KAWASAKI DISEASE CALICUT EXPERIENCE IS KERALA SIMILAR TO JAPAN IN KD? BETTER LATE THAN NEVER AS FAR AS IVIG IS CONCERNED
Neelu M*, Ashraf T.P**, Ajithkumar V.T.***, Riyas A****, Lulu M*****
Post graduate Student in Pediatrics, IMCH - Medical College Calicut, Kerala *, Assistant Professor of pediatrics, IMCH - Medical College Calicut, Kerala **, Assistant Professor of pediatrics, IMCH - Medical College Calicut, Kerala ***, Professor of Pediatrics, IMCH - Medical College Calicut, Kerala ****, Assistant Professor of pediatrics, IMCH - Medical College Calicut, Kerala*****
Objectives
  1. To record clinical features of patients with Kawasaki disease (KD) and follow them up
  2. To evaluate clinical response to treatment with IVIG
  3. To study coronary involvement

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.

Observations:
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)
  • Diagnosis and CAA relationship
  • A diagnosis of KD was made on or before 5th day of illness in 2 children and neither of them had CAA
  • In 16 cases (42%), diagnosis was made between 6-10 days and 56% of them had CAA
  • In 19 cases (50%), diagnosis was made after 10 days and 70% of them had CAA
  • 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 ie, 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: Therefore, IVIG should be given whenever late a diagnosis of KD is made.
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M N, T.P A, V.T. A, A R, M L.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=343
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