Rate, associated factors and outcomes of recurrence of Kawasaki disease in Ontario, Canada

Abstract

Background: Previous studies on recurrence of Kawasaki disease (KD) have mostly been limited to Japan, which has an incidence of KD 8-10-fold higher than North America. The aim of the present study was to determine the rate of KD recurrence for patients in Ontario, to identify factors potentially associated with increased odds of recurrence, and to compare the clinical course and outcomes of index and recurrent KD episodes. Methods: Review was undertaken of all patients with recurrence of KD identified in Ontario, Canada, from 1995 to 2006. All patients with recurrence of KD (defined as at least three clinical signs of KD in addition to fever 35 days), presenting 314 days after the return to baseline from the index episode were included. Results: A total of 1010 patients were followed for 5786 patient-years. During this period a total of 17 recurrent episodes in 16 patients were identified at a median of 1.5 years after the initial episode (2 weeks-5 years). Rate of recurrence of KD was 2.9 episodes/1000 patient-years, which is higher than the expected annual incidence of KD in the same age group (26.2/100 000 per year). No factors associated with increased risk of recurrence were identified, perhaps due to the small number of events. Clinical course and outcomes of the index and recurrent KD episodes were similar. Conclusions:A previous history of KD should increase the index of suspicion for future episodes of KD to allow for rapid recognition, treatment and to achieve optimal outcomes.Key words coronary artery abnormalities, genetics, Kawasaki disease, recurrence.Recurrence after Kawasaki disease (KD) is a well-established phenomenon. 1 Recurrence of KD is thought to affect approximately 4% of children who have had KD in Japan.2 Populationbased studies conducted in the early 1980s have established the prevalence of recurrence of KD in the USA at <1%; these estimates have not been re-evaluated since. 3,4 Estimates have also shown that the risk of having a second episode of KD for children with a previous history of KD is higher than the risk for children in the general population of having an initial episode of KD.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

“…25 In Canada, a review of 1010 patients showed a recurrence rate of 2.9 episodes per 1000 patient-years of follow-up, with recurrences occurring at a median of 1.5 years after the index episode and with similar features and outcomes. 26 However, Nakamura et al 27 reported a higher risk of developing coronary artery sequelae with the recurrent episode, regardless of the sequelae developed with the index episode. The proportion of cases with a positive family history is ≈1%.…”

“…26 However, Nakamura et al 27 reported a higher risk of developing coronary artery sequelae with the recurrent episode, regardless of the sequelae developed with the index episode. The proportion of cases with a positive family history is ≈1%.…”

Environmental epidemiology of Kawasaki disease: Linking disease etiology, pathogenesis and global distribution

“…The high incidence of KD in Asian populations globally is strong evidence of a genetic contribution to disease susceptibility. Significant familial associations have been found in KD with a higher incidence rate being reported in children with family members who have previously had an episode of KD [ 5 – 7 ]. Genome wide linkage studies have identified multiple regions that are associated with an increased risk of KD, and genetic polymorphisms for increased risk of KD, further, increased risk of coronary artery abnormalities resulting from KD have been identified [ 8 – 11 ].…”

Sequential Changes in Left Ventricular Systolic Myocardial Deformation Mechanics in Children with Recurrent Kawasaki Disease

“…Relatively few studies of recurrent KD have been reported. 4) 5) 12) 17) LV longitudinal peak systolic ε has been reported to be a more sensitive parameter than conventional echocardiographic parameters for the detection of early myocardial dysfunction in children. 18) 19) 20) Our results support these findings, as LV longitudinal peak systolic ε in children with acute phase of KD was decreased in comparison with that in controls, in initial and recurrent episodes, while no significant differences in the LVEF or LV mass index were observed between children with KD and controls.…”

“…One study reported an increased incidence of coronary artery abnormalities in recurrent KD, 4) while another reported similar risk of coronary artery abnormalities in children in initial and recurrent KD episodes. 5) …”