Journal of Clinical Pediatrics and Neonatal Care

Clinical Investigation of Kawasaki Disease in Patients aged Five years or Older at Onset

*Dr. Takashi Higaki
Department Of Pediatrics, Ehime University Graduate School Of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan

*Corresponding Author:
Dr. Takashi Higaki
Department Of Pediatrics, Ehime University Graduate School Of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
Email:higaki@m.ehime-u.ac.jp

Published on: 2017-12-31

Abstract

Introduction Kawasaki disease (KD) is a systemic vasculitic syndrome which commonly develops under age 5. Older age at onset is one of the risk factors for cardiovascular complications. Objective and Methods We retrospectively analyzed 200 patients with diagnosis of KD in the Ehime prefectural Central Hospital in Japan between 2008 and 2014. The clinical characteristics of the patients with an onset age of 5 years or older (older age group: n=21) were compared with those with an onset age of less than 5 years (control group; n=179). Results In the older group, none demonstrated erythema around BCG scar, and more patients were initially diagnosed with a disease other than Kawasaki disease (p<0.05), particularly 33% of the older group were primarily diagnosed as cervical lymphadenitis significantly higher than in the control group (4.2%, p<0.001). The required time for diagnosis (p=0.071) and the start date of the starting day of intravenous injection of immunoglobulin (IVIG) (p<0.05) tend to be late in the older group. There were no significant differences in their coronary artery sequelae incidence between two groups, this may have been because treatment was started earlier. Conclusions The prompt diagnosis is warranted for even older patients, just because there was equal chance to prevent coronary artery aneurysms by early intervention of high-dose IVIG (2 g/kg).

Keywords

Kawasaki Disease; Older-Onset; Clinical Characteristics, Cervical Lymphadenitis; High-Dose IVIG

Introduction

Kawasaki disease (KD), first reported 47 years ago, is a vasculitis of still unknown etiology. Approximately 10,000 patients are diagnosed with KD every year in Japan, and this number is gradually increasing [1]. The disease most commonly develops during infancy and early childhood (up to 4 years old), and its incidence peaks around 1 year. The most debilitating feature is the development or persistence of coronary artery damage during the acute phase. Coronary artery dilation or coronary aneurysm developed in approximately 10% of these patients.