Erythema and induration of the Bacillus Calmette-Guérin site for diagnosing Kawasaki disease.

Ann Loh; Phek Hui Jade Kua; Ze Lei Tan

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Erythema and induration of the Bacillus Calmette-Guérin site for diagnosing Kawasaki disease.

Author: Ann LOH ¹ ; Phek Hui Jade KUA ² ; Ze Lei TAN ³
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1. Department of General Paediatrics, KK Women's and Children's Hospital, Singapore.
2. Department of Children's Emergency, KK Women's and Children's Hospital, Singapore.
3. Department of General Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.
Publication Type:Journal Article
Keywords: BCG inoculation site; BCG reactivation; Kawasaki disease
MeSH: BCG Vaccine; administration & dosage; adverse effects; Case-Control Studies; Child, Preschool; Erythema; complications; epidemiology; Female; Fever; complications; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome; complications; diagnosis; epidemiology; Risk Factors; Singapore; epidemiology
From:Singapore medical journal 2019;60(2):89-93
CountrySingapore
Language:English
Abstract: INTRODUCTION:Kawasaki disease (KD) is a challenging diagnosis. Erythema and induration of the Bacillus Calmette-Guérin (BCG) site is increasingly recognised as a significant clinical clue. However, there is little data to support its specificity for KD as compared to other febrile illnesses. We aimed to evaluate BCG reaction or induration as a diagnostic tool for KD.
METHODS:A retrospective case-controlled study of patients discharged with a diagnosis of KD from 2007 to 2010 was conducted. Another group of patients admitted over the same period for possible KD, but later found not to have KD, served as control.
RESULTS:Significantly more infants with KD (69.7%) had BCG site changes than older children (27.8%; p < 0.001). It also presented earlier in the course of KD; < 5 days (53.3%) compared to ≥ 5 days of fever (30.0%; p < 0.001). Positive predictive value of BCG site reaction or induration for KD was 90.8% (95% confidence interval [CI] 0.819-0.962) for infants and 96.2% (95% CI 0.868-0.995) for older children. The prevalence rate of changes at the BCG site was 9.9% among patients with non-KD febrile illnesses and 42.6% among patients with KD.
CONCLUSION:BCG site reaction or induration is a useful clinical clue for the diagnosis of KD in both infants and older children, with a higher prevalence in infants. Physicians should consider KD in children with febrile illness and redness or crust formation at the BCG site, especially in view of low rates of BCG reaction or induration in non-KD febrile illnesses.