Abstract

GRECO, Junior; MOREL AYALA, Zoilo; ASTIGARRAGA, Norma  and  ESPINOLA DE CANATA, Miriam. Kawasaki Disease in a Tertiary Care Hospital. Pediatr. (Asunción) [online]. 2014, vol.41, n.3, pp.185-190. ISSN 1683-9803.

Introduction: Kawasaki disease (KD) is a systemic febrile vasculitis with a preference for small- and medium-sized arteries and that affects primarily children under age 5 years.  It is currently the most common cause of acquired childhood cardiopathy in developed countries. Diagnosis is achieved clinically by the presence of persistent fever of at least 5 days duration and 4 of 5 clinical criteria, including  changes in extremities, polymorphous rash, non-exudative conjunctival injection, changes in the lips and oral mucosa, and cervical lymphadenopathy >1.5 cm, usually unilateral. It may also present incompletely or atypically. The most common complication is dilatation and aneurisms of the coronary arteries. Objective: To determine the clinical, laboratory, and echocardiograph characteristics of KD in patients hospitalized in the pediatric department of the Central Hospital of the Institute of Social Security (IPS) in Asuncion, Paraguay. Methodology: We conducted a retrospective, cross-sectional, descriptive study with description of the characteristics observed in a group of patients with KD hospitalized from 2007 to 2011 at the pediatrics department of the IPS. Results: Of a total of 10 285 patients discharged from the pediatrics department in that period, 29 had KD (0.28%). The male/female ratio was 21/8 (2.6:1), while 24% were less than 1 year of age, 21% aged 1 year to 1 year 11 months, 45% aged 2 to 5 years, 3% aged 6 to 10 years, and 7% over age 10 years.   Day of diagnosis was 9 to 11 days after start of fever in 48%, from 12 to 17 days in 7%, and from 5 to 8 days in the remaining 45%, for an average of 8.9 days. The incomplete form was found in 15 patients (52%), while 12/29 (41%) showed classic presentation and 2/29 (7%) atypical. The most common physical findings were changes in extremities, polymorphous rash, oral and pharyngeal lesions, and conjunctival injection. Echocardiography found 2 normal readings, 22 patients with perivascular brightness, 16 with pericardial effusion, 6 with coronary artery ectasia, and 2 with coronary aneurysms. Response to the first dose of intravenous immunoglobulin occurred in 83% (24/29), while 17% (5/29) were refractory and received a second dose as well as methylprednisolone. Conclusions: As KD is a self-limiting disease, it is important to keep the possibility of incomplete or atypical manifestation in mind to avoid the most common and severe complication, coronary aneurysms.

Keywords : Kawasaki disease; aneurysm; atypical; incomplete; intravenous immunoglobulin; corticosteroids.

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