Features of Kawasaki disease in early childhood

Abstract

Kawasaki disease causes diagnostic difficulties due to insufficient knowledge of doctors, and therefore often goes under the «disguise» of other diseases and therefore is under-recognized in Russia so far. Laboratory tests reveal leukocytosis, increased erythrocyte sedimentation rate, hypochromic anemia and thrombocytosis, accompanied by hypercoagulation. Late diagnosis and treatment of Kawasaki disease increase the risk for thrombosis and coronary arteries aneurysms, myocardial infarction at a young age, death. The results of the original research targeted to analyze the clinical course and outcomes of Kawasaki disease in 15 infants treated at the department of children under one year of age of the Nizhny Novgorod Regional Pediatric Clinical Hospital during the last 6 years, are presented. The cardiovascular conditions included pericarditis in 4 patients, coronary arteritis in 2 patients, coronary arteritis with dilation of the coronary arteries entrance and thickening of the walls - in 4, myocarditis - in 1 patient, 1 patient had no signs of cardiovascular involvement. All patients without coronary artery aneurysms were treated with intravenous immunoglobulin (1-2 g/kg per course), acetylsalicylic acid (80-100 mg/kg daily) up to fever reduction, followed by 3-5 mg/kg per day up to the normal values of acute inflammation markers and platelet counts, and aggregation inhibitors. In 2 patients, Kawasaki disease led to death, thus in both cases the diagnosis and, consequently, treatment initiation were late. Early diagnosis and rational treatment of Kawasaki disease (high doses of intravenous immunoglobulin in combination with acetylsalicylic acid) is the key to a favorable outcome. Fever of unknown origin, which lasts 7 days or more in a child of an early age, is an absolute indication for echocardiography with mandatory visualization of the coronary arteries. Tactics of following up patients, who underwent Kawasaki disease, is determined by the degree of coronary lesions and the risk of myocardial ischemia.