A 10-year cross-sectional retrospective study on Kawasaki disease in Iranian children: incidence, clinical manifestations, complications, and treatment patterns

Payman Sadeghi,Sayed Yousef Mojtahedi,Effat Hosseinali Beigi,Mohsen Jafari,Anahita Izadi,Pourya Yarahmadi,Azadeh Afshin,Leila Khedmat

doi:10.1186/s12879-021-06046-2

Payman Sadeghi, Sayed Yousef Mojtahedi + Show 6 more

Open Access

https://doi.org/10.1186/s12879-021-06046-2

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Abstract

BackgroundKawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years.MethodsA 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008–2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment.ResultsChildren with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found.ConclusionAs most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.

Highlights

Kawasaki disease (KD), known as mucocutaneous lymph node syndrome, usually occurs in pediatric populations
Study design and participants A cross-sectional retrospective study was designed and implemented with participating 190 patients with KD who were admitted to Bahrami Children Hospital (BCH; Tehran, Iran), affiliated with Tehran University of Medical Sciences (TUMS)
The KD diagnosis was made according to the diagnostic clinical criteria presented by the American Heart Association (AHA) [25, 26]

Summary

Introduction

Kawasaki disease (KD), known as mucocutaneous lymph node syndrome, usually occurs in pediatric populations. The Kawasaki disease was the first time in 1967 reported by Dr Tomisaku Kawasaki among 50 children in Tokyo, Japan [2, 3]. The annual incidence of Kawasaki syndrome among American children is 17.5–20.8 per 100,000 [3, 4]. The annual incidence of KD in Japanese children is more than 300 per 100,000 [6]. During 1997–2002, the incidence rate of KD among Iranian children was 7.4 per 100,000 [7]. Epidemiological studies revealed that the occurrence rate of KD has been increasing among Iranian children [8]. Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years

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