Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country

Bah, Mohd Nizam Mat; Alias, Emieliyuza Yusnita; Razak, Hasliza; Sapian, Mohd Hanafi; Foo, Fang Han; Abdullah, Nisah

doi:10.1007/s00431-021-04135-7

Cited by 14 publications

(14 citation statements)

References 32 publications

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“…Lymphadenopathy can lead to lymphatic circulation disorders, accumulation of lymph in the posterior pharyngeal wall, formation of hypodense oedematous areas, and imaging findings similar to posterior pharyngeal abscess, which could explain why the retropharyngeal low-attenuation area seen in neck radiological findings is its extension without significant ring enhancement and mass effects on the airway. The inflammatory responses in the mucosal immune system produce excess levels of inflammatory cytokines during the acute phase of KD [ 35 , 36 ]. Retropharyngeal low-density lesions in IKD might be caused by a similar mechanism, which could explain why they are seen in older patients whose mucosal immune systems are more mature.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

et al. 2022

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Objective Incomplete Kawasaki disease (IKD) initially presenting as retropharyngeal abnormality is very rare and is prone to misdiagnosis and missed diagnosis, often leading to poor prognosis. Most patients were misdiagnosed with retropharyngeal abscesses. Here, we describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients. Methods We performed a retrospective case–control study comparing IKD patients initially presenting with retropharyngeal abnormalities to both KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients admitted to Shenzhen Children’s Hospital between January 2016 and December 2021. Results We evaluated data from 10 IKD patients initially presenting with retropharyngeal abnormalities (Group A), 20 typical KD patients (Group B) and 16 surgical drainage confirmed retropharyngeal abscess patients (Group C). Compared to Group B, we observed that Group A was older and had a more intense inflammatory response. On the day of admission, Groups A and C had similar early clinical presentations, and there were no significant differences in any major signs or symptoms. Close observation for the development of new KD signs and symptoms and unresponsiveness to empirical antibiotic therapy after 3 days is extremely important. The CRP (p = 0.011), AST (p = 0.002) and ALT (p = 0.013) levels were significantly higher and the WBC (P = 0.040) levels were significantly lower in Group A than in Group C. Neck radiological findings, such as the presence of ring enhancement (p = 0.001) and mass effects on the airway, are also useful tools for distinguishing these two diseases. Conclusion The careful observation of the signs and symptoms of this disease and the comprehensive analysis of the laboratory tests and neck radiological findings may help clinicians become aware of retropharyngeal abnormality as an atypical presentation of KD. Then, unnecessary treatments could be reduced, and the occurrence of serious complications can be avoided.

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Section: Discussionmentioning

confidence: 99%

“…The present study has some limitations, including a small sample size, single-centre design and retrospective design. The location of the study may affect the results of the study as well because KD is more common in the northeastern Asian population [ 36 ]. These facts may restrict the generalizability of the present findings.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

et al. 2022

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“…Data were retrieved from the KD Clinical Information System, a clinical registry for KD in Johor that includes 18 medical facilities 10 . It contains the demographic, clinical, laboratory, treatment, and coronary data of all newly diagnosed KD patients in Johor State.…”

Section: Methodsmentioning

confidence: 99%

“…Diagnosis of KD and coronary aneurysms (detected at 6-8 weeks of illness) was made using the American Heart Association guidelines on KD 11 and described in detail in our previous publication. 10 Complete KD was diagnosed in a patient with a fever of 5 days and with at least four clinical diagnostic criteria, while incomplete KD was diagnosed in a patient with less than four clinical diagnostic criteria. Patients with unusual clinical presentations or complications, such as shock, seizure, joint pain, or acute abdomen were considered as atypical presentation.…”

Section: Definitionmentioning

confidence: 99%

Delayed diagnosis of Kawasaki disease in Malaysia: Who is at risk and what is the outcome

Bah

Alias

Sapian

et al. 2022

Pediatrics International

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Background Data on the delayed diagnosis of (KD) is limited. This study aimed to determine the prevalence and trend of delayed diagnosis over time and identify the associated risk factors in Malaysia. Methods This retrospective, observational, population‐based study involved all children with KD registered in Johor Kawasaki Clinical Registry over 10 years (January 2010 and December 2019). The prevalence of delayed diagnosis and its trend over time was calculated. Multivariable binary logistic regression was used to identify the independent risk factors for delayed diagnosis. Results There were 556 cases of KD, with 28% having incomplete criteria, 11% atypical presentation, while 10% developed a coronary aneurysm. The overall prevalence of delayed diagnosis was 9.9% (95% confidence interval (CI): 7.6–12.7%). There was a statistically significant decrease in delayed diagnosis over time (P = 0.008), with the latest rate of 4.6%. The majority of delayed diagnoses were due to failure to diagnose the disease during the initial consultation. Independent risk factors for delayed diagnosis were children older than 1 year, diagnosis before 2015, atypical presentation, and incomplete KD, with adjusted odds ratios (ORs) of 2.7, 2.3, 4.3, and 3.6, respectively. Compared to early diagnosis of KD, delayed diagnosis was significantly associated with coronary aneurysms (27.3% vs. 8.2%, P < 0.001, OR 4.2, [95% CI: 2.1–8.3]). Conclusions One‐tenth of cases of KD were diagnosed late, but it has improved over time. Children > 1 year, presenting with atypical presentation, and incomplete criteria are associated with late diagnosis.

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“…Kawasaki disease (KD) is an acute systemic vasculitis with complex pathological triggers, usually occurring in children under the age 5 [ 1 ]. According to KD epidemiological data, the median diagnosis age of the disease is 1.4 years old, with a predilection for boys and the rainy season as the peak period [ 2 ]. The disease mainly has a negative impact on children's medium-sized arteries, especially the coronary arteries [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Gamma Globulins in Children with Kawasaki Disease and Factors Influencing Children’s Short-Term Prognosis

Sun¹,

Lu²,

Wu³

2022

Computational and Mathematical Methods in Medicine

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Purpose. To explore and analyze the therapeutic effect of gamma globulins (GG) on Kawasaki disease (KD) in children and the influencing factors of short-term prognosis. Methods. First, 90 pediatric KD patients admitted between January 2019 and January 2021 were selected and divided into a control group ( n = 40 ) and a research group ( n = 50 ) according to the difference in treatment. In addition to routine treatment and nursing given to both groups, control group was given aspirin (ASA), based on which research group was supplemented with GG therapy. The treatment outcome and adverse events (AEs) of the two cohorts of patients were analyzed and compared, and the influencing factors of children’s short-term prognosis were analyzed by logistics multivariate analysis. Results. Research group had a statistical higher overall response rate than control group, with significantly fewer cases suffering from AEs such as nausea and vomiting, diarrhea, rash, dizziness and headache, and coronary artery injury. On the other hand, logistics multivariate analysis identified that gender, body mass index (BMI), onset time, platelet (PLT), and treatment mode all independently influence the short-term prognosis of children with KD. Conclusions. GG therapy is effective in treating pediatric KD patients and can effectively prevent AEs. In addition, gender, BMI, onset-to-treatment time, PLT, C-reactive protein (CRP), and treatment methods are independent risk factors for short-term prognosis of children with KD.

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Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country

Cited by 14 publications

References 32 publications

Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

Delayed diagnosis of Kawasaki disease in Malaysia: Who is at risk and what is the outcome

Efficacy of Gamma Globulins in Children with Kawasaki Disease and Factors Influencing Children’s Short-Term Prognosis

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