Background Kawasaki disease, or mucocutaneous lymph node syndrome, is a self-limited disease but may cause cardiac complications such as coronary artery aneurysm in 15 to 25% of patients. If left untreated, it can lead to myocardial infarction, sudden death or ischemic heart disease. Nowadays, it is the leading cause of acquired heart disease in children in the developed countries, surpassing acute rheumatic fever.1 It is therefore important to recognize Kawasaki disease early to prevent the complications and death.
Objectives This study aims determine the incidence of cardiac involvement in patients with Kawasaki disease among children admitted at the Philippine General Hospital.
Methods Medical records of patients with Kawasaki disease, as identified in the database of Sections of Rheumatology and Cardiology, admitted from January 2012 to December 2013 were reviewed. Demographic, clinical, available laboratory exams, chest radiographic, electrocardiographic, and echocardiographic data, if any, were recorded. The course, management, length of hospital stay as well as the clinical outcome, duration of OPD follow-up, maintenance medications was evaluated.
Results Thirty-eight patients with mean age of 2.67±2.26 years old, 66% males with Kawasaki disease were included. Fifty-nine percent had cardiac involvement, with 41% having coronary artery dilatation (left main coronary artery 29%, left anterior descending artery 21%, right main coronary artery 26%, circumflex branch in 10%), 10% had pericardial effusion, 10% with irregular borders of coronary arteries, and 8% with mitral regurgitation. Seventy-six percent of our cases received intravenous immunoglobulin with 55% receiving intravenous immunoglobulin (IVIG) within 10 days of illness 13% between 10 and 14 days of illness. The initial cardiac findings of pericardial effusion, irregular borders and mitral regurgitation resolved in the subsequent echocardiogram studies after IVIG. For the remaining patients with residual coronary artery abnormalities on follow-up, the mean duration to normalization of abnormal echocardiography findings is 5±3.11 months. There was no mortality. The possible predictive factors for the development of cardiac abnormalities (duration of fever, gender, age, hemoglobin, platelet count, neutrophils and atypical presentation) published in other studies were not found to be significantly associated in this study population.
Conclusions The incidence of cardiac involvement in patients with Kawasaki disease among children admitted at the Philippine General Hospital is 59% with 41% having coronary artery dilatation, higher than published in other studies. There was no significant association was seen between duration of fever, gender, age, hemoglobin, platelet count, neutrophils and atypical presentation with the development of cardiac abnormalities. Hence, high index of suspicion among physicians can be helpful for early diagnosis and management.
Newburger, J., Takahashi, M., Gerber, M., et al. Diagnosis, treatment, and long-term management of Kawasaki Disease. Circulation 2004 (110): 2747-2771.
Acknowledgements UP-PGH Department of Pediatrics
Disclosure of Interest None declared