Kawasaki Disease: A Clinician’s Update

Abstract

Aims. Kawasaki disease is an acute systemic vasculitis and is the most common cause of acquired heart disease in children in the developed world. This review aims to synthesise recent insights into the disease and provide an update for clinicians on diagnostic and treatment practices. Methods. We conducted a review of the literature exploring epidemiology, aetiology, diagnosis, and management of Kawasaki disease. We searched MEDLINE, Medline In-Process, Embase, Google Scholar, and reference lists of relevant articles. Conclusions. Kawasaki disease is a febrile vasculitis which progresses to coronary artery abnormalities in 25% of untreated patients. The disease is believed to result from a genetically susceptible individual's exposure to an environmental trigger. Incidence is rising worldwide, and varies widely across countries and within different ethnic groups. Diagnosis is based on the presence of fever in addition to four out of five other clinical criteria, but it is complicated by the quarter of the Kawasaki disease patients with “incomplete” presentation. Treatment with intravenous immunoglobulin within ten days of fever onset improves clinical outcomes and reduces the incidence of coronary artery dilation to less than 5%. Given its severe morbidity and potential mortality, Kawasaki disease should be considered as a potential diagnosis in cases of prolonged paediatric fever.

Clinical Profile of Kawasaki Disease (KD) in Children admitted at Dhaka Shishu Hospital

“…the disease often leads to the formation of ectasia, dilatation, or aneurysm of the coronary arteries (CA). [12][13] The disease has become the leading cause of acquired heart disease among children in the United States and other developed countries. 12 By far, no study evaluating the clinical course of KD, its diagnosis, management and complications has yet been done in the context of our population.…”

“…[12][13] The disease has become the leading cause of acquired heart disease among children in the United States and other developed countries. 12 By far, no study evaluating the clinical course of KD, its diagnosis, management and complications has yet been done in the context of our population. Therefore the present study was undertaken to determine the annual admission of children with KD in Dhaka Shishu Hospital and to evaluate its presenting symptoms, clinical features and laboratory tests for the diagnosis of complete and incomplete KD in children.…”

Kawasaki Disease: The Clinical and Cardiologic Early-Term Characteristics and Prognoses of 44 Children with Acute Attack

“…5,6 Özellikle hastaların büyük çoğunluğunun beş yaşın altında olduğu, üç aydan küçük ve beş yaşın üstündeki çocuklarda daha az ortaya çıktığı bildirilmektedir.…”

“…3 Çocukluk ça-ğında Henoch-Schönlein vaskülitinden sonra en sık görülen vaskülit olup; gelişmiş ülkelerde edinsel kalp hastalığının en sık nedenidir. 4,5 KH'nın erken tanısı ve tedavisi sayesinde koroner arter hastalığı (KAH) sıklığı önemli derecede azalmıştır. Buna rağmen tedavi edilmeyen olguların %20-25'inde KAH görülmektedir.…”

Kawasaki disease – experience of Pediatric University Hospital, Sofia, Bulgaria, 1993–2014. Part II: cardiovascular manifestations and treatment

“…Kawasaki disease is a vasculitis syndrome and represents 23% of all forms of vasculitis in Caucasian children [1]. According to the revised 2012 nomenclature of childhood vasculitis syndromes, it is defined as arteritis, affecting mainly medium and small arteries [2].…”