Korean Circ J.  2010 Jun;40(6):283-287. 10.4070/kcj.2010.40.6.283.

Affects of "Age at Diagnosis" on Coronary Artery Lesions in Patients With Incomplete Kawasaki Disease

• Cho MA
• Choi YJ
• Jung JW

• KMID: 2225189
• DOI: http://doi.org/10.4070/kcj.2010.40.6.283

Abstract

BACKGROUND AND OBJECTIVES
Diagnosis of Kawasaki disease (KD) is based on 5 clinical features. Incomplete KD (IKD), which has fewer features, is more common in infants and older children, in whom the rate of coronary artery aneurysms is paradoxically higher. We conducted this study to evaluate risk factors associated with age-at-diagnosis on coronary arterial lesions (CAL) in patients with IKD.
SUBJECTS AND METHODS
Retrospective data from 396 patients with KD in a single center were collected from January 2003 to July 2007. Patients were grouped according to their age at diagnosis; Group A (<1 year of age), Group B (1< or =age<5 years of age), and Group C (> or =5 years of age).
RESULTS
Among a total of 396 patients with KD, 87 (22.0%) were in Group A, 246 (62.1%) in Group B, and 63 (15.9%) in Group C. In groups A and C, lag times for starting intravenous immunoglobulin (IVIG) were longer than in Group B. There were no differences in the incidence of IKD, late CAL, or rates of IVIG retreatment among the three groups. Among 174 patients with IKD, there were no age-related differences in late CAL incidence or IVIG retreatment. Compared with typical KD, duration of fever and lag times to start IVIG were longer, and the rate of IVIG retreatment was higher in IKD, but there was no difference in the risk of CAL between typical KD and IKD.
CONCLUSION
In the management of KD, especially the incomplete type, age-associated factors appear not to be significant for predicting the development of CAL.

Keyword

Mucocutaneous lymph node syndrome

MeSH Terms

Aneurysm
Child
Coronary Vessels
Fever
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Incidence
Infant
Mucocutaneous Lymph Node Syndrome
Retreatment
Retrospective Studies
Risk Factors
Immunoglobulins
Immunoglobulins, Intravenous

Reference

1. Melish ME. Kawasaki syndrome. Pediatr Rev. 1996. 17:153–162.

2. Laupland KB, Dele Davies H. Epidemiology, etiology, and management of Kawasaki disease: state of the art. Pediatr Cardiol. 1999. 20:177–183.

3. Rowley AH, Shulman ST. Kawasaki syndrome. Pediatr Clin North Am. 1999. 46:313–329.

4. Park YW, Han JW, Park IS, et al. Kawasaki disease in Korea, 2003-2005. Pediatr Infect Dis J. 2007. 26:821–823.

5. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004. 110:2747–2771.

6. Ayusawa M, Sonobe T, Uemura S, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int. 2005. 47:232–234.

7. Yanagawa H, Nakamura Y, Yashiro M, et al. Incidence survey of Kawasaki disease in 1997 and 1998 in Japan. Pediatrics. 2001. 107:E33.

8. Fukazawa R, Ogawa S. Long-term prognosis of patients with Kawasaki disease: at risk for future atherosclerosis? J Nippon Med Sch. 2009. 76:124–133.

9. Rosenfeld EA, Corydon KE, Shulman ST. Kawasaki disease in infants less than one year of age. J Pediatr. 1995. 126:524–529.

10. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967. 16:178–222.

11. Furusho K, Kamiya T, Nakano H, et al. High dose intravenous gammaglobulin for Kawasaki disease. Lancet. 1984. 2:1055–1058.

12. Shulman ST, Rowley AH. Advances in Kawasaki disease. Eur J Pediatr. 2004. 164:285–291.

13. Hsiao JY, Chen MR, Huang FU, Kao HA, Sung TC. Clinical analysis of Kawasaki disease in infants below 6 months of age. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1988. 29:318–323.

14. Fan PC, Chiu CH, Yen MH, Huang YC, Li CC, Lin TY. School-aged children with Kawasaki disease: high incidence of cervical lymphadenopathy and coronary artery involvement. J Paediatr Child Health. 2003. 39:55–57.

15. Kato H, Koike S, Yamamoto M, Ito Y, Yano E. Coronary aneurysm in infants and young children with mucocutaneous lymph node syndrome. J Pediatr. 1975. 86:892–898.

16. Cheung YF, O K, Woo CW, et al. Oxidative stress in children late after Kawasaki disease: relationship with carotid atherosclerosis and stiffness. BMC Pediatr. 2008. 8:20.

17. Lee SJ, Ahn HM, You JH, Hong YM. Carotid intima-media thickness and pulse wave velocity after recovery from Kawasaki disease. Korean Circ J. 2009. 39:264–269.

18. Cho HJ, Yu JJ, Kim HS. The detection of acute phase Kawasaki myocarditis via echocardiographic functional studies. Korean Circ J. 2001. 31:1318–1323.

19. Nakamura Y, Fujita Y, Nagai M. Cardiac sequelae of Kawasaki disease in Japan: statistical analysis. Pediatrics. 1991. 88:1144–1147.

20. Han RK, Sinclair B, Newman A, et al. Recognition and management of Kawasaki disease. CMAJ. 2000. 162:807–812.

21. Lee SY, Gwon HC, Park SW, et al. Acute myocardial infarction in young patient probably due to Kawasaki disease. Korean Circ J. 2001. 31:119–124.