Retrospective study of the course, treatment and long-term follow-up of Kawasaki disease: a single-center experience from Poland

Abstract

Kawasaki disease (KD) is an acute, self-limited, systemic vasculitis and the most common cause of acquired coronary artery disease in pediatric population in the developed countries. It occurs mostly in Asian countries; however, due to better access to diagnostic and imaging tests, it is more frequently diagnosed among pediatric patients in Poland. The aim of this study was to describe the clinical course with special interest in cardiac involvement, treatment and follow-up of Polish patients with KD. It is a single-center retrospective study. Clinical features (including coronary involvement), laboratory results and treatment were evaluated. In our study group, we observed elevated levels of indicators of inflammation: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocytosis, platelet count, fibrinogen, d-dimer and ferritin. We also noticed changes in lipid profile and liver enzymes. Twenty-four patients were diagnosed with coronary artery abnormalities. Mean day of treatment equaled 9th day of the disease. Kawasaki disease should be suspected in all pediatric patients who have fever lasting 5 days, or more particularly those under 5 years of age. It is very important to apply treatment within the first 10 days of disease due to the high risk of cardiovascular complications. Each child should have echocardiography on admission, around 14th day of the disease, after 4-6 weeks from the onset of symptoms, as well as long-term observation at least once a year due to the fact that the inflammatory process and changes in the lipid profile increase the risk of atherosclerosis. Children with coronary aneurysms should undergo checkups every 6 months.

Epidemiology of Kawasaki Disease in Europe

“…This discrepancy is due to variations in definition and assessment of coronary artery involvement, time of evaluation and study design. The disease was recurrent in < 2.5% of cases (34,35,40,43) and mortality <0.5% in recent series (19,26,29,34,35,40,42,44,47). Familial cases are rare, reported in <1% of cases in first-and second-degree relatives (40).…”

“…Overall, 11% to 23% of children showed resistance to the first intravenous Ig infusion (29,34,40,42,46,47). Frequencies of coronary artery lesions ranged from 2 to 65% (19,21,26,34,35,40,42,(46)(47)(48). This discrepancy is due to variations in definition and assessment of coronary artery involvement, time of evaluation and study design.…”

“…In recent years, 58–80% of KD cases were complete as compared with 80–87% in the 1990's ( 21 , 30 , 42 , 43 , 45 ). The mean delay to treatment with intravenous Ig was 5.3–10 days ( 26 , 29 , 34 , 40 , 42 ), mostly about 7 days ( 21 , 46 , 47 ). Overall, 11% to 23% of children showed resistance to the first intravenous Ig infusion ( 29 , 34 , 40 , 42 , 46 , 47 ).…”

“…The mean delay to treatment with intravenous Ig was 5.3–10 days ( 26 , 29 , 34 , 40 , 42 ), mostly about 7 days ( 21 , 46 , 47 ). Overall, 11% to 23% of children showed resistance to the first intravenous Ig infusion ( 29 , 34 , 40 , 42 , 46 , 47 ). Frequencies of coronary artery lesions ranged from 2 to 65% ( 19 , 21 , 26 , 34 , 35 , 40 , 42 , 46 – 48 ).…”

Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review

“…Common gastrointestinal findings include diarrhea, vomiting, abdominal pain, hepatitis, and gallbladder hydrops while pancreatitis and jaundice are less common. Elevations in serum aminotransferases and/or gammaglutamyl-transpeptidase (GGT) documented in about one third/one half of patients are mild to moderate [ 1 , 2 , 3 , 4 , 5 ] and are described to be transient as they improve rapidly with the resolution of acute symptoms [ 6 ]. Here, we describe the case of a KD patient with an atypically protracted course of hypertransaminasemia and focus on recovery time of abnormal liver function tests in this condition.…”