Factors associated with delay in diagnosis of Kawasaki disease in India

Abstract

A retrospective analysis was carried out to identify factors associated with delay in diagnosis of Kawasaki disease in a tertiary care pediatric hospital setting in Chennai, India. Over a period of 2 years, a total of 37 cases were studied. The cases were divided into Early Diagnosis Group (EDG) and Delayed Diagnosis Group (DDG) with the cut-off for early diagnosis being ten days. A greater proportion of cases in the EDG presented primarily to our institution (P=0.004). In the DDG group greater number of cases had received medical attention from practicing pediatricians prior to referral. There was greater interval in onset of individual symptoms in the DDG group. There was no difference between the two groups with regard to age, gender, total blood counts, CRP, liver enzymes, urine analysis or serum albumin values. Platelet counts were higher in the DDG compared to the EDG (P=0.004).Coronary abnormalities were more common in the DDG (P=0.05). Our findings suggest that children presenting primarily to a tertiary care centre with symptoms of Kawasaki disease are more likely to be associated with early diagnosis and delay in onset of neck swelling or oral lesions may be associated with delayed diagnosis. There is a need for creating more awareness about Kawasaki disease among practicing pediatricians in India.

Kawasaki Disease- Management Strategies Given Symptoms Overlap to COVID-19: A Review

“… 24 This contrasts with the low recurrence (2.4%) reported in a Swiss study of 30 years of KD. 53 Similarly, the lack of awareness and a delay in diagnosis have been reported from India 54 - 56 and Nepal 57 in Asia. The study from Nepal reported a low incidence of 0.1% i.e.…”

Chromhidrosis

“…The oxidative state of the pigment determines the sweat color 2 . Depending on the level of oxidation of the lipofuscin granules in the apocrine glands, the sweat color may be yellow, blue, green, or blue black 3 …”

“…2 Depending on the level of oxidation of the lipofuscin granules in the apocrine glands, the sweat color may be yellow, blue, green, or blue black. 3 Chromhidrosis is diagnosed clinically and is commonly preceded by an aura of warmth or a prickling sensation. The diagnosis can be confirmed via skin biopsy.…”

Spontaneous Duodenal Perforation as a Complication of Kawasaki Disease

“…Kawasaki disease is a clinical diagnosis. Although elevated creatinine levels, ESR, and platelets count may also be seen in limited patients [ 2 ], in this particular patient we observed CRP+++ by qualitative test and elevated ESR levels that may be because of IVIG infusion in addition to inflammation [ 4 ]. Also, hyponatremia (Na, 125 meq/L) means severe inflammation in KD [ 3 ], and it may be a clue to the diagnosis of KD [ 5 ].…”

“…The patient filled all diagnostic criteria of KD except for cervical lymphadenopathy, which is the least common diagnostic criterion [ 4 ]. Our patient went under standard treatment for possible diagnosis of typical KD.…”