Kawasaki disease – experience of Pediatric University Hospital, Sofia, Bulgaria, 1993–2014. Part I: clinical manifestations

Abstract

Kawasaki disease (KD) is a vasculitis syndrome causing coronaritis in young children. As a result of the vascular damage, coronary lesions (CL), ectasia and aneurysms form in 20%-25% of the untreated children. The assessment of KD is difficult and challenging because of the lack of specific diagnostic or laboratory criteria. This is a retrospective study of 107 patients for a period of 21 years (1993-2014). In the cohort, 30.8% of patients had CL (19.6% had coronary aneurysms and 11.2% had significant coronary dilatations). The number of CL was high compared to that reported in international studies, although 45% of children were treated by modern protocols. In an attempt to analyse the reasons for the high coronary risk, the aim of this study was to investigate the clinical aspects of the disease and to establish the diagnostic problems causing diagnosis delay, which is subsequently related to increased coronary risk. The high incidence of the observed CL was associated with the failure of recognizing the disease, delayed diagnosis and, subsequently, lack of correct treatment. The analysis of the clinical presentation indicated significant correlation of gastrointestinal syndrome with typical and atypical KD. The incidence of the gastrointestinal syndrome correlated with the typical KD symptoms (p = 0.030), suggesting that it could be considered as a further diagnostic criterion.

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

“…The data of 107 patients diagnosed with KD over a period of 21 years CONTACT Albena Telcharova-Mihaylovska albenatm@gmail.com were analysed: 65 boys and 42 girls from 2 months to 13 years of age [8]. The male-to-female ratio was 1.5:1.…”

“…The release of cytokines in the acute febrile phase of the Kawasaki disease causes coronaritis with the consequences of formation of significant dilations and aneurysms [8]. Such were observed by echocardiography in 25% of the patients with no intravenous immunoglobulin (IVIG) treatment [4].…”

“…The objective of the present study was to discuss the clinical experience with KD of the Pediatric Rheumatology Clinic at the University Pediatric Hospital, Sofia, Bulgaria [8], and to assess the diagnostic and therapeutic factors that influence the risk of coronary complications: the values of CRP, ESR and fever in the acute and subacute phase of the disease, the cardiac manifestations in the acute phase of KD and the provided treatment. We discuss the results from the follow-up during the first year after the disease onset and from the longitudinal follow-up.…”