Method: Part of ongoing prospective study of KD which was started in January 2003. Children admitted with KD at the Institute of Maternal and Child Health attached to Medical College Calicut were included in the study. The diagnosis of KD was made according to AHA criteria.
Observation: Epidemiology Out of 38 children with KD, 63% were males. Youngest was 4- month-old male infant and oldest was 12-year-old boy. 13% of children were <1 yr, 63% in the age group of 1 and 5 years and 24% beyond 5 years of age. In Japan, the peak age is 6-11 months, where as in USA and Europe the peak age is 18-24 months. The higher incidence in our study is similar to the Australian study.
Clinical Features: Fever and peeling of the skin at the extremities were the most consistent clinical features that occurred in all cases. Non purulent conjunctivitis and oral mucosal changes present in 97% cases. Significant lymphadenopathy in 80% of cases and rash in 70%. Extreme irritability and severe tiredness was found in 83%.
One child had jaundice. All the viral markers were negative in this child.
Incidence of CAA
- 61% had coronary artery anomalies (CAA).
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Diagnosis and CAA relationship
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A diagnosis of KD was made on or before 5th day of illness in 2 children and neither of them had CAA.
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In 16 cases (42%) diagnosis was made between 6-10 days and 56% of them had CAA,
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In 19 cases (50%) diagnosis was made after 10 days and 70% of them had CAA.
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In 50% cases diagnosis was made late because of late referral from the peripheral hospitals.
Timing of IVIG and CAA regression
Out of 33 children, who received IVIG, 21 had CAA at the time of diagnosis.
43% of them i.e., 9 children were given IVIG on or before 10th day of illness and 57% i.e., 14 children were given IVIG after the 10th day of illness.
Regression of CAA was found in 89% in first group and 75% in second group.
12 children who received IVIG, coronaries were normal at the time of diagnosis, and none of them developed CAA on follow up.
CAA on follow-up
27% of CAA had regressed in 6 weeks, 68% in 6 months and overall 82% at 1 year follow-up. One child who also had jaundice had giant aneurysm which has not regressed even at 1 year follow-up.
Conclusions:
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Irritability and severe tiredness is a frequently occurring clinical feature (83%) which may be included in the clinical criteria.
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Coronary Artery Anomaly was significantly high in our study group i.e., 61%. This is the highest incidence of CAA, the highest so far reported being 20-40% in Kato's series. This warrants genetic work up. Or is the environment in Kerala similar to the one in Japan both endowed with long coastal line.
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IVIG is useful in prevention of CAA, 32% of children who received IVIG coronaries were normal at the time of diagnosis, one of them later developed CAA.
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It helps the regression of CAA. Regression of CAA was found in 89% of children who received IVIG in the initial 10 days of illness and in 75% of children who received it after 10 days of illness.
Therefore, IVIG should be given however late a diagnosis of KD is made
