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Otorhinolaryngological manifestations and delayed diagnosis in Kawasaki disease
M Rouault1, A Coudert1, R Hermann2
1Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Centre Hospitalier et Universitaire, Lyon, France; Université de Lyon, Lyon, France.
Insights
Ear, nose, and throat (ENT) symptoms in Kawasaki disease (KD) often lead to delayed diagnosis. Early recognition of these ENT manifestations is crucial for timely treatment and improved patient outcomes.
Area of Science:
- Pediatrics
- Rheumatology
- Infectious Diseases
Background:
- Kawasaki disease (KD) is a critical pediatric vasculitis impacting coronary arteries.
- Early diagnosis and management significantly improve coronary outcomes in KD.
- The role of ENT manifestations in KD diagnosis is not fully understood.
Purpose of the Study:
- To describe ENT manifestations in children diagnosed with Kawasaki disease.
- To investigate the association between ENT symptoms and delayed KD diagnosis.
- To assess the impact of ENT-related misdiagnosis on patient management.
Main Methods:
- Retrospective, single-center study of 142 children treated for KD (2009-2017).
- Patients classified into 'ENT spectrum diagnosis' or 'non-ENT diagnosis' groups based on initial presentation.
- Comparison of diagnostic times, fever duration, and antibiotic use between groups using Student's t-test.
Main Results:
- Children with initial ENT spectrum diagnosis had significantly longer diagnostic times (8.51 days vs. 5.77 days).
- Prolonged fever duration and increased antibiotic use were observed in the ENT group.
- Four children in the ENT group required surgical intervention for complications like abscesses.
Conclusions:
- ENT manifestations are common presenting symptoms of KD, often causing diagnostic delays.
- Misleading ENT presentations can lead to inappropriate medical and surgical interventions.
- Enhanced practitioner education is vital for earlier recognition and management of KD presenting with ENT symptoms.
Objectives:
Kawasaki disease (KD) is a febrile multisystemic vasculitis of unknown etiology whose coronary prognosis is improved by early diagnosis and management. The objective of this study was to describe ENT manifestations encountered and to look for a delayed diagnosis associated with these manifestations.
Methods:
A retrospective descriptive single-center study was conducted in Lyon between January 2009 and December 2017. All children treated for Kawasaki disease were included in the study. Clinical, biological and cardiac ultrasound data were collected. According to the diagnosis made at the first medical visit, children were classified into two groups: diagnosis of ENT spectrum or non-ENT diagnosis. The diagnostic times were compared by a Student test.
Results:
142 patients were included: 64 in the ENT diagnostic group, 78 in the non-ENT diagnostic group. When the initial diagnosis was of ENT spectrum, the diagnostic time of KD was significantly longer: 8.51 days vs 5.77 days - (p < 0.01). The total duration of fever was also longer - 10.92 vs 8.32 days - (p = 0.013) - and the frequency of antibiotics intake more important - 92.2% vs 46.2% - (p < 0.01). Four children underwent surgery in the ENT diagnostic group: two retro-pharyngeal abscesses, one paracentesis and one cervicectomy.
Conclusions:
ENT manifestations are frequently at the forefront of KD and constitute a misleading clinical picture responsible for delayed diagnosis and potentially inappropriate medico-surgical management. It is necessary to provide more education to practitioners for earlier recognition of Kawasaki disease.
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