Affects of "Age at Diagnosis" on Coronary Artery Lesions in Patients With Incomplete Kawasaki Disease

Abstract

Background and ObjectivesDiagnosis of Kawasaki disease (KD) is based on 5 clinical features. Incomplete KD (IKD), which has fewer features, is more common in infants and older children, in whom the rate of coronary artery aneurysms is paradoxically higher. We conducted this study to evaluate risk factors associated with age-at-diagnosis on coronary arterial lesions (CAL) in patients with IKD.Subjects and MethodsRetrospective data from 396 patients with KD in a single center were collected from January 2003 to July 2007. Patients were grouped according to their age at diagnosis; Group A (<1 year of age), Group B (1≤age<5 years of age), and Group C (≥5 years of age).ResultsAmong a total of 396 patients with KD, 87 (22.0%) were in Group A, 246 (62.1%) in Group B, and 63 (15.9%) in Group C. In groups A and C, lag times for starting intravenous immunoglobulin (IVIG) were longer than in Group B. There were no differences in the incidence of IKD, late CAL, or rates of IVIG retreatment among the three groups. Among 174 patients with IKD, there were no age-related differences in late CAL incidence or IVIG retreatment. Compared with typical KD, duration of fever and lag times to start IVIG were longer, and the rate of IVIG retreatment was higher in IKD, but there was no difference in the risk of CAL between typical KD and IKD.ConclusionIn the management of KD, especially the incomplete type, age-associated factors appear not to be significant for predicting the development of CAL.

Age-related differences in clinical characteristics of Kawasaki disease

“…However, the prevalence of cervical lymphadenopathy was lower in patients aged <1 year than in those at other ages, and these patients were more likely to have incomplete clinical presentation. These results showed similarities with earlier results obtained by Cho et al ( 14 ), who reported that the least common symptom in patients with KD aged <1 year was cervical lymphadenopathy. We also found that the duration of fever before admission was significantly longer in patients aged <1 year than in the other age groups, which presumably was attributed to the high proportion of incomplete KD in these patients.…”

Diagnosis of Incomplete Kawasaki Disease in Infants Based on an Inflammation at the Bacille Calmette-Guérin Inoculation Site

“…However, pediatricians occasionally encounter febrile children who do not fulfill the diagnostic criteria but who have several findings compatible with those of KD. In this type of situation, the diagnosis of incomplete KD is a clinical challenge that cannot be avoided by delaying the diagnosis because the risk of coronary complications is seen even in incomplete presentation of the disease 3-5)…”

Fatal Parvovirus B19 Myocarditis in Children and Possible Dysimmune Mechanism

“…2 Risk factors for coronary artery lesions include delayed diagnosis and an age of onset outside the typical age distribution (>6 months and <5 years). 3 Diagnosis of KD is based on clinical criteria-fever for at least 5 days and…”