Aims: Kawasaki disease is an acute systemic vasculitis with a rising incidence in the UK. Presentation and final diagnosis could be ‘typical’ or ‘atypical/incomplete’ and can be a diagnostic challenge for general paediatricians, but UK data is scarce. This audit aimed to review the burden, presentation and management of Kawasaki disease in the general paediatrics department of a large teaching hospital over a 5 year period.
Method All cases coded as Kawasaki disease over a 5 year period from 1st June 2008 to 1st Jun 2013 were identified from electronic records. Clinical details were collected from the case notes using a proforma.
Results 24 cases were identified. Median age of diagnosis was 26 months (range 4 months–9 years). 42% were male. The mean duration of fever at presentation to hospital was 6.3 days (range 115 days). The frequencies of characteristic clinical features were fever (100%), non-purulent conjunctivitis (96%), rash (75%), cervical lymphadenopathy (75%), irritability (71%), mucositis (67%), extremity changes (33%) and desquamation (17%). 11 (46%) cases were classed as ‘atypical/incomplete’, which was more commonly diagnosed in infants. Atypical cases were also diagnosed more frequently during the latter half of the study period (60% vs 44%). Blood results showed a mean CRP of 123. Other abnormalities included thrombocytosis (58%), thrombocytopaenia (21%), low albumin (75%) and raised transaminase (42%). Treatment with intravenous immunoglobulin (IVIG) was commenced on average after 7.6 days of fever and 1 day after admission. IVIG and Aspirin were used in all cases except one and 3 patients required two doses of IVIG. Coronary artery aneurysms were detected in 4 cases (16%). Of these, one was in the atypical group.
Conclusions Our results show a typical age and sex distribution. Fever and conjunctivitis were the most frequent features with abnormalities in platelets, ALT and albumin also being common. In spite of a short lead period and early treatment, 16% of our cases developed coronary aneurysms. The larger proportion of atypical cases over time suggests that general paediatricians are increasingly vigilant and using their clinical judgement to diagnose and treat these children early.