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Indian Academy of Pediatrics Position Paper on Kawasaki Disease
Bhaskar Shenoy1, Surjit Singh2, M Zulfikar Ahmed3
1Department of Pediatrics, Manipal Hospitals, Bangalore, Karnataka, India. Correspondence to: Dr Bhaskar Shenoy, Head, Department of Pediatrics, Manipal Hospitals, Bangalore, Karnataka, India. bshenoy@gmail.com.
Insights
Practice guidelines for diagnosing and managing Kawasaki disease (KD) in Indian children are essential. Early diagnosis and treatment with intravenous immunoglobulin (IVIG) significantly reduce coronary artery abnormalities (CAA).
Area of Science:
- Pediatrics
- Rheumatology
- Cardiology
Background:
- Kawasaki disease (KD) is a critical systemic vasculitis affecting young children.
- Untreated KD carries a significant risk (15-25%) of developing coronary artery abnormalities (CAA), potentially leading to long-term cardiovascular issues.
- KD diagnosis is primarily clinical, necessitating awareness of its characteristic symptoms to avoid missed diagnoses.
Purpose of the Study:
- To establish evidence-based practice guidelines for the diagnosis and management of Kawasaki disease specifically tailored for Indian children.
- To provide a consensus-driven approach to KD care within the Indian pediatric population.
Main Methods:
- Formation of a specialized committee under the Indian Academy of Pediatrics.
- Review of recent international and national publications on Kawasaki disease.
- Development of a draft protocol based on expert consensus and existing guidelines.
Main Results:
- Kawasaki disease diagnosis relies on clinical presentation, supported by laboratory findings and 2D echocardiography.
- Intravenous immunoglobulin (IVIG) is the recommended first-line therapy.
- Expeditious initiation of IVIG post-diagnosis is crucial for effective management.
Conclusions:
- Clinical recognition of KD symptoms is paramount for timely diagnosis.
- Prompt administration of IVIG is vital in reducing the incidence of coronary artery abnormalities.
- These guidelines aim to improve KD outcomes in Indian children through standardized diagnostic and management protocols.
Objective:
To formulate practice guidelines on diagnosis and management of Kawasaki disease (KD) for Indian children.
Justification:
KD is a systemic vasculitis that predominantly affects infants and children less than 5 years of age. Coronary artery abnormalities (CAA) develop in around 15-25% of untreated children with KD. Coronary artery involvement can lead to long-term cardiovascular implications such as development of premature coronary artery disease. Diagnosis of KD is essentially clinical based on recognition of a constellation of characteristic symptoms and signs. Timely diagnosis and initiation of intravenous immunoglobulin (IVIG) therapy is known to produce five-fold reduction in the incidence of CAA. As there is no confirmatory laboratory test for KD, the diagnosis may be missed if one is not familiar with the nuances of clinical diagnosis.
Process:
A committee was formed under the auspices of Indian Academy of Pediatrics in early 2018 for preparing guidelines on KD in Indian children. A meeting of the consultative committee was held in Mumbai, and a draft protocol was devised. All members scrutinized the recent publications on the subject and an attempt was made to arrive at a broad consensus. Published guidelines on the subject were also reviewed.
Recommendations:
The diagnosis is clinical and is aided by laboratory and 2D echocardiography. First line of therapy is IVIG, and should be started expeditiously once the diagnosis is made.
