Kawasaki disease – An indian perspective.

Kawasaki disease (KD) was first reported from Japan in 1967 by a young pediatrician, Tomisaku Kawasaki, while working at the Red Cross Hospital in Tokyo. Soon therafter, Marian Melish independently reported children with a similar clinical profile from Hawaii in the United States. KD has now been reported from all parts of the world, including several centers in India. Based on the epidemiology and clinical features, an infectious etiology has been suspected for long but no definitive causative agent has been implicated so far. Like many other vasculitides, the diagnosis of this condition is based on the recognition of a temporal sequence of clinical features, none of which is pathognomonic in isolation. KD is believed to be the commonest vasculitic disorder of children. Incidence rates as high as 60-150 per 100,000 children below 5 years of age have been reported from several countries. In India (as also perhaps in many other developing countries), however, majority of children with KD continue to remain undiagnosed probably because of the lack of awareness amongst pediatricians. The clinical features of KD can be confused with other common conditions like scarlet fever and the Stevens Johnson syndrome, if the clinician is not careful. Development of coronary artery abnormalities (CAA) is the hallmark of KD and accounts for most of the morbidity and mortality associated with the disease. Prompt recognition of the disease and early initiation of treatment with intravenous immunoglobulin (IVIG) results in significant reduction in the occurrence of CAA. It is, therefore, imperative for the pediatrician to diagnose and treat KD expeditiously. KD should be considered in the differential diagnosis of all febrile illnesses in young children where the fever persists for more than 5-7 days.

Alteraçöes cardíacas na doença de Kawasaki / Coronary artery lesions in Kawasaki disease

A doença de Kawasaki é uma enfermidade que afeta principalmente crianças menores de 5 anos, ainda de etiologia desconhecida. Diagnóstico precoce e tratamento adequado reduzem o risco de complicaçöes. Os autores fazem aqui uma breve atualizaçäo da literatura e relatam sua experiência de 15 anos de seguimento. Säo analisados 153 casos, com estudo ecocardiográfico em 143, cateterismo cardíaco e estudo com radioisótopos nos que apresentam aneurismas gigantes das artérias coronárias. Detectou-se coronarite em 37 (28,9 'por cento'), dos quais 7 apresentavam diâmetro arterial igual ou maior que 8 mm. Cinco evoluíram com formaçäo de trombos. Näo houve óbitos nessa estatística. Os autores, baseados em sua experiência propöem tratamento com gamaglobulina, aspirina e diridamol, dependendo da fase da doença, e seguimento dos pacientes a longo prazo.