Banoo Nargis, Bashir Amber, Tariq Syed, Radhakrishnan Sitaraman, Abid Shaira
Department of Pediatrics, GB Panth Hospital, GMC Srinagar, Srinagar, Jammu and Kashmir, India.
Department of pediatric cardiology, Fortis Escorts Heart Institute, New Delhi, India.
Ann Pediatr Cardiol. 2021 Oct-Dec;14(4):459-464. doi: 10.4103/apc.APC_201_20. Epub 2022 Mar 25.
The aim of this study was to evaluate presenting symptoms, clinical features, and laboratory tests for the diagnosis of Kawasaki disease (KD) in children and their short-term follow-up at a tertiary care hospital of North India from April 2017 to March 2020.
A total of 31 children (23 boys and 8 girls) up to 10 years of age were included in this study. The diagnosis of KD was made as per the American Heart Association 2017 guidelines. Clinical features, laboratory parameters, and coronary involvement were compared between the complete and incomplete KD groups.
The incidence of complete versus incomplete KD was 19 (61.2%) versus 12 (38.7%) children, respectively. Change in extremities and oral mucosal changes were more encountered in the complete KD group as compared to the incomplete KD group (100% vs. 58.3%, = 0.004, and 78.9% vs. 33.3%, = 0.002, respectively). Coronary artery aneurysm was seen in 54% of the patients on echocardiography which was greater in the incomplete KD group (83.3%) as compared to the complete KD group (36.8%). The median time from the onset of symptoms to intravenous immunoglobulin infusion was <10 days in 84.2% of the patients with complete KD versus 41.7% with incomplete KD which was statistically significant. Fifty percent of the children with coronary ectasia and small aneurysm had normal coronaries at follow-up of 6 months.
KD is probably underdiagnosed in most developing countries, like that of ours, and requires a high index of suspicion.
本研究旨在评估2017年4月至2020年3月期间在印度北部一家三级医疗中心就诊的儿童川崎病(KD)的症状表现、临床特征及实验室检查,并对其进行短期随访。
本研究共纳入31名10岁以下儿童(23名男孩和8名女孩)。KD的诊断依据美国心脏协会2017年指南。比较了完全型和不完全型KD组的临床特征、实验室参数及冠状动脉受累情况。
完全型KD与不完全型KD的发病率分别为19例(61.2%)和12例(38.7%)。与不完全型KD组相比,完全型KD组肢体变化和口腔黏膜变化更为常见(分别为100%对58.3%,P = 0.004;78.9%对33.3%,P = 0.002)。超声心动图显示54%的患者存在冠状动脉瘤,其中不完全型KD组(83.3%)高于完全型KD组(36.8%)。完全型KD患者中84.2%从症状出现到静脉注射免疫球蛋白的中位时间<10天,而不完全型KD患者为41.7%,差异有统计学意义。50%冠状动脉扩张和小动脉瘤患儿在6个月随访时冠状动脉恢复正常。
在我们这样的大多数发展中国家,KD可能未得到充分诊断,需要高度怀疑。