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Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor

European Journal of Pediatrics volume 168, Article number: 157 (2009) Cite this article

An Erratum to this article was published on 28 August 2009

Abstract

Kawasaki disease (KD) patients younger than 1 year of age are at especially high risk of developing coronary artery abnormalities (CAA). To define the clinical characteristics of this group, as well as the risk factors predisposing them to CAA, we reviewed the medical records of 136 KD patients younger than 1 year of age who were treated at the Korea University Medical Center from January 2001 to July 2006. Of these patients, 16 developed CAA (11.8%). The CAA(+) group had a longer duration of total fever than the CAA(−) group (9.1±3.7 days vs. 6.3±2.0 days, p=0.011), but did not differ in the duration of pre- and post-intravenous gamma-globulin (IVGG) fever. The CAA(+) group had fewer diagnostic symptoms than the CAA(−) group (2.7±1.1 vs. 4.3±1.2, p<0.001). Of the hematological findings, the CAA(+) group only differed from the CAA(−) group in having significantly higher total white blood cell (19.2±6.0 vs. 14.7±4.7 K/mm3, p=0.007) and platelet (462.9±101.0 vs. 383.6±121.1 K/mm3, p=0.014) levels. Multivariable logistic regression analysis showed that the only factors which were significantly associated with the development of CAA were the total number of symptoms (OR=0.493, 95% CI=0.293–0.829, p=0.007) and the duration of total fever (OR=1.405, 95% CI=1.092–1.808, p=0.008). Conclusively, incomplete clinical manifestations and a longer duration of total fever are significantly associated with the development of CAA in KD patients younger than 1 year of age. Therefore, these patients should be monitored for incomplete KD, especially if unexplained fever continues, and treatment to shorten the duration of total fever should be initiated.

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Abbreviations

KD:

Kawasaki disease

IVGG:

Intravenous gamma-globulin

CAA:

Coronary artery abnormalities

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

BNP:

B-type natriuretic peptide

References

  1. Anderson MS, Todd JK, Glodé MP (2005) Delayed diagnosis of Kawasaki syndrome: an analysis of the problem. Pediatrics 115(4):e428–e433

    PubMed  Article  Google Scholar 

  2. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, Ishii M, Harada K; Kawasaki Disease Research Committee (2005) Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int 47:232–234

    PubMed  Article  Google Scholar 

  3. Belay ED, Maddox RA, Holman RC, Curns AT, Ballah K, Schonberger LB (2006) Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994–2003. Pediatr Infect Dis J 25(3):245–249

    PubMed  Article  Google Scholar 

  4. Burns JC, Glodé MP (2004) Kawasaki syndrome. Lancet 364(9433):533–544

    PubMed  Article  Google Scholar 

  5. Chang FY, Hwang B, Chen SJ, Lee PC, Meng CC, Lu JH (2006) Characteristics of Kawasaki disease in infants younger than six months of age. Pediatr Infect Dis J 25(3):241–244

    PubMed  Article  Google Scholar 

  6. Council on Cardiovascular Disease in the Young; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; American Heart Association (2001) Diagnostic guidelines for Kawasaki disease. Circulation 103(2):335–336

    Google Scholar 

  7. de Zorzi A, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger JW (1998) Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr 133(2):254–258

    PubMed  Article  Google Scholar 

  8. Freeman AF, Shulman ST (2004) Refractory Kawasaki disease. Pediatr Infect Dis J 23(5):463–464

    PubMed  Article  Google Scholar 

  9. Genizi J, Miron D, Spiegel R, Fink D, Horowitz Y (2003) Kawasaki disease in very young infants: high prevalence of atypical presentation and coronary arteritis. Clin Pediatr (Phila) 42(3):263–267

    Article  Google Scholar 

  10. Harada K (1991) Intravenous gamma-globulin treatment in Kawasaki disease. Acta Paediatr Jpn 33(6):805–810

    PubMed  CAS  Google Scholar 

  11. Honkanen VE, McCrindle BW, Laxer RM, Feldman BM, Schneider R, Silverman ED (2003) Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease. Pediatr Cardiol 24(2):122–126

    PubMed  Article  CAS  Google Scholar 

  12. Kim T, Choi W, Woo CW, Choi B, Lee J, Lee K, Son C, Lee J (2007) Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr 166(5):421–425

    PubMed  Article  Google Scholar 

  13. Ministry of Health and Welfare (1984) Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Ministry of Health and Welfare, Tokyo, Japan

  14. 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(2):177–180

    PubMed  Article  CAS  Google Scholar 

  15. 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; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association (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(17):2747–2771

    PubMed  Article  Google Scholar 

  16. Omland T (2008) Advances in congestive heart failure management in the intensive care unit: B-type natriuretic peptides in evaluation of acute heart failure. Crit Care Med 36(1 Supp):S17–S27

    PubMed  Article  CAS  Google Scholar 

  17. Rosenfeld EA, Corydon KE, Shulman ST (1995) Kawasaki disease in infants less than one year of age. J Pediatr 126:524–529

    PubMed  Article  CAS  Google Scholar 

  18. Shulman ST, Rowley AH (2004) Advances in Kawasaki disease. Eur J Pediatr 163(6):285–291

    PubMed  Article  Google Scholar 

  19. Tseng CF, Fu YC, Fu LS, Betau H, Chi CS (2001) Clinical spectrum of Kawasaki disease in infants. Zhonghua Yi Xue Za Zhi (Taipei) 64(3):168–173

    CAS  Google Scholar 

  20. 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(1):e10

    PubMed  Article  CAS  Google Scholar 

  21. Yanagawa H, Nakamura Y, Yashiro M, Uehara R, Oki I, Kayaba K (2006) Incidence of Kawasaki disease in Japan: the nationwide surveys of 1999–2002. Pediatr Int 48(4):356–361

    PubMed  Article  Google Scholar 

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Affiliations

  1. Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea

    Yunku Yeo, TaeYeon Kim, KeeSoo Ha, GiYoung Jang, JungHwa Lee, KwangChul Lee, ChangSung Son & JooWon Lee

  2. Department of Pediatrics, Korea University Medical Center, Kojan-dong 516, Ansan-si, Kyungki-do, Republic of Korea

    JungHwa Lee

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  1. Yunku Yeo
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  2. TaeYeon Kim
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  3. KeeSoo Ha
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  4. GiYoung Jang
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  5. JungHwa Lee
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  6. KwangChul Lee
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  7. ChangSung Son
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  8. JooWon Lee
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Correspondence to JungHwa Lee.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00431-009-1045-6

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Yeo, Y., Kim, T., Ha, K. et al. Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr 168, 157 (2009). https://doi.org/10.1007/s00431-008-0722-1

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  • DOI: https://doi.org/10.1007/s00431-008-0722-1

Keywords

  • Kawasaki disease
  • Infants
  • Coronary abnormalities
  • Incomplete manifestation