Comparison of Clinical Symptoms and Cardiac Lesions in Children with Typical and Atypical Kawasaki Disease

Abstract

The present study was performed to evaluate the clinical symptoms and cardiovascular complications in patients with typical and atypical Kawasaki disease (KD). This retrospective study was conducted on the medical records of 176 patients with KD for three years. The study population was divided into two groups of typical and atypical based on the KD clinical criteria. The two groups were compared in terms of demographic data, clinical symptoms, cardiac lesions, and laboratory markers. Based on the diagnostic criteria, 105 (60%) and 71 (40%) patients were diagnosed with typical and atypical KD, respectively. The mean age of the typical patients (38.16 months) was higher than that of the atypical group (24.03 months) at the time of diagnosis (p < 0.05). The results revealed no significant difference between the two groups regarding the seasonal distribution of KD onset (p = 0.422). However, the most common season for the diagnosis of the disease was spring, followed by winter. There was no significant difference between the two groups in terms of fever duration (p = 0.39). Furthermore, vomiting was more common in the atypical patients than in the typical group (p = 0.017). In terms of the cardiac lesions, ectasia (p = 0.005) and lack of tapering of the distal coronary vessels (p = 0.015) were more frequently detected in the atypical group than in the typical group. Considering the laboratory findings, thrombocytosis (p = 0.010) and anemia (p = 0.048) were more common in the atypical group, compared to those in the typical group. On the other hand, the typical group had a higher serum alanine aminotransferase level (adjusted for age) (p = 0.012) and Hyponatremia (serum sodium concentration ≤130 mmol/L) (p = 0.034). Based on the findings of the current study, the fever duration from onset to diagnosis was slightly more in atypical KD patients than in the typical group, but not statistically significant, possibly due to more timely diagnosis of atypical KD. There was no difference in coronary aneurysm between the two groups at the time of diagnosis. The atypical group had a higher frequency of coronary ectasia and lack of tapering, indicating cardiac involvement. Consequently, these conditions should be given more attention in the atypical patients. Furthermore, the higher frequency of anemia and thrombocytosis in the atypical patients can be useful for diagnosis of this kind of KD.

Multisystem inflammatory syndrome in pediatric COVID-19 patients: a meta-analysis

“…In addition, according to the center for disease control and prevention, any pediatric death with evidence of SARS-CoV-2 infection, and if individuals fulfill full or partial criteria for Kawasaki disease but meet the case definition for multiple inflammatory syndrome, they should be considered as having this syndrome. The Kawasaki disease signs and symptoms that might be associated with the multisystem inflammatory syndrome include bilateral conjunctival injection, oral changes such as cracked and erythematous lips and strawberry tongue, cervical lymphadenopathy, extremity changes such as erythema or palm and sole desquamation, and polymorphous rash [ 23 ]. Lastly, (4) outcome indicators: the mean and standard deviation or median and interquartile range for COVID-19-related complications and mortality.…”

Kawasaki disease in siblings in close temporal proximity to each other—what are the implications?

“…Despite being so-called "incomplete" KD, coronary artery involvement may, in fact, be higher in these patients [24]. Unless detected early and treated promptly, the long-term consequences in patients with incomplete KD can be grave [25]. Incomplete KD was recognized even in the first published manuscript on KD [26].…”

<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

“…21 Atypical forms of KD have a higher frequency of coronary ectasia, vomiting, anemia, thrombocytosis and a higher serum alanine aminotransferase level. 22,23 Secondly, another aspect of our case is represented by renal damage as a result of vasculitis at this level, represented by severe dyselectrolytemia (K = 2.2 mmol/L), proteinuria (30mg/dL) and glycosuria, persisted reduced urine gravity (1004-1008) and polyuria (2.25-2.5L/m 2 /24 hrs) interpreted as part of renal tubular abnormalities. Severe hypopotassemia could also attribute to gastrointestinal manifestation, but persisted dyselectrolytemia despite large quantities of potassium solutions infused, associated with other manifestations of renal tubular disorders (polyuria, low urine specific gravity, hyperchloremic metabolic acidosis, mild proteinuria and glycosuria) and rapid clinical and laboratory findings improvement after immunoglobulin administration suggests the renal tubular damage.…”