KAWASAKI DISEASE - A TWO YEAR FOLLOW UP STUDY OF CLINICAL, LABORATORY AND ECHOCARDIOGRAPHIC PROFILES
Aparna K.R*, M. Zulfikar Ahamed**, P.G. Hariprasad***, Lalitha Kailas****
SAT Hospital, Medical College, Trivandrum *, SAT Hospital, Medical College, Trivandrum **, SAT Hospital, Medical College, Trivandrum***, SAT Hospital, Medical College, Trivandrum****
Objectives
  1. To study the clinical profile, laboratory abnormalities including lipid and Echocardiographic abnormalities in the acute phase of Kawasaki disease.
  2. To follow up these cases clinically and Echocardiographically for regression of aneurysms and for the appearance of new lesions if any.
  3. To compare the difference in outcome between administration of IVIG before and after 10 days of onset of illness.
  4. To find out the predictors for coronary artery involvement, if any.
Participants and Methods
The study was a prospective one done in the division of pediatric cardiology, Department of Pediatrics, SAT Hospital, Medical College, Trivandrum.

Patients in wards who were clinically diagnosed as Kawasaki disease based on fever > 5 days with 4/5 of the following features i.e., conjunctival congestion, changes in extremities, rash, cervical lymphadenopathy and oral mucosal changes were included in the study. 50 consecutive cases during the study period August 2002 to December 2005 were included.

The full clinical profile of all patients was studied. The investigations included ESR, CRP and Platelet count which were repeated every week for 4 weeks. ESR more than 35 mm/1st hour was taken significant. CRP was taken positive or negative. Liver function tests, urine examination, and a lipid profile in the convalescent phase of the illness were done. X-ray and ECG were taken. A 2D Echo examination by a single pediatric cardiologist using 6 and 8 MHz probes was done in the acute phase, at 6 weeks, 6 months, 1 year interval. Aneurisms were classified as mild [< 4 mm], moderate [4-8 mm] and severe [> 8 mm]. Data was analyzed using SPSS computer software.

Observations and Results:
  • The patients were in the range group 4 months to 5 years. 62% of them were in 2-5 year age group.
  • The Male:Female ratio was 1.7:1.
  • 90% fulfilled the classic criteria for diagnosis.
  • Cardiographic abnormalities were minimum [2%].
  • ECG and X-ray abnormalities were in <5%.
  • 42% had thrombocytosis in 3rd week after onset of illness.

The mean platelet count in those who had aneurysm was 4.33 L/mm3 in the first week after onset of illness, which increased 4.72 L/mm3 in the second week and decreased to 2.7 L/mm3 in the fourth week.

ESR ranged from 20 to 135 mm/1st hour, ESR normalized in 4 weeks in most patients.

Liver enzyme were significantly elevated in 32%. There was no clinical jaundice in any.

There was statistically significant rise in the triglyceride level of those with aneurysms compared with those who did not, in the convalescent period.

Coronary artery aneurysms were male sex, ESR > 80 mm/1st hour in the second week after onset of illness, ESR > 35 mm/1st hour in the fourth week, Polymorphonuclear leukocytosis in the peripheral smear. IVIG if given < 10 days after onset of illness was found protective against development of aneurysm.

On follow up, 77.6% aneurysms regressed by the end of one year.
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K.R A, Ahamed Z M, Hariprasad P, Kailas L.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=342
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