Kawasaki Disease Hospitalization: Outcomes in Two Tertiary Care Hospitals in Bangladesh

Abstract

Kawasaki disease (KD) is an acute self-limiting inflammatory disease associated with vasculities, affecting predominantly medium sized vessels and encountered these cases infrequently in clinical practice. The most concerning complication is coronary artery aneurysm (CAA) leading to myocardial infarction or sudden death. Fever is the essential feature. Kawasaki disease is invariably associated with an inflammatory process with elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count. Early recognition and treatment with IVIG (Intravenous venous immunoglobulin), and Aspirin showed highest protection against development of coronary artery disease. Incidence of KD is more in East Asia or in Asian ancestry living in other countries. The reason for high incidence in developing country is still unknown. Recently a significant number of cases attended in day to day practice which led conducting this study to assess the pattern of presentation, management and outcome after treatment and to aware the health care providers about the nature of the disease. This observational study conducted during September 2014 to March 2016. All the cases reported to the department of paediatric echocardiography for coronary artery analysis and suspected as KD were included in the study. History, clinical examination and investigation reports were analyzed from records. Age, gender, clinical feature, management, follow-up, echocardiography findings and outcome were analyzed. Data were collected from records of Echocardiography Department and Paediatric Cardiology Department of Lab Aid Cardiac Hospital and Combined Military Hospital, Dhaka. Among 27 cases, 16 were male (49.25%) and 11 were female (40.75%). Age distribution showed 8 (29.63%) were under one year of age, 13(48.14%) were in 1-5 years age group, 6 (22.23%) were in more than 5 years age group. All 27 cases were presented with fever, strawberry tongue, conjunctivitis, skin rash with peeling. Raised ESR, CRP and neutrophilic leukocytosis were found in all 27 cases. Cervical lymphadenopathy was found in 15 (55.52%) cases. Coronary artery changes were observed in 24 cases (88.89%). IVIG was given in 25 (92.60%) cases and Aspirin was given in 27 cases. Complete cure was achieved in 25 (92.59%) cases and one case died from thrombo-embolic event of radial artery and amputation of hand. The outcome of KD depends on the severity of coronary artery involvement. Patients with aneurysm larger than 08 mm are at highest risk of myocardial infarction. Less than 08 mm aneurismal dilatation regress with time. In this series outcome was excellent due to timely diagnosis and proper intervention.

Coronary Artery Involvement in Kawasaki Disease-Echocardiographic Evaluation of Cases in a Tertiary Care Hospital

“…33 Kawasaki disease is the commonest cause of myocardial infarction in children. 34 In two of our cases with Z score >5 and diameter more than 8 mm associated with high cardiac troponin were treated with heparin infusion for 48 hours.…”

Presentation and Outcome of Children with Kawasaki Disease: Experience in A Tertiary Care Hospital in Bangladesh

“…The duration of the febrile episodes in children who are left untreated, ranges from 5 to 25 days, with an average duration of approximately 10 days. 9 Bilateral conjunctival injection mainly affects the bulbar conjunctivae, without suppuration, and usually starts soon after fever appears. Bright red, swollen lips with vertical cracking with bleeding were the most recognizable alterations.…”