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Diagnosis of incomplete Kawasaki disease

  • Yu, Jeong-Jin (Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan)
  • Received : 2012.01.02
  • Accepted : 2012.01.25
  • Published : 2012.03.15

Abstract

Several authors suggested that the clinical characteristics of incomplete presentation of Kawasaki disease are similar to those of complete presentation and that the 2 forms of presentation are not separate entities. Based on this suggestion, a diagnosis of incomplete Kawasaki disease in analogy to the findings of complete presentation is reasonable. Currently, the diagnosis of incomplete Kawasaki disease might be made in cases with fewer classical diagnostic criteria and with several compatible clinical, laboratory or echocardiographic findings on the exclusion of other febrile illness. Definition of incomplete presentation in which coronary artery abnormalities are included as a necessary condition, is restrictive and specific. The validity of the diagnostic criteria of incomplete presentation by the American Heart Association should be thoroughly tested in the immediate future.

Keywords

References

  1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967;16:178-222.
  2. Japan Kawasaki Disease Research Center, Japan Kawasaki Disease Research Committee [Internet]. Tokyo: Japan Kawasaki Disease Research Center, Japan Kawasaki Disease Research Committee; c2012 [cited 2001 Jan 9]. Diagnostic guidelines of Kawasaki disease. Available from: http://kawasakidisease. org/diagnostic/.
  3. Council on Cardiovascular Disease in the Young; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; American Heart Association. Diagnostic guidelines for Kawasaki disease. Circulation 2001;103:335-6. https://doi.org/10.1161/01.CIR.103.2.335
  4. Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, et al. Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 2007;49:421-6. https://doi.org/10.1111/j.1442-200X.2007.02396.x
  5. Witt MT, Minich LL, Bohnsack JF, Young PC. Kawasaki disease: more patients are being diagnosed who do not meet American Heart Association criteria. Pediatrics 1999;104:e10. https://doi.org/10.1542/peds.104.1.e10
  6. Sonobe T, Kawasaki T. Atypical Kawasaki disease. Prog Clin Biol Res 1987;250:367-78.
  7. Barone SR, Pontrelli LR, Krilov LR. The differentiation of classic Kawasaki disease, atypical Kawasaki disease, and acute adenoviral infection: use of clinical features and a rapid direct fluorescent antigen test. Arch Pediatr Adolesc Med 2000;154:453-6. https://doi.org/10.1001/archpedi.154.5.453
  8. Forsey J, Mertens L. Atypical Kawasaki disease-a clinical challenge. Eur J Pediatr 2011 Nov 25 [Epub]. DOI:10.1007/s00431-011-1629-9.
  9. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. 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. Pediatrics 2004;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  10. Perrin L, Letierce A, Guitton C, Tran TA, Lambert V, Koné-Paut I. Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine 2009;76:481-5. https://doi.org/10.1016/j.jbspin.2008.11.015
  11. Manlhiot C, Christie E, McCrindle BW, Rosenberg H, Chahal N, Yeung RS. Complete and incomplete Kawasaki disease: two sides of the same coin. Eur J Pediatr 2011 Dec 3 [Epub]. DOI:10.1007/s00431-011-1631-2.
  12. Rodriguez-Lozano AL, Rivas-Larrauri FE, Hernandez-Bautista VM, Yamazaki-Nakashimada MA. Fever is not always present in Kawasaki disease. Rheumatol Int 2011 Sep 1 [Epub]. DOI:10.1007/s00296-011- 2123-4.
  13. Falcini F, Cimaz R, Calabri GB, Picco P, Martini G, Marazzi MG, et al. Kawasaki's disease in northern Italy: a multicenter retrospective study of 250 patients. Clin Exp Rheumatol 2002;20:421-6.
  14. Hsieh YC, Wu MH, Wang JK, Lee PI, Lee CY, Huang LM. Clinical features of atypical Kawasaki disease. J Microbiol Immunol Infect 2002; 35:57-60.
  15. Sudo D, Monobe Y, Yashiro M, Mieno MN, Uehara R, Tsuchiya K, et al. Coronary artery lesions of incomplete Kawasaki disease: a nationwide survey in Japan. Eur J Pediatr 2011 Dec 10 [Epub]. DOI:10.1007/s00431-011- 1630-3.
  16. Chang FY, Hwang B, Chen SJ, Lee PC, Meng CC, Lu JH. Characteristics of Kawasaki disease in infants younger than six months of age. Pediatr Infect Dis J 2006;25:241-4. https://doi.org/10.1097/01.inf.0000202067.50975.90
  17. Chuang CH, Hsiao MH, Chiu CH, Huang YC, Lin TY. Kawasaki disease in infants three months of age or younger. J Microbiol Immunol Infect 2006;39:387-91.
  18. Burns JC, Wiggins JW Jr, Toews WH, Newburger JW, Leung DY, Wilson H, et al. Clinical spectrum of Kawasaki disease in infants younger than 6 months of age. J Pediatr 1986;109:759-63. https://doi.org/10.1016/S0022-3476(86)80689-8
  19. Rowley AH, Gonzalez-Crussi F, Gidding SS, Duffy CE, Shulman ST. Incomplete Kawasaki disease with coronary artery involvement. J Pediatr 1987;110:409-13. https://doi.org/10.1016/S0022-3476(87)80503-6
  20. Yellen ES, Gauvreau K, Takahashi M, Burns JC, Shulman S, Baker AL, et al. Performance of 2004 American Heart Association recommendations for treatment of Kawasaki disease. Pediatrics 2010;125:e234-41. https://doi.org/10.1542/peds.2009-1465
  21. Fukushige J, Takahashi N, Ueda Y, Ueda K. Incidence and clinical features of incomplete Kawasaki disease. Acta Paediatr 1994;83:1057-60. https://doi.org/10.1111/j.1651-2227.1994.tb12985.x
  22. Muta H, Ishii M, Egami K, Hayasaka S, Nakamura Y, Yanagawa H, et al. Serum sodium levels in patients with Kawasaki disease. Pediatr Cardiol 2005;26:404-7. https://doi.org/10.1007/s00246-004-0789-z
  23. Koren G, Lavi S, Rose V, Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr 1986;108:388-92. https://doi.org/10.1016/S0022-3476(86)80878-2
  24. Ichida F, Fatica NS, Engle MA, O'Loughlin JE, Klein AA, Snyder MS, et al. Coronary artery involvement in Kawasaki syndrome in Manhattan, New York: risk factors and role of aspirin. Pediatrics 1987;80:828-35.
  25. Daniels SR, Specker B, Capannari TE, Schwartz DC, Burke MJ, Kaplan S. Correlates of coronary artery aneurysm formation in patients with Kawasaki disease. Am J Dis Child 1987;141:205-7.
  26. Japan Kawasaki Disease Research Committee. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo: Ministry of Health and Welfare, 1984.
  27. de Zorzi A, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger JW. Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr 1998;133:254-8. https://doi.org/10.1016/S0022-3476(98)70229-X
  28. Yu JJ, Jang WS, Ko HK, Han MK, Kim YH, Ko JK, et al. Perivascular brightness of coronary arteries in Kawasaki disease. J Pediatr 2011;159: 454-7.e1. https://doi.org/10.1016/j.jpeds.2011.02.029
  29. Hiraishi S, Yashiro K, Oguchi K, Kusano S, Ishii K, Nakazawa K. Clinical course of cardiovascular involvement in the mucocutaneous lymph node syndrome. Relation between clinical signs of carditis and development of coronary arterial aneurysm. Am J Cardiol 1981;47:323-30. https://doi.org/10.1016/0002-9149(81)90404-5
  30. Newburger JW, Sanders SP, Burns JC, Parness IA, Beiser AS, Colan SD. Left ventricular contractility and function in Kawasaki syndrome. Effect of intravenous gamma-globulin. Circulation 1989;79:1237-46. https://doi.org/10.1161/01.CIR.79.6.1237
  31. Yu JJ, Choi HS, Kim YB, Son JS, Kim YH, Ko JK, et al. Analyses of left ventricular myocardial deformation by speckle-tracking imaging during the acute phase of Kawasaki disease. Pediatr Cardiol 2010;31:807-12. https://doi.org/10.1007/s00246-010-9708-7
  32. Sinha R, Balakumar T. BCG reactivation: a useful diagnostic tool even for incomplete Kawasaki disease. Arch Dis Child 2005;90:891. https://doi.org/10.1136/adc.2004.071332
  33. Kawamura T, Wago M. Brain natriuretic peptide can be a useful biochemical marker for myocarditis in patients with Kawasaki disease. Cardiol Young 2002;12:153-8. https://doi.org/10.1017/S1047951102000318
  34. Kawamura T, Wago M, Kawaguchi H, Tahara M, Yuge M. Plasma brain natriuretic peptide concentrations in patients with Kawasaki disease. Pediatr Int 2000;42:241-8. https://doi.org/10.1046/j.1442-200x.2000.01225.x
  35. Kurotobi S, Kawakami N, Shimizu K, Aoki H, Nasuno S, Takahashi K, et al. Brain natriuretic peptide as a hormonal marker of ventricular diastolic dysfunction in children with Kawasaki disease. Pediatr Cardiol 2005;26:425-30. https://doi.org/10.1007/s00246-004-0812-4
  36. Bang S, Yu JJ, Han MK, Ko HK, Chun S, Choi HS, et al. Log-transformed plasma level of brain natriuretic peptide during the acute phase of Kawasaki disease is quantitatively associated with myocardial dysfunction. Korean J Pediatr 2011;54:340-4. https://doi.org/10.3345/kjp.2011.54.8.340
  37. Dahdah N, Siles A, Fournier A, Cousineau J, Delvin E, Saint-Cyr C, et al. Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol 2009;30:810-7. https://doi.org/10.1007/s00246-009-9441-2
  38. Yu JJ, Kwak BO, Jeon YH, Park YM, Lee R, Chung S, et al. Elevation of the index of left ventricular mass during the acute and subacute phase of Kawasaki disease, and its association with indexes of diastolic function. Cardiol Young 2009;19:64-9. https://doi.org/10.1017/S1047951108003405
  39. Takeuchi D, Saji T, Takatsuki S, Fujiwara M. Abnormal tissue doppler images are associated with elevated plasma brain natriuretic peptide and increased oxidative stress in acute Kawasaki disease. Circ J 2007;71:357- https://doi.org/10.1253/circj.71.357

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