Diagnostic characteristics of supplemental laboratory criteria for incomplete Kawasaki disease in children with complete Kawasaki disease

Abstract

PurposeIn 2004, the American Heart Association (AHA) had published an algorithm for the diagnosis of incomplete Kawasaki disease (KD). The aim of the present study was to investigate characteristics of supplemental laboratory criteria in this algorithm.MethodsWe retrospectively examined the medical records of 355 patients with KD who were treated with intravenous immunoglobulin (IVIG) during the acute phase of the disease. Laboratory data were obtained before the initial IVIG administration and up to 10 days after fever onset. In 106 patients, laboratory testing was performed more than twice.ResultsThe AHA supplemental laboratory criteria were fulfilled in 90 patients (25.4%), and the frequency of laboratory examination (odds ratio [OR], 1.981; 95% confidence interval [CI], 1.391-2.821; P<0.001) was a significant predictor of it. The fulfillment of AHA supplemental laboratory criteria was significantly associated with refractoriness to the initial IVIG administration (OR, 2.388; 95% CI, 1.182-4.826; P=0.013) and dilatation of coronary arteries (OR, 2.776; 95% CI, 1.519-5.074; P=0.001).ConclusionRepeated laboratory testing increased the rate of fulfillment of the AHA supplemental laboratory criteria in children with KD.

Changes in clinical and laboratory features of Kawasaki disease noted over time in Daejeon, Korea

“…Because of early visit to hospital and changed phenotype of KD in Korea, application of the laboratory diagnostic criteria suggested by the AHA for incomplete KD patients with short fever duration can have some clinical obstacles, such as waiting for 1-2 days or more after admission [34]. Moreover, early IVIG treatment may affect the appearance of clinical diagnostic criteria of patients with potentially complete KD.…”

Suppressed plasmablast responses in febrile infants, including children with Kawasaki disease

“…KD classically presents as a minimum of five days of fever with conjunctivitis, singular lymph node swelling, oral mucous membrane inflammation, peripheral extremity swelling, and rash [ 1 , 4 , 6 , 14 ]. Four of five criteria define classic KD, however, incomplete presentations with fewer symptoms can also result in coronary artery abnormalities [ 3 ]. Laboratory values such as leukocytosis, anemia, alanine aminotransferase (ALT) elevation, late thrombocytosis, urethritis, or hypoalbuminemia [ 2 ] can be useful to diagnose KD, particularly for incomplete forms [ 3 ].…”

Involvement of Nervous System in Kawasaki Disease

“…It is estimated that in Europe, 10 to 15 new cases per 100,000 children are diagnosed every year. 4,5 Diagnosis is made clinically, and classically, 5 days of fever plus four or five diagnostic criteria must be met to establish the diagnosis. These criteria include (a) erythema of the lips or oral cavity, (b) polymorphous rash of the trunk, (c) swelling or erythema of the hands or feet (acute phase) followed by periungual desquamation (convalescent phase), (d) bilateral conjunctival injection, and (e) cervical lymphadenopathy (at least one lymph node > 1.5 cm in diameter).…”

“…These criteria include (a) erythema of the lips or oral cavity, (b) polymorphous rash of the trunk, (c) swelling or erythema of the hands or feet (acute phase) followed by periungual desquamation (convalescent phase), (d) bilateral conjunctival injection, and (e) cervical lymphadenopathy (at least one lymph node > 1.5 cm in diameter). 5 Heart complications constitute a significant cause of morbidity in these patients, which may appear in the acute phase (myocarditis, pericarditis, mitral regurgitation, and coronary artery ectasia) or in the subacute phase of the disease (coronary artery aneurysms). 6 Many children, especially infants, do not exhibit all of the above criteria (nontypical or incomplete Kawasaki disease 5 days with fever but < additional four diagnostic criteria).…”

“…Nevertheless, administration of appropriate treatment (intravenous immunoglobulin, acetylsalicylic acid) within 10 days from fever onset results in a significant reduction of this proportion. 5 A specific etiology has not yet been identified. Nevertheless, a series of genes coding for immune system components have been correlated with this entity, while specific epidemiological features (e.g., age distribution, ethnicity, outbreaks) imply the existence of environmental triggers.…”