Abstract
Objective: In this study, we aimed to evaluate clinical and laboratory characteristics of patients with Kawasaki disease (KD) in Konya region of Turkey. Methods: The hospital records of patients who were hospitalized with the diagnosis of KD in the Pediatrics Clinics of Konya Training and Research Hospital between May 2010 and June 2012 were reviewed retrospectively. Results: Seven cases were found to have the diagnosis of KD, two of whom were incomplete KD. Oropharynx changes were the most common (100%) feature in our patients. Five (71%) patients had bulbar conjunctivitis. Three (43%) patients had erythema at the site of BCG inoculation. Adenopathy was present in all of our patients with the classical form. A desquamation was observed in one case at the seventh day of fever. No cardiac manifestation was seen. Elevated erythrocyte sedimentation rate and thrombocytosis were present in all patients. All of the patients were received intravenous immunoglobulin in the first ten days of the fever. Conclusion: KD should be considered as a possible diagnosis in any child presenting with prolonged fever. BCG reaction can be attributed as a diagnostic criterion for incomplete form of the disease especially in countries where BCG vaccination is routinely performed. Early treatment is essential to prevent cardiovascular complications. Key words: Kawasaki disease, vasculitis, BCG reaction, children
Keywords
References
- Sundel RP, Petty RE. Kawasaki Disease. In: Cassidy JT, Petty
- RE, eds. Textbook of Pediatric Rheumatology, 6th edn.
- Philadelphia: Elsevier Saunders, 2011:505-520.
- Kawasaki T. Acute febrile mucocutaneous syndrome with
- lymphoid involvement with specific desquamation of the
- fingers and toes in children. Arerugi 1967;16:178-222.
- Ozen S, Bakkaloglu A, Dusunsel R, et al. Turkish Pediatric
- Vasculitis Study Group. Childhood vasculitides in Turkey:
- a nationwide survey. Clin Rheumatol 2007;26:196-200.
- Burns JC. Kawasaki disease. Adv Pediatr 2001; 48:157-177.
- Burgner D, Harnden A. Kawasaki disease: what is the epidemiology
- telling us about the etiology? Int J Infect Dis 2005;
- :185-194.
- Plantin P, Blayo M, Dupré D, Schoenlaub P. BCG reactivation:
- a rare but specific sign of Kawasaki disease. Presse
- Med 1998; 27:716.
- Fukushige J, Takahashi N, Ueda Y, Ueda K. Incidence and
- clinical features of incomplete Kawasaki disease. Acta Paediatr
- ;83:1057-1060.
- Joffe A, Kabani A, Jadavji T. Atypical and complicated Kawasaki
- disease in infants. Do we need criteria? West J Med
- ;162:322-327.
- Kayiran SM, Dindar A, Gurakan B. An evaluation of children
- with Kawasaki disease in Istanbul: a retrospective followup
- study. Clinics 2010;65:1261-1265.
- Başara BB, Güler C, Eryılmaz Z, ve ark. T.C. Sağlık Bakanlığı
- Sağlık İstatistikleri Yıllığı 2011, Bölüm:5 Sayfa:49,
- Ankara, Türkiye, 2012.
- Sireci G, Dieli F, Salerno A. T cells recognize an immunodominant
- epitope of heat shock protein 65 in Kawasaki disease.
- Mol Med 2000;6:581-590.
- Kakisaka Y, Ohara T, Katayama S, et al. Human herpes
- virus type 6 can cause skin lesions at the BCG inoculation
- site similar to Kawasaki Disease. Tohoku J Exp Med
- ;228:351-353.
- Hsu YH, Wang YH, Hsu WY, Lee YP. Kawasaki disease
- characterized by erythema and induration at the Bacillus
- Calmette-Guérin and purified protein derivative inoculation
- sites. Pediatr Infect Dis J 1987;6:576-578.
- Uehara R, Igarashi H, Yashiro M, et al. Kawasaki disease
- patients with redness or crust formation at the Bacille
- Calmette-Guérin inoculation site. Pediatr Infect Dis J
- ;29:430-433.
- Binnetoğlu K, Kuşdal Y, Altun G, Babaoğlu K. Kocaeli
- Bölgesinde Kawasaki Hastalığı Tanısı Alan 24 Hastanın
- Klinik ve Epidemiyolojik Özellikleri. Çocuk Enf Derg
- ; 4:71-75.
- Lai CC, Lee PC, Wang CC, et al. Reaction at the bacillus
- Calmette-Guérin inoculation site in patients with Kawasaki
- disease. Pediatr Neonatol 2013;54:43-48.
- Takayama J, Yanase Y, Kawasaki T. A study on erythematous
- change at the site of the BCG inoculation. Acta Pediatr
- Jpn 1982;86:567-572.
- Seo JH, Yu JJ, Ko HK, et al. Diagnosis of incomplete Kawasaki
- disease in infants based on an inflammation at the
- Bacille Calmette-Guérin inoculation site. Korean Circ J
- ;42:823-829.
- Wang S, Best BM, Burns JC. Periungual desquamation
- in patients with Kawasaki disease. Pediatr Infect Dis J
- ;28:538-539.
- Gülhan B, Kesici S, Beken S, et al. Varying clinical features
- of Turkish Kawasaki disease patients. Turk J Pediatr
- ;54:1-6.
- Ozdemir H, Ciftçi A, Karbuz A, et al. Incomplete Kawasaki
- disease in an infant presenting with only prolonged fever.
- Turk J Pediatr 2013; 55:529-532.
- Ozdemir H, Ciftçi E, Tapisiz A, et al. Clinical and epidemiological
- characteristics of children with Kawasaki disease
- in Turkey. J Trop Pediatr 2010;56:260-262.
- Burns JC, Mason WH, Glode MP, et al. Clinical and epidemiologic
- characteristics of patients referred for evaluation
- of possible Kawasaki disease. United States Multicenter
- Kawasaki Disease Study Group. J Pediatr 1991;118:680-
- -
- Ting EC, Capparelli EV, Billman GF, et al. Elevated gamma-glutamy
- l transferase concentrations in patients with
- acute Kawasaki disease. Pediatr Infect Dis J 1998;17:431-
- -
- Newburger JW, Takahashi M, Gerber MA, et al; Committee
- on Rheumatic Fever, Endocarditis, and Kawasaki Disease,
- Council on Cardiovascular Disease in the Young, American
- Heart Association. 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;114:1708-1733.
- American Academy of Pediatrics. Kawasaki disease. In:
- Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red
- Book: 2006 Report of the Committee on Infectious Diseases,
- th edn. Elk Grove, Village, IL: American Academy of
- Pediatrics; 2006: 414.
- Newburger JW, Takahashi M, Burns JC, et al. The treatment
- of Kawasaki syndrome with intravenous gamma globulin.
- N Engl J Med 1986;315:341-347.
Abstract
Amaç: Bu çalışmada, kliniğimizde Kawasaki hastalığı (KH) tanısıyla takip ettiğimiz vakalarımızın klinik ve laboratuvar özelliklerini sunmayı amaçladık. Yöntemler: Konya Eğitim ve Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları Kliniği’ne Mayıs 2010 ve Haziran 2012 tarihleri arasında KH tanısıyla yatırılarak takip edilen hastaların kayıtları retrospektif olarak incelendi.Bulgular: Yedi vakanın Kawasaki hastalığı tanısıyla izlendiği tespit edildi. Bu vakaların ikisi inkomplet Kawasaki hastalığı tanısı almıştı. Hastalarımızın tümünde (%100) orafarenks bulguları mevcuttu. Beş hastada (%71) bulbar konjonktivit vardı. Üç hastada (%43) BCG aşı yerinde eritem gözlendi. Klasik Kawasaki hastalığı tanısı alanların tümünde servikal adenopati mevcuttu. Bir hastada ateşin yedinci gününde ortaya çıkan ve bir hafta içinde düzelen periungual deskuamasyon gözlendi. Tüm hastalarımızda yüksek eritrosit sedimentasyon hızı ve trombositoz mevcuttu. Takipleri süresince hastaların hiçbirinde kardiak komplikasyon gözlenmedi. Hastalarımızın tümü ateşin ilk 10 günü içinde IVIG tedavisi almıştı.Sonuç: Uzamış ateş şikayetiyle gelen her hastada ayırıcı tanıda KH düşünülmelidir. BCG aşısının rutin olarak uygulandığı ülkelerde BCG aşı yerinde gelişen eritem özellikle inkomplet KH’nda tanı kriteri olarak kullanılabilir. Kardiyovaskuler komplikasyonların gelişmesini önlemek açısından hastalığın erken tanısı tedavisinin başlanması çok önemlidir
Keywords
References
- Sundel RP, Petty RE. Kawasaki Disease. In: Cassidy JT, Petty
- RE, eds. Textbook of Pediatric Rheumatology, 6th edn.
- Philadelphia: Elsevier Saunders, 2011:505-520.
- Kawasaki T. Acute febrile mucocutaneous syndrome with
- lymphoid involvement with specific desquamation of the
- fingers and toes in children. Arerugi 1967;16:178-222.
- Ozen S, Bakkaloglu A, Dusunsel R, et al. Turkish Pediatric
- Vasculitis Study Group. Childhood vasculitides in Turkey:
- a nationwide survey. Clin Rheumatol 2007;26:196-200.
- Burns JC. Kawasaki disease. Adv Pediatr 2001; 48:157-177.
- Burgner D, Harnden A. Kawasaki disease: what is the epidemiology
- telling us about the etiology? Int J Infect Dis 2005;
- :185-194.
- Plantin P, Blayo M, Dupré D, Schoenlaub P. BCG reactivation:
- a rare but specific sign of Kawasaki disease. Presse
- Med 1998; 27:716.
- Fukushige J, Takahashi N, Ueda Y, Ueda K. Incidence and
- clinical features of incomplete Kawasaki disease. Acta Paediatr
- ;83:1057-1060.
- Joffe A, Kabani A, Jadavji T. Atypical and complicated Kawasaki
- disease in infants. Do we need criteria? West J Med
- ;162:322-327.
- Kayiran SM, Dindar A, Gurakan B. An evaluation of children
- with Kawasaki disease in Istanbul: a retrospective followup
- study. Clinics 2010;65:1261-1265.
- Başara BB, Güler C, Eryılmaz Z, ve ark. T.C. Sağlık Bakanlığı
- Sağlık İstatistikleri Yıllığı 2011, Bölüm:5 Sayfa:49,
- Ankara, Türkiye, 2012.
- Sireci G, Dieli F, Salerno A. T cells recognize an immunodominant
- epitope of heat shock protein 65 in Kawasaki disease.
- Mol Med 2000;6:581-590.
- Kakisaka Y, Ohara T, Katayama S, et al. Human herpes
- virus type 6 can cause skin lesions at the BCG inoculation
- site similar to Kawasaki Disease. Tohoku J Exp Med
- ;228:351-353.
- Hsu YH, Wang YH, Hsu WY, Lee YP. Kawasaki disease
- characterized by erythema and induration at the Bacillus
- Calmette-Guérin and purified protein derivative inoculation
- sites. Pediatr Infect Dis J 1987;6:576-578.
- Uehara R, Igarashi H, Yashiro M, et al. Kawasaki disease
- patients with redness or crust formation at the Bacille
- Calmette-Guérin inoculation site. Pediatr Infect Dis J
- ;29:430-433.
- Binnetoğlu K, Kuşdal Y, Altun G, Babaoğlu K. Kocaeli
- Bölgesinde Kawasaki Hastalığı Tanısı Alan 24 Hastanın
- Klinik ve Epidemiyolojik Özellikleri. Çocuk Enf Derg
- ; 4:71-75.
- Lai CC, Lee PC, Wang CC, et al. Reaction at the bacillus
- Calmette-Guérin inoculation site in patients with Kawasaki
- disease. Pediatr Neonatol 2013;54:43-48.
- Takayama J, Yanase Y, Kawasaki T. A study on erythematous
- change at the site of the BCG inoculation. Acta Pediatr
- Jpn 1982;86:567-572.
- Seo JH, Yu JJ, Ko HK, et al. Diagnosis of incomplete Kawasaki
- disease in infants based on an inflammation at the
- Bacille Calmette-Guérin inoculation site. Korean Circ J
- ;42:823-829.
- Wang S, Best BM, Burns JC. Periungual desquamation
- in patients with Kawasaki disease. Pediatr Infect Dis J
- ;28:538-539.
- Gülhan B, Kesici S, Beken S, et al. Varying clinical features
- of Turkish Kawasaki disease patients. Turk J Pediatr
- ;54:1-6.
- Ozdemir H, Ciftçi A, Karbuz A, et al. Incomplete Kawasaki
- disease in an infant presenting with only prolonged fever.
- Turk J Pediatr 2013; 55:529-532.
- Ozdemir H, Ciftçi E, Tapisiz A, et al. Clinical and epidemiological
- characteristics of children with Kawasaki disease
- in Turkey. J Trop Pediatr 2010;56:260-262.
- Burns JC, Mason WH, Glode MP, et al. Clinical and epidemiologic
- characteristics of patients referred for evaluation
- of possible Kawasaki disease. United States Multicenter
- Kawasaki Disease Study Group. J Pediatr 1991;118:680-
- -
- Ting EC, Capparelli EV, Billman GF, et al. Elevated gamma-glutamy
- l transferase concentrations in patients with
- acute Kawasaki disease. Pediatr Infect Dis J 1998;17:431-
- -
- Newburger JW, Takahashi M, Gerber MA, et al; Committee
- on Rheumatic Fever, Endocarditis, and Kawasaki Disease,
- Council on Cardiovascular Disease in the Young, American
- Heart Association. 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;114:1708-1733.
- American Academy of Pediatrics. Kawasaki disease. In:
- Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red
- Book: 2006 Report of the Committee on Infectious Diseases,
- th edn. Elk Grove, Village, IL: American Academy of
- Pediatrics; 2006: 414.
- Newburger JW, Takahashi M, Burns JC, et al. The treatment
- of Kawasaki syndrome with intravenous gamma globulin.
- N Engl J Med 1986;315:341-347.
Details
| Primary Language | English |
|---|---|
| Journal Section | Research Articles |
| Authors | |
| Publication Date | May 9, 2015 |
| Submission Date | May 9, 2015 |
| Published in Issue | Year 2015 Volume: 42 Issue: 1 |