, Bose A, Burgner D et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 2002;86:286-90.
22. G. Simonini, CD Rose, A Vierucci et al. Diagnosing Kawasaki syndrome: the need for a new clinical tool. Rheumatology 2005;44:959-961.84
23. Mark TW, LuAnn M, John FB, Paul CY. Kawasaki Disease: More patients are being diagnosed who do not meet American Heart Association criteria. Pediatrics 1999;104:e10.
24. 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;114:1708-33.
25. Hirata ร, Nakamura Y, Matsumoto K, Yanagawa H. Long-term consequences of Kawasaki disease among first-year junior high school students. Arch Pediatr Adol Med 2002;156:77-80.
26. M Iemura, M Ishii, T Sugimura et al. Long-term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart 2000;83:307-311.
27. Senzaki H, Chen CH, Ishido H. Arterial hemodynamics in patients after Kawasaki disease. Circulation 2005;111:2119-25.
28. Tsuda E, Kamiya T, Ono Y et al. Dilated coronary arterial lesions in the late period after Kawasaki disease. Heart 2005;91:177-82.
29. Parisi Q, Abbate A, Biondi-Zoccai GG et al. Clinical manifestations of coronary aneurysms in the adult as possible sequelae of Kawasaki disease during infancy. Acta Cardiol. 2004;59:5-9.
30. Bartoloni G, Salvatrice DM, Carlo R. Sudden death in a 21-year-old man caused by thrombosed coronary aneurysm: late sequelae or a very late onset of Kawasaki disease? Cardiovasc Pathol. 2002;11:318-21.
31. Seve P, Stankovic K, Smail A et al. Adult Kawasaki disease: report of two cases and literature review. Semin Arthritis Rheum. 2005;34:785-92.
32. Fason JT, Fry YW, Smith D. Kawasaki disease in a postpartum patient. J Natl Med Assoc 2004;96:1499-502.(abstract)
33. Smith BA, Grider DJ. Sudden death in a young adult: sequelae of childhood Kawasaki disease. Am J Emerg Med 1993;11:381-3.
