European Journal of Pediatrics

, Volume 171, Issue 4, pp 657–662 | Cite as

Complete and incomplete Kawasaki disease: two sides of the same coin

  • Cedric Manlhiot
  • Erin Christie
  • Brian W. McCrindle
  • Hans Rosenberg
  • Nita Chahal
  • Rae S. M. Yeung
Original Article

Abstract

We sought to determine differences in clinical presentation, treatment response and coronary artery outcomes between complete and incomplete KD. All patients treated for KD between January 1990 and April 2007 were reviewed. Patients were classified as having an incomplete presentation if presenting with fever ≥5 days and <4 “classic” KD clinical signs. A total of 955 patients were included. Incomplete clinical presentation was seen in 217 cases (23%). Patient's demographic, clinical and laboratory characteristics were similar between groups with few exceptions. Patients presenting with incomplete KD had a longer median interval from symptom onset to diagnosis (7 [4–17] versus 6 [6–13] days, p < 0.001) and were less likely to be treated with intravenous immunoglobulin (86% versus 96%, p < 0.001). No significant difference between groups were seen in regard to coronary artery abnormalities (incomplete 13% versus complete 11%, p = 0.58). Conclusion: Complete and incomplete KD appear to be different sides of the same coin, differing only in the number of signs and symptoms at presentation. Similar laboratory findings and coronary artery outcomes between the two groups support this conclusion.

Keywords

Kawasaki disease Clinical signs Coronary artery abnormalities 

References

  1. 1.
    Burns JC, Wiggins JW Jr, Toews WH, Newburger JW, Leung DY, Wilson H, Glode MP (1986) Clinical spectrum of Kawasaki disease in infants younger than 6 months of age. J Pediatr 109:759–763PubMedCrossRefGoogle Scholar
  2. 2.
    Canter CE, Bower RJ, Strauss AW (1981) Atypical Kawasaki disease with aortic aneurysm. Pediatrics 68:885–888PubMedGoogle Scholar
  3. 3.
    Durongpisitkul K, Soongswang J, Laohaprasitiporn D, Nana A, Prachuabmoh C, Kangkagate C (2003) Immunoglobulin failure and retreatment in Kawasaki disease. Pediatr Cardiol 24:145–148PubMedCrossRefGoogle Scholar
  4. 4.
    Egami K, Muta H, Ishii M, Suda K, Sugahara Y, Iemura M, Matsuishi T (2006) Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 149:237–240PubMedCrossRefGoogle Scholar
  5. 5.
    Fukushige J, Takahashi N, Ueda Y, Ueda K (1994) Incidence and clinical features of incomplete Kawasaki disease. Acta Paediatr 83:1057–1060PubMedCrossRefGoogle Scholar
  6. 6.
    Han RK, Sinclair B, Newman A, Silverman ED, Taylor GW, Walsh P, McCrindle BW (2000) Recognition and management of Kawasaki disease. CMAJ 162:807–812PubMedGoogle Scholar
  7. 7.
    Hsieh YC, Wu MH, Wang JK, Lee PI, Lee CY, Huang LM (2002) Clinical features of atypical Kawasaki disease. J Microbiol Immunol Infect 35:57–60PubMedGoogle Scholar
  8. 8.
    Kim T, Choi W, Woo CW, Choi B, Lee J, Lee K, Son C (2007) Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr 166:421–425PubMedCrossRefGoogle Scholar
  9. 9.
    Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, Morikawa A (2006) Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 113:2606–2612PubMedCrossRefGoogle Scholar
  10. 10.
    Lin YT, Manlhiot C, Ching JC, Han RK, Nield LE, Dillenburg R, Pepelassis D, Lai LS, Smythe JF, Chahal N, Yeung RS, McCrindle BW (2010) Repeated systematic surveillance of Kawasaki disease in Ontario from 1995 to 2006. Pediatr Int 52:699–706PubMedCrossRefGoogle Scholar
  11. 11.
    Manlhiot C, Millar K, Golding F, McCrindle BW (2010) Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease. Pediatr Cardiol 31:242–249PubMedCrossRefGoogle Scholar
  12. 12.
    Manlhiot C, Yeung RS, Clarizia NA, Chahal N, McCrindle BW (2009) Kawasaki disease at the extremes of the age spectrum. Pediatrics 124:e410–e415PubMedCrossRefGoogle Scholar
  13. 13.
    McCrindle BW, Li JS, Minich LL, Colan SD, Atz AM, Takahashi M, Vetter VL, Gersony WM, Mitchell PD, Newburger JW (2007) Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 116:174–179PubMedCrossRefGoogle Scholar
  14. 14.
    Minich LL, Sleeper LA, Atz AM, McCrindle BW, Lu M, Colan SD, Printz BF, Klein GL, Sundel RP, Takahashi M, Li JS, Vetter VL, Newburger JW (2007) Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics 120:e1434–e1440PubMedCrossRefGoogle Scholar
  15. 15.
    Mori M, Imagawa T, Yasui K, Kanaya A, Yokota S (2000) Predictors of coronary artery lesions after intravenous gamma-globulin treatment in Kawasaki disease. J Pediatr 137:177–180PubMedCrossRefGoogle Scholar
  16. 16.
    Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110:2747–2771PubMedCrossRefGoogle Scholar
  17. 17.
    Rosenfeld EA, Corydon KE, Shulman ST (1995) Kawasaki disease in infants less than one year of age. J Pediatr 126:524–529PubMedCrossRefGoogle Scholar
  18. 18.
    Rowley AH, Gonzalez-Crussi F, Gidding SS, Duffy CE, Shulman ST (1987) Incomplete Kawasaki disease with coronary artery involvement. J Pediatr 110:409–413PubMedCrossRefGoogle Scholar
  19. 19.
    Sabharwal T, Manlhiot C, Benseler SM, Tyrrell PN, Chahal N, Yeung RS, McCrindle BW (2009) Comparison of factors associated with coronary artery dilation only versus coronary artery aneurysms in patients with Kawasaki disease. Am J Cardiol 104:1743–1747PubMedCrossRefGoogle Scholar
  20. 20.
    Song D, Yeo Y, Ha K, Jang G, Lee J, Lee K, Son C (2009) Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. Eur J Pediatr 168:1315–1321PubMedCrossRefGoogle Scholar
  21. 21.
    Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, Yashiro M, Nakamura Y, Yanagawa H (2007) Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 49:421–426PubMedCrossRefGoogle Scholar
  22. 22.
    Terai M, Shulman ST (1997) Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr 131:888–893PubMedCrossRefGoogle Scholar
  23. 23.
    Wallace CA, French JW, Kahn SJ, Sherry DD (2000) Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics 105:E78PubMedCrossRefGoogle Scholar
  24. 24.
    Wilder MS, Palinkas LA, Kao AS, Bastian JF, Turner CL, Burns JC (2007) Delayed diagnosis by physicians contributes to the development of coronary artery aneurysms in children with Kawasaki syndrome. Pediatr Infect Dis J 26:256–260PubMedCrossRefGoogle Scholar
  25. 25.
    Witt MT, Minich LL, Bohnsack JF, Young PC (1999) Kawasaki disease: more patients are being diagnosed who do not meet American Heart Association criteria. Pediatrics 104:e10PubMedCrossRefGoogle Scholar
  26. 26.
    Yeo Y, Kim T, Ha K, Jang G, Lee J, Lee K, Son C (2009) Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr 168:157–162PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Cedric Manlhiot
    • 2
  • Erin Christie
    • 1
  • Brian W. McCrindle
    • 2
  • Hans Rosenberg
    • 1
  • Nita Chahal
    • 2
  • Rae S. M. Yeung
    • 1
  1. 1.Division of Rheumatology, Department of PediatricsUniversity of Toronto, The Hospital for Sick ChildrenTorontoCanada
  2. 2.Labatt Family Heart Centre, Department of PediatricsUniversity of Toronto, The Hospital for Sick ChildrenTorontoCanada

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