Coronary lesion in Kawasaki disease in children

Background: Kawasaki is an acute fever disease with systematic vein infection and often seen in children.Objectives:This study aims to determine features and risk factors of coronary artery lesion (CAL) in Kawasaki disease in children. Subjects and method:A descriptive, prospective study was conducted on 83 patients diagnosed with Kawasaki disease whom treated at National Hospital for Pediatric from January 2005 to March 2007. They were divided into 2 groups: with and without CAL. All data from clinical characteristics, laboratory and echocardiography were analyzed to evaluate the differences between 2 groups. Univariate and multivariate analysis were used. Results: Among 83 patients diagnosed with Kawasaki disease, 27 patients (32.5%) was found with CAL. 24 patients (88.9%) had both right and left coronary artery abnormalities. The CAL in left anterior descending (LAD) and in left circumflex coronary artery (LCX) was 55.6% and 25.9% respectively. Risk level II: 7 patients (25.9%). Risk level III: 14 patients (51.9%) and risk level IV: 6 patients (22.2%). 14 patients (51.9%) with CAL were resolved at 6th month of the illness. Independent risk factors of CAL in acute stage included age under 12 months (OR = 3.97, p<0.05). IVIG treatment was within the first 10 day of the illness (OR=0.25, p<0.05). Non - responsiveness to \u03b3globulin therapy (OR=7.69, p<0.01). CRP before starting initial treatment above 90mg/1 (OR = 12.81, p<0.05). Platelets before starting \u03b3 globulin therapy ~ 557 000/ mm3 with OR=4.73 and p<0.05. Conclusion:Early detection and treatment were necessary in order to decrease CAL in patients with Kawasaki disease.

Epidemiological and clinical characteristics of Kawasaki disease in children

Background:Kawasaki is acute fever disease with systematic vein infection which often seen in children under 5 years old. Objectives:Describe the clinical characteristics and laboratory, echocardiography data in children with Kawasaki between early diagnosed group and late one. Subjects and method: A descriptive, prospective study was carried out on 77 Kawasaki disease patients were selected, including 50 patients were diagnosed before day 10 of illness (group 1) and 27 patients were diagnosed on or after day 10 (group 2) in the National Pediatrics hospital from June 2004 to June 2006. Results:The mean was 13.4 months. Age under 12 months was 61 %. Male/female ratio was 1.7: 1. Fever, red lips, red eyes, skin rash, extremities edema and cervical lymphadenopathy occurred in the first week. The inflammatory response was strong (CRP: 83.6 mg/I, erythrocyte sedimentation rate (ESR) after an hour: 79.1 mm. WBC: 27800/ mm3). There were no differences between patients in the group 1 and group 2 in age, gender, time to the first medical visit, C-reactive protein (CRP) concentration, white blood cell count or erythrocyte sedimentation rate. Patients in the group 1 had significantly close clustering of symptoms onset in the first few days of illness, but patients in the group 2 had onset of symptoms scattered over 4 days. A platelet count of over 500.000/mm3 occurred more often in the group 2 (60%) than the group 1 (31.3%). Coronary involvement was observed in 23 patients (29.8%) including 17 patients who had coronary dilation and 6 patients with coronary aneurysm. Conclusion:Coronary artery abnormalities in the group 2 (48.1%) occurred significantly more than the group 1 (20%).

Doppler echocardiography in diagnosis of valvular open in the rheumatism without clinical carditis

A study on 51 patients with rheumatism of the heart and without clinical carditis, ages of 5-15 in the Institute of Pediatry during 1996-2000 has shown that 23 cases (45,1%) had symptoms of pathological valvular open by Doppler of which mitral open in the 3 cardiac valves. The extend of valvular open reduced when disease was stable. The Doppler can detect carditis without clinical symptoms due to rheumatism of the heart.

The Kawasaki disease in the National Institute of Pediatry

33 patients with the Kawasaki disease diagnosed in the National Institute of Pediatry, with ages of 3-4.5 (male: 22; female: 11) during 2/1995- 4/2000. The results have shown that this was not a rarely disease in our country, current difficult to diagnose. The symptoms comprised pyrexia over 4 days, rash, red conjunctivitis, periostomatous change or the nodules in the maxillary should be attributed to the Kawasaki disease. The cardiovascular problem were comon in the progress of the disease: The coronary lesion: 12/30; coronary aneurysm 23.3%. There is no complication of the coronary aneurysm in patients who were administrated the gamaglobulin within the 2 weeks of the disease