Sasan Saket , Saeed Mojtahedzadeh , Abdolah Karimi , Reza Shiari , Fariba Shirvani ,
Volume 11, Issue 3 (yafteh 2009)
Abstract
Background: Kawasaki disease (KD) is an acute febrile vasculitis of childhood occurs worldwide, with Asians at highest risk. Approximately 20% of untreated patients develop coronary artery abnormalities including aneurysms, myocardial infarction and sudden death. KD is the common cause of acquired heart disease in children in the United States and Japan. The aim of this study was to determine the severity of kawasaki disease based on laboratory and echocardiographic findings. Materials and Methods: In this cross-sectional research, we studied records of all patients (n=61) admitted to Mofid Children’s hospital with Kawasaki disease from December 21, 2004 to January 21, 2008. Patients with exclusion criteria were omitted (n=11) and other 50 patients were entered the study. At least three CFM echocardiograms were performed for all of these children with Kawasaki disease: at diagnosis, after 2-3 wk and 6-8 wk after onset of illness. These CFM echocardiograms was performed only by one Paediatric cardiologist (he didn’t have any information about severity and other characteristics of the disease in these patients). All patients were followed up for 12 weeks after discharge. Results: There were 32(64%) boys and 18(36%) girls in this study (total number: 50). The male to female ratio was 1. 8: 1. 100% of the patients had fever, 82% changes in oral cavity & lips, 78% bilateral bulbar conjunctival injection, 64% changes of the peripheral extremities, 58% polymorphous rash and 40% cervical adenopathy. Coronary artery aneurysm was seen in 2% of the patients. No recurrence of KD was observed among these children. Based on laboratory and echocardiographic findings, the patients divided into two groups: severe (n=24) and non-severe (n=26). Mean age of the children, mean duration of hospitalization and rash were significantly higher in the severe group. There was no significant difference between number of patients with K<3. 4mEq/L in two groups. Number of patients with Na<135mEq/L was significantly higher in the severe group (p=0. 01). Mitral regurgitation and 2-times receiving IVIG were significantly higher in the severe group (p=0. 02 and p=0. 008, respectively). Conclusion: Our data demonstrated that sooner performance of CFM echocardiogram and ESR, CRP, Platelet count and Na levels can help us to detect severe Kawasaki disease easer & faster.
Dr Saeid Mojtahedzadeh, Dr Sasan Saket, Dr Reza Shiari , Dr Fariba Shirvani, Dr Abdolah Karimi,
Volume 12, Issue 4 (3-2011)
Abstract
Kawasaki disease (KD, also called mucocutaneous lymph node syndrome) is one of the most common childhood vasculitis. Although the etiology of the disease is unknown infectious, genetic and immunologic factors have been supposed to be responsible for KD occurrence. Complications such as coronary artery aneurysm, cardiomyopathy and heart failure, may occur, which can cause significant morbidity and mortality in children. KD is the common cause of acquired heart disease in children in the United States and Japan. Materials and Methods: 61 patients with approved KD admitted in the Mofid Children’s Hospital (from December 2004 to January 2008) and their parents were studied in this cross-sectional survey. 11 patients were omitted according to exclusion criteria, 50 patients were divided into two groups: Mild (n=26) and severe (n=24). Data was analyzed via Fisher’s exact test and student’s t-test using SPSS software, V. 11,5. p<0.05was taken into account significant. Results: 50 patients (32 males, 18 females) with mean age of 43 months were concluded in this survey. All of the patients had fever (100%), coronary artery aneurism was seen in 2% of the patients. No recurrence of KD was seen among these children and there was no history of KD in their parents and siblings. Mitral valve prolaps in mothers and ischemic heart disease in fathers among sever group were significantly higher than mild group (p=0.03 and p=0.001, respectively). Mitral regurgitation and 2-times receiving IVIG was significantly higher in severe group (p=0.02 and p=0.008, respectively). Conclusion: This study showed that mitral valve prolaps in mothers and ischemic heart disease in fathers had significant relation with Kawasaki disease in their children. Also, CRP, ESR, Na, LFT and echocardiography are useful to detect and manage severe Kawasaki disease. To provide more accurate conclusions, prospective and multicentric studies with larger sample sizes are necessary.
