Clinical analysis of 106 cases of Kawasaki disease in infants
Wei ZHANG
;
Sha LI
;
Li WANG
;
Shipin FENG
;
Wei LUO
;
Min XIE
Chinese Journal of Applied Clinical Pediatrics.2014;29(21):1640-1642. doi:10.3760/cma.j.issn.2095-428X.2014.21.012
Objective Through investigating the clinical and laboratory characteristics of Kawasaki disease (KD) in infants younger than 12 months in order to improve the accuracy of early diagnosis of KD and decrease the risk of coronary artery lesion (CAL).Methods Clinical manifestations,diagnosis and treatment of total 106 patients younger than 12 months with KD hospitalized in Chengdu Women and Children's Central Hospital from Jan.2006 to Jan.2014 were reviewed.Results (1) Among 106 cases,72 cases were male and 34 cases were female,the ratio of male to female was 2.1:1.0.The age varied from 2 months to 12 months,and the average age was (8.4 ± 2.7) months.Twenty-eight cases were younger than 6 months,78 cases were within 6 months to 12 months.(2)KD scattered the whole year and occurred more frequently in spring and summer.The average duration of fever before final diagnosis was (8.0 ±3.5) days.The major clinical manifestation were erythema and cracking of lips (77.4％,82/106 cases),rash (73.6％,78/106 cases),eye conjunctival hyperemia (70.8％,75/106 cases),changes in extremities (59.4％,63/ 106 cases),strawberry tongue (48.1％,51/106 cases),cervical lymphadenopathy (40.6％,43/106 cases),respectively.Among 106 cases,33 cases (31.1％) were diagnosed as incomplete KD (IKD),86 cases (78.9％) accompanied with one or more than one systematic or organic lesion,33 cases (31.1％) were misdiagnosed before the final diagnosis of KD,32 cases (30.2％) accompanied with CAL.Ninety-five point nine percent(94/98 cases) were sensitive to the first dose of intravenous immunogloblin (IVIG) therapy.(3)Compared with the infants of KD older than 6 months,the infants younger than 6 months had longer fever duration before the final diagnosis,higher prevalence of IKD,higher incidence of gastrointestinal involvement and anemia,higher white blood count,lower haemoglobin and albumin values,higher incidence of CAL and coronary artery aneurysms (CAA) (all P ＜ 0.05).IVIG treatment response for both groups was sensitive (P ＞ 0.05).Conclusions (1) Infants KD,especially younger than 6 months old had higher rate of IKD,often accompanied with other organic lesion,and were easily to be misdiagnosed and missed diagnosis.Most infants KD were sensitive to the first dose of IVIG therapy.(2) Infants of KD younger than 6 months old were more prone to suffer from CAL and CAA.(3) To avoid misdiagnosis and missed diagnosis of infants KD,cardiac ultrasonography is important for those who have unexplained fever over 5 days and were not sensitive to the treatment,especially the male.
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