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Kawasaki disease: clustering in infants and pre-school children in Kuwait
N H Jawad1, A Shaltout, J al-Momem
1Department of Paediatrics, Al-Amiri Hospital, Kuwait City, Kuwait.
Insights
Five children diagnosed with Kawasaki disease (KD) within two months, some with unusual symptoms, highlight potential infectious causes. Early treatment did not prevent cardiac complications in some cases, suggesting a need for further investigation into KD triggers.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Kawasaki disease (KD) is a critical pediatric illness affecting coronary arteries.
- Understanding KD's etiology is crucial for timely diagnosis and management.
- Recent case clusters suggest an environmental or infectious trigger.
Purpose of the Study:
- To report a cluster of five pediatric cases of Kawasaki disease.
- To analyze clinical presentations, including atypical cases.
- To assess early treatment outcomes and cardiac involvement.
Main Methods:
- Retrospective case review of five children diagnosed with KD.
- Inclusion criteria: fulfillment of at least four of five diagnostic criteria.
- Echocardiographic assessment for cardiac complications.
Main Results:
- Five pediatric patients (3 female, 2 male; 5 months-3 years) presented within two months.
- Two cases showed atypical presentations: infectious mononucleosis-like and hydrops of the gallbladder.
- Despite early treatment, three patients had echocardiographic changes, including myocarditis and coronary artery abnormalities.
Conclusions:
- This cluster of five Kawasaki disease cases suggests a potential infectious etiology.
- Atypical presentations can complicate early diagnosis.
- Cardiac sequelae underscore the importance of prompt recognition and management.
Abstract:
We report five children who presented within a 2-month period and who all fulfilled at least four of the five criteria essential for the diagnosis of Kawasaki disease. They were three girls and two boys aged between 5 months and 3 years. Two of them had atypical presentations; one mimicked infectious mononucleosis and the other had severe abdominal pain and was later found to have hydrops of the gall bladder. Although treatment was started within the 1st 10 days of the illness, echocardiographic changes were found in three cases: one had myocarditis and the other two showed in the coronary arteries. The occurrence of five cases in such as short period of time is similar to the clusterings of Kawasaki disease reported in Japan and the USA, and strongly suggests the presence of a causative infectious agent.