Epidemiologic study of Kawasaki disease and cases resistant to IVIG therapy in Thailand.

The incidence of Kawasaki disease (KD) in Thailand has never been studied before. We reviewed the data from the National Registry of Thai Children who had KD between 1998-2002 to evaluate the incidence of KD and cases resistant to treatment with intravenous immunoglobulin (IVIG). Resistance to IVIG was defined as remaining febrile at least 48 hours after initial IVIG therapy. There were 710 KD patients in the registry. The incidence of KD was from 2.14 to 3.43 cases per 100,000 children aged 0-5 years. During the acute phase 15.6% of 435 patients were considered as resistant cases. Resistant cases of KD in Thai children are quite common (15.6%) even after IVIG treatment. We found that patients who had high white blood cell counts (> 16,500 cells/mm3) had a higher likelihood of being resistant.

Aortoesophageal fistula: a life-threatening cause of upper gastrointestinal hemorrhage in double aortic arch, a case report.

The authors present the case of a 2-month-old infant with double aortic arch that developed massive bright red upper gastrointestinal hemorrhage from aortoesophageal fistula (AEF) after prolonged endotracheal and nasogastric intubation. Emergency thoracotomy with AEF and double aortic arch repaired were done successfully under cardiopulmonary bypass. Due to tracheomalacia and left phrenic nerve injury, tracheal extubation could not be done until 1 month after correction of the vascular ring. The endotracheal and nasogastric tube led to fistula formation by compression of the esophageal wall against an abnormal double aortic arch. When a double aortic arch is suspected, prolonged nasogastric intubation should be avoided.

Kawasaki disease in central area of Northeast Thailand.

Kawasaki disease (KD) is a leading cause of acquired heart disease of childhood. The authors retrospectively reviewed cases of KD in major referral centers of central Northeast Thailand from July 1991 to June 2003. Seventy-three episodes occurring in 72 patients were diagnosed with KD by the American Heart Association criteria with a mean age of presentation of 27 +/- 19 months. The annual incidence was 2.2 per 100,000 children < 5 years of age. Coronary artery abnormalities (CAA) were found in 15 (20.5%) children. Nine patients (18%) who were diagnosed before 10 days were not treated with intravenous immunoglobulin (IVIG). Two (13%) of the 15 patients still had coronary lesions at the end of the follow-up period of 35.5 +/- 13.4 months. Index of suspicious should be maintained in children who had clinical signs of KD for early diagnosis and prompt treatment with IVIG.