54 Kawasaki disease: experience in a general paediatric department of the CHU de Annaba Algeria

Abstract

Abstract Background Kawasaki disease (adeno-cutaneous-mucosal syndrome) is an acute febrile systemic vasculitis, affecting with predilection infants. Of unknown aetiology, its diagnosis is based on clinical criteria validated by the CDC and updated by the American Heart Association. Its prognosis is linked to the presence of coronary complications. Its prevalence in Algeria remains unknown, the increase in the number of cases in recent years has raised questions about its situation in our department. Objective To study the epidemiological, diagnostic, therapeutic, biological and evolutionary aspects of this disease. Materials and methods The authors report the results of a retrospective study of 2 years and 4 months, concerning 15 cases of Kawasaki disease hospitalized and treated in the pediatric department of the University Hospital of Annaba. The information was obtained from the hospitalization records. Results 15 cases of Kawasaki disease were identified during the study period. Almost half of the patients were between 2 and 5 years of age, with an average age of 26.3 months (range: 11 months-9 years). A clear male predominance was noted (SR: 2). The reasons for hospitalization were dominated by fever (73%), skin involvement (66%) and stomatitis (40%). The clinical examination showed the frequency of the classical criteria of the disease with almost constant fever (100%), polymorphous skin rash 93.33%, oral-pharyngeal involvement 93.33%, involvement of hands and feet 40%, conjunctivitis 53.33% and adenopathies 46.67%. Biologically, the blood count showed anaemia (93.33%), hyperleukocytosis (66.67%) and hyperplateletosis (46.67%); an accelerated blood count in all our patients and an elevated CRP in 86.67% of cases. Doppler ultrasound performed in all patients returned normal in 73.33% of cases and found 2 cases of mitral insufficiency and 1 case of 8 mm coronary aneurysm. All our patients were treated with human immunoglobulins (2 g/kg IV) associated with aspirin 80–100 mg/kg/d in 4 doses. The evolution was favorable for all our patients. Conclusion Kawasaki disease is a pediatric vasculitis whose severity is related to coronary complications, which are prevented by early administration of IG and aspirin. It is therefore imperative to think of the disease in front of a prolonged fever associated with cutaneous and mucosal clinical signs and a biological inflammatory syndrome.