Comparison of clinico-haematological and echocardiographic features at diagnosis between complete and incomplete Kawasaki disease: a 12-years single centered experience from a tertiary care referral center of Bangladesh
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250408Keywords:
Complete KD, Coronary artery aneurysm, Kawasaki disease, Incomplete KDAbstract
Background: Kawasaki disease (KD) is the most common cause of acquired heart disease in childhood with coronary artery abnormalities among 15-25% of cases. This study aimed to compare the clinico-haematological profile and initial echocardiographic changes of coronary arteries among complete and incomplete KD patients admitted in a tertiary care center in Bangladesh.
Methods: This was a retrospective study of 66 children diagnosed with KD admitted in the Department of Paediatrics from July 2010 to March 2023 at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh.
Results: In our study, 51.5% patients had complete KD while 48.5% had incomplete KD. Children with incomplete KD (9.23±4.74 days) had a longer-lasting fever in comparison to complete KD patients (7.36±3.21 days). All the typical clinical symptoms of KD were observed significantly less frequently in children with incomplete KD. Laboratory findings between the two groups showed no significant differences. We observed that children with incomplete KD had significantly higher frequency of abnormal coronary artery at diagnosis (67.7%) in comparison to children with complete KD (34.3%). Here, children with incomplete KD had significantly higher frequency of at least one coronary artery aneurysm and mild coronary artery aneurysms in relation to complete KD patients.
Conclusions: All the typical clinical symptoms of KD were observed significantly less frequently along with longer dutration of fever in children with incomplete KD. Laboratory findings between the two groups showed no significant differences. Children with incomplete KD had significantly higher frequency of abnormal coronary artery at diagnosis in comparison to complete KD patients.
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References
Uehara R, Belay ED. Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol. 2012; 22(2):79-85. DOI: https://doi.org/10.2188/jea.JE20110131
Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Jpn J Allergy. 1967;16:178-222.
Singh S, Vignesh P, Burgner D. The epidemiology of Kawasaki disease: a global update. Arch Dis Childh. 2015;100(11):1084-8. DOI: https://doi.org/10.1136/archdischild-2014-307536
Kim GB. Reality of Kawasaki disease epidemiology. Kor J Pediatr. 2019;62(8):292. DOI: https://doi.org/10.3345/kjp.2019.00157
Singh S, Bhattad S. Kawasaki disease incidence at Chandigarh, North India, during 2009-2014. Rheumatol Int. 2016;36:1391-7. DOI: https://doi.org/10.1007/s00296-016-3543-y
McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927-999. DOI: https://doi.org/10.1161/CIR.0000000000000484
Newburger JW, Takahashi M, Burns JC. Kawasaki disease. J Am Coll Cardiol. 2016;67(14):1738-49. DOI: https://doi.org/10.1016/j.jacc.2015.12.073
Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics. 1974;54(3):271-6. DOI: https://doi.org/10.1542/peds.54.3.271
Burns JC. Kawasaki disease update. Ind J Pediatr. 2009;76 (1):71-6. DOI: https://doi.org/10.1007/s12098-009-0031-3
Sharma D, Singh S. Kawasaki disease-A common childhood vasculitis. Ind J Rheumatol. 2015;10:S78-83. DOI: https://doi.org/10.1016/j.injr.2015.07.010
Wang Q, Morikawa Y, Akahoshi S, Miyata K, Sakakibara H, Matsushima T, et al. Follow-up duration of echocardiography in patients with kawasaki disease with no initial coronary aneurysms. J Pediatr. 2022;244:133-8. DOI: https://doi.org/10.1016/j.jpeds.2021.11.022
Bhattad S, Gupta S, Israni N, Mohanty S. Profile of Kawasaki disease at a tertiary care center in India. Ann Pediatr Cardiol. 2021;14(2):187-91. DOI: https://doi.org/10.4103/apc.APC_57_20
Jindal AK, Pilania RK, Guleria S, Vignesh P, Suri D, Gupta A, et al. Kawasaki disease in children older than 10 years: a clinical experience from Northwest India. Fronts Pediatr. 2020;8:24. DOI: https://doi.org/10.3389/fped.2020.00024
Tanaka A, Inoue M, Hoshina T, Koga H. Correlation of coronary artery abnormalities with fever pattern in patients with Kawasaki disease. J Pediatr. 2021;236:95-100. DOI: https://doi.org/10.1016/j.jpeds.2021.05.020
Ha KS, Jang GY, Lee J, Lee KC, Son CS. Laboratory markers in incomplete Kawasaki disease according to coronary artery outcome. Kor Circul J. 2018;48(4):287. DOI: https://doi.org/10.4070/kcj.2017.0342
Singh S, Gupta D, Suri D, Kumar RM, Ahluwalia J, Das R, et al. Thrombocytopenia as a presenting feature of Kawasaki disease: a case series from North India. Rheumatol Inter. 2009;30:245-8. DOI: https://doi.org/10.1007/s00296-009-0947-y
Furusho K, Kamiya T, Nakano H, Kiyosawa N, Shinomiya K, Hayashidera T, et al. High-dose intravenous gammaglobulin for Kawasaki disease. Lancet. 1984;2(8411):1055-8. DOI: https://doi.org/10.1016/S0140-6736(84)91504-6
Newburger JW, Takahashi M, Burns JC, Beiser AS, Chung KJ, Duffy CE, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Medi. 1986;315(6):341-7. DOI: https://doi.org/10.1056/NEJM198608073150601
Zhang T, Yanagawa H, Oki I, Nakamura Y, Yashiro M, Ojima T, et al. Factors related to cardiac sequelae of Kawasaki disease. Europ J Pediatr. 1999;158:694-7. DOI: https://doi.org/10.1007/s004310051181
Van Stijn D, Korbee JM, Netea SA, de Winter VC, Zwinderman KA, Kuipers IM, et al. Treatment and coronary artery aneurysm formation in Kawasaki Disease: a per-day risk analysis. J Pediatr. 2022;243:167-72. DOI: https://doi.org/10.1016/j.jpeds.2021.12.054
Perrin L, Letierce A, Guitton C, Tran TA, Lambert V, Koné-Paut I. Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine. 2009;76(5):481-5. DOI: https://doi.org/10.1016/j.jbspin.2008.11.015
Sudo D, Monobe Y, Yashiro M, Mieno MN, Uehara R, Tsuchiya K, et al. Coronary artery lesions of incomplete Kawasaki disease: a nationwide survey in Japan. Europ J Pediatr. 2012;171:651-6. DOI: https://doi.org/10.1007/s00431-011-1630-3
Kolko N, Bhat YA, Al Mesned A, Al Qwaee A, Al Akhfash A, Alhobani M, et al. Comparison of demographic, clinical, and echocardiographic features between complete and incomplete, and early and late presenters of kawasaki disease: a 10-year single-center experience. Cureus. 2023;15(9). DOI: https://doi.org/10.7759/cureus.45819
Banoo N, Bashir A, Tariq S, Radhakrishnan S, Abid S. Clinical profile of Kawasaki disease in children admitted at a tertiary care hospital of North India and their short-term follow-up. Ann Pediatr Card 2021;14(4):459-64. DOI: https://doi.org/10.4103/apc.APC_201_20
Bressieux-Degueldre S, Gradoux E, Di Bernardo S, Sekarski N. Complete and incomplete Kawasaki disease: Clinical differences and coronary artery outcome from a national prospective surveillance study in Switzerland. Fronti Pediatr. 2023;11:1137841. DOI: https://doi.org/10.3389/fped.2023.1137841
Manlhiot C, Christie E, McCrindle BW, Rosenberg H, Chahal N, Yeung RS. Complete and incomplete Kawasaki disease: two sides of the same coin. Europ J Pediatr. 2012;171:657-62. DOI: https://doi.org/10.1007/s00431-011-1631-2
Ha KS, Jang G, Lee J, Lee K, Hong Y, Son C, et al. Incomplete clinical manifestation as a risk factor for coronary artery abnormalities in Kawasaki disease: a meta-analysis. Europ J Pediatr. 2013;172:343-9. DOI: https://doi.org/10.1007/s00431-012-1891-5