Clinical Manifestations of Kawasaki Disease at Different Age Spectrum: A Ten-Year Study

Abstract

Background and objectives: The present study is the first known in Latin America to enroll a substantial number of Kawasaki disease (KD) patients with an extended follow-up. This study aimed to: (1) to expose the difficulties and delays in the diagnosis of KD in a developing country, (2) to describe and correlate the clinical features of this disorder with the children’s age at the time of disease onset, (3) to correlate the frequent lack of early diagnosis with a delayed application of appropriate treatment, and (4) to describe the outcome and eventual recurrences of KD in our region. Materials and Methods: Three hundred and one participants (183 males and 118 females) included in the study were diagnosed and, subsequently, clinically followed for ten years (January 2007 to December 2016) at the Pediatric Rheumatology Walk-in Clinic of the Children’s Hospital of Brasilia. Results: Episodes ranged from four months to two years. This rate of recurrence was well-above that disclosed by previous reports. Delay in diagnosis, in all age groups, caused an undesirable delay between the disease onset, the final diagnosis, and the administration of intravenous immunoglobulin (IVIG). KD recurred in 25 (8.3%) of the children during the first three years of follow-up. In seven patients, KD recurred twice, with an interval between episodes ranging from four months to two years. Conclusions: This rate of recurrence was well-above that disclosed by previous reports. In Latin America, aside from a handful of physicians and researchers, KD is being ignored. There is a pressing need to educate primary health care physicians and bring awareness to the fact that KD is not an exotic condition that affects only the Asian populations but a disorder that already exists among us and that frequently results in severe consequences.

Kawasaki Disease- Management Strategies Given Symptoms Overlap to COVID-19: A Review

“…The report also found long-term behavioral abnormalities presenting as irritability, aggressiveness, and learning deficit observed during follow-up. 24 This contrasts with the low recurrence (2.4%) reported in a Swiss study of 30 years of KD. 53 Similarly, the lack of awareness and a delay in diagnosis have been reported from India 54 - 56 and Nepal 57 in Asia.…”

“…Delays in diagnosis and treatment have serious effects, especially in developing countries. 23 - 24 In developed countries, KD has replaced rheumatic fever as the main cause of acquired heart disease in children.…”

“… 31 , 34 , 36 It is more frequent in the extremes of ages, among infants <1 year and >8 years. 24 The diagnostic criteria are based on supportive laboratory findings and echocardiography. Children with incomplete/atypical KD require evaluation in a step-by-step algorithm.…”

Actualización de la Enfermedad de Kawasaki

“…Los criterios diagnósticos requieren ≥ 1 nódulo linfático de más de 1,5 cm de diámetro. Este es el criterio diagnóstico observado con menor frecuencia (9,10).…”

Cholestatic Jaundice as Atypical Initial Feature of Kawasaki Disease

“…To the Editor: The diagnosis of Kawasaki disease (KD) is based on clinical criteria and there exist no specific diagnostic laboratory tests [1]. Although KD is the common acute febrile disease in children, especially in Asia [2][3][4], seldom is the cholestasis reported as the initial feature of KD.…”