Management of Kawasaki disease in the British Isles.

Abstract

Kawasaki disease in the British Isles was surveyed by an active reporting scheme, based on all cases reported to the British Paediatric Surveillance Unit that were diagnosed between 1 January and 31 December 1990. The study was prompted by the need to investigate the high case fatality rate of Kawasaki disease of 2% observed in 1988.One hundred and sixty three patients were identified of whom six (3.7°/0) died. Forty five children (28%) suffered cardiac complications of which 39 (24%) were coronary artery abnormalities; five children were diagnosed at postmortem examination, and coronary artery abnormalities were detected by echocardiography in 34. One hundred and forty nine children (930/o) had echocardiography. High thrombocytosis, leucocytosis, duration of fever, and younger age were associated with the presence of coronary artery abnormalities. Erythrocyte sedimentation rate, sex, and the number of diagnostic criteria were not. One hundred and thirty three children (87%) received aspirin.

Epidemiology, Etiology, and Management of Kawasaki Disease: State of the Art

“…There is anecdotal evidence suggesting the use of corticosteroids in refractory cases, but this should be considered in light of the results of one study from the pre-IVIG era comparing ASA and corticosteroid, in which coronary aneurysms developed in 11.1% and 64.7% of cases, respectively [41,100]. The use of IVIG should not be reserved only for cases fulfilling all five criteria for Kawasaki disease because many cases that present atypically later develop aneurysms [25,80]. A high index of suspicion and early use of IVIG is prudent in children with an undiagnosed persisting febrile illness compatible with Kawasaki disease to avoid missing atypical cases and to prevent cardiac complications [2,25,32,54].…”

“…The use of IVIG should not be reserved only for cases fulfilling all five criteria for Kawasaki disease because many cases that present atypically later develop aneurysms [25,80]. A high index of suspicion and early use of IVIG is prudent in children with an undiagnosed persisting febrile illness compatible with Kawasaki disease to avoid missing atypical cases and to prevent cardiac complications [2,25,32,54]. The empiric use of antibiotics and antiviral agents has not been proven in randomized trials, but infection should be carefully searched for and treated if identified.…”

Recurrent Kawasaki disease

“…In Britain, Kawasaki disease remains uncommon. The reported incidence in the UK is 3 to 4 cases per 100,000 children aged under 5 years, 6 about one thirtieth of that in Japan. 7 It is possible that cases are missed, not least because many common childhood infections have similar clinical features.…”

“…7 Up to 4% of cases of untreated Kawasaki disease will progress to sudden death during the acute phase of the illness as a result of aneurysmal thrombus formation, myocardial infarction or dysrhythmia. 6 While many aneurysms appear to resolve spontaneously, long-term morbidity can result from scarring of cardiac tissue. In about 1% of cases the heart valves are affected, 9 in which case antibiotic prophylaxis against infective endocarditis will be necessary prior to relevant dental procedures in the future.…”

Features of Kawasaki disease in early childhood

“…По международным данным, заболеваемость колеб-лется в пределах 3,4-100 на 100 тыс. [7,9,11,13]. Болезни наиболее подвержены дети до 5 лет с пиком заболеваемости в возрасте 9-11 мес.…”