Clinical features of Kawasaki disease and its outcomes at Thammasat University Hospital

Abstract

Background: Kawasaki disease is a common acquired heart disease in children. Some patients had coronary complications, and there were reported of mortality after Kawasaki disease(KD). Early recognization and management would decrease the morbidity and mortality.

Objective: To study epidemiology data, clinical manifestations, laboratory findings, treatment, outcomes, and cardiovascular complications of the KD patients in Thammasat Hospital.

Methodology: A 7-year retrospective descriptive analytic study of KD in children, diagnosed with American Heart Association 2004 criteria, who admitted to Thammasat University Hospital during January, 2002 to January, 2009.

Results: KD was diagnosed in 30 patients, male:female ratio was 1.7:1. The majority of patients (86.7%) were below 5 years of age. The clinical manifestations were fever more than 5 days (96.7%), polymorphous exanthematous rash (93.3%), changes in lips and oral cavity (93.3%), changes in extremities (66.7%), bilateral conjunctivitis (50.0%), and cervical lymphadenopathy (40%). Patients were classified by clinical manifestations into complete Kawasaki disease (50%) and incomplete Kawasaki disease (50%). About laboratory findings, there were anemia (10.0%), leukocytosis (90%), thrombocytosis (26.7%), high erythrocyte sedimentation rate (90%). Two-dimensional echocardiagraphic study was performed in all patients. Of these 30 patients, cardiovascular complications were diagnosed in 3 patients (10.0%). All patients were treated with intravenous immunoglobulin (IVIG) (2gm/kg) plus acetyl salicylic acid (ASA) (80-100 mg/kg/day). Most of them (90.0%) had no fever within 48 hours after treatment. Three patients (10%) received the second dosage of IVIG (Resistant IVIG KD), subsequently the fever were resolved within 48 hours after secondary treatment, and no cardiac complication. A six months echocardiogram follow-up of those who diagnosed cardiac complication, there was one patient (3.33%) still had the cardiac complication.

Conclusion: KD in Thammasat University Hospital was found predominantly in young children under 5 year olds. Clinical manifestations were similar to previous studies. Laboratory investigation was beneficial in diagnosis. All patients were treated with IVIG (2gm/kg) plus ASA (80-100 mg/kg/day) and most of them had good results. Cardiovascular complication developed in ten percents of patients.

Key words: Kawasaki disease, IVIG, gammaglobulin, aspirin