Evaluation of clinical characteristics of Kawasaki syndrome and risk factors for coronary artery abnormalities among children in Denmark

Abstract

In Denmark, more than one in 10 children with Kawasaki syndrome develop coronary artery abnormalities. Physicians should increase their index of suspicion for early diagnosis and treatment of Kawasaki syndrome among patients susceptible to increased risk of coronary artery abnormalities, particularly in infants who may have a more atypical presentation of the illness.

Safety netting versus overtreatment in paediatrics: viral infection or incomplete Kawasaki disease?

“…KD is a clinical diagnosis based on prolonged fever of 5 days or more with four of the five principal features including (1) bilateral bulbar conjunctival injection, (2) oral mucous membrane changes including injected or fissured lips, injected pharynx or strawberry tongue, (3) peripheral extremity changes including erythema of palms or soles, oedema of hands or feet (acute phase) and periungual desquamation, (4) polymorphous rash and (5) cervical lymphadenopathy (at least one lymph node >1.5 cm in diameter). 3 11 12 …”

“… 15 In the presence of risk factors, up to 25% of Europeans can develop both early and late cardiac lesions. 3 8 In tertiary care centres where initial paediatric echocardiography is available, the presence of echogenic lesions is critical in the decision to treat in the presence of elevated inflammatory markers. Practitioners at secondary care facilities, without access to paediatric echocardiography, face more diagnostic uncertainty.…”

“… 5 It is of major concern as 10%–25% of confirmed untreated cases may develop coronary aneurysms and have increased risk of myocardial ischaemia, infarction and sudden death. 3 6 A subset of incomplete cases who do not meet all established criteria for KD are also recognised in the literature to be at equivalent risk of serious sequelae and are more likely to go untreated. 6 7 This recognition failure leading to treatment delay increases the risk of immediate and delayed coronary artery aneurysm, which is the leading cause of acquired heart disease in children.…”

“… 6 7 This recognition failure leading to treatment delay increases the risk of immediate and delayed coronary artery aneurysm, which is the leading cause of acquired heart disease in children. 3 8 The following case of intermittent prolonged fever and rash in a 4-year-old boy illustrates the difficulty clinicians face to treat prophylactically when a common presentation of upper respiratory tract infection partially fulfils the diagnostic criteria for a more severe illness such as incomplete KD (iKD).…”

Kawasaki disease, autoimmune disorders, and cancer: a register-based study

“…The 10-, 20-, 30-and 35-year risks of being diagnosed with autoimmune diseases after the primary KD diagnosis were all significantly increased ( Table 3). The median time to autoimmune disease was 2 years (Q1-Q3 [0-12]) in the KD group and 12 years (Q1-Q3 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]) in the control group. The median follow-up time at risk was 11 years in the KD group and 12 years in the control group.…”