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Atypical and complicated Kawasaki disease in infants. Do we need criteria?
1Department of Pediatrics, Alberta Children's Hospital, University of Calgary Faculty of Medicine, Canada.
Insights
Infants with Kawasaki disease often present atypically and face higher complication risks. Early intravenous immune globulin therapy is crucial for preventing coronary artery issues in these young patients.
Area of Science:
- Pediatrics
- Cardiology
- Infectious Diseases
Background:
- Kawasaki disease in infants often presents atypically.
- Delayed diagnosis and treatment in infants lead to higher complication rates.
- Limited studies compare infants with older children regarding Kawasaki disease presentation and outcomes.
Purpose of the Study:
- To compare the clinical presentation and outcomes of Kawasaki disease in infants versus older children.
- To identify risk factors for atypical Kawasaki disease and coronary artery complications in infants.
- To evaluate the effectiveness of early intravenous immune globulin therapy in preventing complications.
Main Methods:
- Retrospective review of 44 Kawasaki disease cases (March 1980-1990).
- Categorization of patients into infant and older child groups.
- Analysis of atypical presentations, coronary artery complications, and treatment responses.
Main Results:
- Infants constituted 25% of cases, with 45% presenting atypically compared to 12% in older children.
- Infants had a significantly higher incidence of atypical Kawasaki disease (P = .007) and coronary artery complications (P = .002).
- All infants with atypical Kawasaki disease developed coronary artery complications; none receiving early intravenous immune globulin therapy did.
Conclusions:
- Current diagnostic criteria for Kawasaki disease are too restrictive for infants.
- Clinical judgment is essential for diagnosing atypical Kawasaki disease in infants.
- Early administration of intravenous immune globulin is recommended for suspected atypical Kawasaki disease in infants to prevent coronary artery complications.
Abstract:
Case reports suggest that infants with Kawasaki disease have atypical presentations and a high complication rate, likely related to delayed diagnosis and treatment. To date, no study of consecutive cases has compared infants with older children who have both atypical and typical Kawasaki disease. We retrospectively reviewed 44 cases of Kawasaki disease treated at our hospital from March 1980 to 1990: 11 (25%) were infants; 9 (20%) had atypical Kawasaki disease, of which 5 (56%) were infants; the male to female ratio was 1.7:1. Infants had a higher incidence of atypical Kawasaki disease (5 [45%] versus 4 [12%]; P = .007) and of coronary artery complications (7 [64%] versus 3 [9%]; P = .002), and coronary artery complications developed in all of the infants with atypical Kawasaki disease (5 [100%] versus 0 [0%]; P < .01). Yet, the other manifestations and laboratory changes were at least as common as in the older children. Coronary artery complications did not develop in any patient who received early intravenous immune globulin therapy. We suggest that in infants with Kawasaki disease, accepted criteria are too restrictive to allow early diagnosis and effective treatment. Until a definitive test is available, clinical judgment is required in the diagnosis of atypical Kawasaki disease. Intravenous immune globulin is known to be safe, and its early use in patients with suspected atypical Kawasaki disease is appropriate.