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Inexplicable fever could be symptom of Kawasaki disease
Kawasaki disease should be considered as a possible diagnosis for young children with persistent inexplicable fever, according to recent study findings published in The Pediatric Infectious Disease Journal.
Carline E. Tacke, MD, of Emma Children’s Hospital at the Academic Medical Center in the Netherlands, and colleagues evaluated 341 children (median age, 2.6 years) with Kawasaki disease to determine incidence of the disease in the Netherlands and the characteristics, treatment regimens and cardiac outcomes of the patients. Nearly 80% of patients were younger than 5 years, and 23.2% were younger than 1 year at disease onset; 61% of children included in the study were boys.
During the study period (2008-2012), the incidence rate for patients younger than 5 years was 5.8 per 100,000 and 8.7 per 100,000 for patients younger than 1 year.
Throughout the study period, most cases occurred in the winter (29.6%), followed by spring (24.9%), autumn (24.6%) and summer (20.8%).
Physicians returned questionnaires regarding clinical characteristics of the disease for 93.5% of patients. Persistent fever for 5 or more days was present in all patients except for 4.4% who were treated on day 3 or 4. The most common manifestations included rash (89.6%); oral mucositis (87.4%); conjunctival infection (87.1%); changes of the peripheral extremities (77.4%); and lymphadenopathy (71.9%). Other reported clinical manifestations included gastrointestinal symptom (26.3%); arthritis/arthralgia (10.3%); coughing (16.9%); otitis media (11.9%); and jaundice (1.9%). Seventy-one patients had incomplete Kawasaki disease with persistent fever and fewer than four clinical criteria.
Six days was the median hospitalization duration. No deaths were reported, but 3.4% of patients were admitted to the ICU.
High-dose intravenous immunoglobulin (IVIG) was given to all patients except 3.4% because of an initially missed diagnosis. Eight of the patients whose diagnosis was missed were treated with high-dose aspirin after Kawasaki disease diagnosis.
Coronary artery aneurysms were found during the acute phase in 13.5% of patients at echocardiographic evaluation. Three patients had giant aneurysms, two of whom were younger than 1 year with incomplete disease presentation; none responded to IVIG.
“A remarkable finding on the incidence rates is that it seems to be related to the population density which varies throughout the country,” the researchers wrote. “We observed a difference in the incidence of [Kawasaki disease] within the different provinces of the Netherlands with the highest incidences in the most densely populated provinces. Urbanization and industrialization have been previously suggested to be related to the occurrence of [Kawasaki disease], which may be accompanied by important socio-cultural differences between the highly populated areas versus the agricultural regions in the Netherlands.”
Disclosure: The study was funded in part by the Stinafo Foundation. The researchers report no relevant financial disclosures.
