THE RETROSPECTIVE EVALUATION OF CASES DIAGNOSED WITH KAWASAKI DISEASE

Öz

Aim: Kawasaki disease (KD) is an acute febrile disease of childhood with vasculitis. We aimed to evaluate the epidemiological and clinical characteristics of KD cases diagnosed and treated in the Pediatric Clinic of our hospital in the last decade. Material and Method: Forty five patients diagnosed with KD and treated between 01 January 2010 and 01 January 2020 was included in the study. The demographic characteristics, clinical and laboratory findings, and treatment processes of the patients were evaluated retrospectively. Results: Of the 45 patients 23 (51.2%) were male. The mean age was 35.26 ± 28.16 months. The average duration of fever was 7,16±3.5 day. The patients were most frequently admitted in the spring (31.1%; 14 patients), and winter (31.1%; 14 patients). Twenty two (71.1%) of the patients diagnosed as complete KD, 13 (28.8%) patients were diagnosed as incomplete KD. While coronary involvement was present in 16 patients (35.5%), 29 patients (64.4%) didn’t. The mean platelet count was higher in patients with coronary involvement (p=0.006). Conclusion: Cardiac involvement was observed at a rate of 35.5%. Platelet levels were higher in those with cardiac involvement. Considering that the platelet level increases in the subacute period in KD, it can be inferred as a result of an increase in cardiac involvement in patients who were admitted to the hospital late. Therefore the awareness of pediatricians about incomplete KD forms should be increased in addition to KD.

Anahtar Kelimeler

• Kawasaki disease
• coronary artery
• children

KAWASAKİ HASTALIĞI TANISI KONULAN HASTALARIN GERİYE YÖNELİK DEĞERLENDİRİLMESİ

Öz

Amaç: Kawasaki hastalığı (KH) çocukluk çağında vaskülitle seyreden akut ateşli bir hastalıktır. Son 10 yılda hastanemiz pediatri kliniğinde KH tanısı alan hastaların epidemiyolojik ve klinik özelliklerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: 01/01/2021-01/01/2020 tarihleri arasında KH tanısı konulan ve tedavi edilen 40 hasta çalışmaya alındı. Hastaların demografik ve klinik özellikleri, laboratuar bulguları ve tedavi süreçleri geriye yönelik değerlendirildi. Bulgular: Kırk beş hastadan 23 (51.2%) ü erkekti. Ortalama yaş 35.26±8.16 ay idi. Ortalama ateş süresi 7.16±3.5 gündü. Hastalar daha çok bahar (%31.1, 14 hasta) ve kış aylarında (%31.1, 14 hasta) başvurdu. Yirmi iki hasta (%71.1) komplet KH, 13 hasta ise (%28.8) inkomplet KH tanısı aldı. Koroner tutulum 16 hastada varken (%35.5), 29 unda yoktu (%64.4). Koroner tutulumu olan hastaların ortalama platelet sayısı yüksekti (p=0.006). Sonuç: Kardiyak tutulum %35.5 oranında saptandı. Platelet düzeyi kardiyak tutulumu olanlarda daha yüksekti. KH da platelet düzeyinin subakut dönemde arttığı düşünüldüğünde, hastaneye geç başvuran hastalarda kardiyak tutulumda artış sonucu çıkarılabilir. Bu nedenle çocuk hekimlerinin KH'na ek olarak inkomplet KH konusundaki farkındalıkları artırılmalıdır.

Anahtar Kelimeler

• kawasaki hastalığı
• koroner tutulum
• çocuklar

Kaynakça

1. Kliegman R, Stanton B, Schor N, St. Geme J, Behrman R (eds). Nelson Textbook of Pediatrics. 19th ed. New York: Elsevier-Health Science, 2011.
2. Greco A, De Virgilio A, Rizzo MI, Tombolini M, Gallo A, Fusconi M, et al. Kawasaki disease: an evolving paradigm. Autoimmun Rev 2015;14:703-9.
3. Golshevsky D, Cheung M, Burgner D. Kawasaki disease--the importance of prompt recognition and early referral. Aust Fam Physician 2013;42(7):473-6
4. Jamieson N, Singh-Grewal D. Kawasaki disease: a clinician’s update. Int J Pediatr 2013;2013:645391.
5. Mc Crindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientic statement for health professionals from the American heart association. Circulation 2017;135:e927-99.
6. Shulman ST. Kawasaki Disease. In Cherry J, HarrisonDemmler GJ, Kaplan SL, Steinbach WJ, Hotez P (eds). Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 7th Edition. Philadelphia, PA. Elsevier Saunders; 2014. p. 1064-1085.
7. Giray T, Biçer S, Küçük Ö, Çöl D, Yalvaç Z, Gürol Y, et al. Four cases with Kawasaki disease and viral infection: aetiology or association. Infez Med 2016;24:340-344.
8. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Long-term consequences of Kawasaki disease. A 10- to21-year follow-up study of 594 patients. Circulation 1996;94:1379-1385.

9. Makino N, Nakamura Y, Yashiro M, Ae R, Tsuboi S, Aoyama Y, et al. Descriptive epidemiology of, Kawasaki disease in Japan, 2011-2012: from the results of the 22nd nationwidw survey. J Epidemiol 2015;25:239- 45.
10. Şahin A, Şahin L, Karabulut M, Dalgıç N. Clinical and Epidemiological Characteristics of Cases Monitored by the Diagnosis of Kawasaki Disease. J Pediatr Inf 2018;12(3):87-92.
11. Son MBF, Newburger JW. Kawasaki disease. Pediatr Rev 2018;39:78-90.
12. Demir AD, Goknar N, Uzuner S, Vehapoglu A, Saritas T, Oktem F. The different cutaneous presentations in three cases of Kawasaki disease as confounding factor of diagnosis. J Pak Med Assoc 2016;66:1188-1190.
13. Topçu S, Akgün Doğan Ö, Öz N, Tanır G. Kırk dokuz Kawasaki olgusunun değerlendirilmesi: Bir retrospektif kohort çalışması. J Pediatr Inf 2014;8:64-70.
14. Ozeki Yukie, Yamada F, Saito A, Kishimoto T, Yashiro M, Makino N, et al. Epidemiologic features of Kawasaki disease distinguised by seasonal variation: an age-specific analysis. Ann Epidemiol 2018;28:796-800.
15. Hedrich CM, Schnabel A, Hospach. Kawasaki disease. Front Pediatr 2018;6:198.
16. Kim GB, Han JW, Park YW, Song MS, Hong YM, Cha SH, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwidw syrvey, 2009-2011. Pediatr Infect Dis J 2014;33:24-7.
17. Sánchez-Manubens J, Bou R, Anton J. Diagnosis and classification of Kawasaki disease. J Autoimmun 2014;48-49:113- 117
18. Ece A, Güneş A, Tan İ, Uluca Ü, Kelekçi S, Yel S ve ark. Kawasaki hastalığı: 13 vakanın değerlendirilmesi. Dicle Tıp Dergisi 2013;40:95-99.
19. Bozabalı S. Kawasaki hastalığı: Olgularımızın klinik ve epidemiyolojik özellikleri. Türkiye Çocuk Hastalıkları Dergisi 2018; DOI: 10.12956/ tjpd.2018.329.
20. Gülhan B, Kesici S, Beken S, Çilsal E, Kale G. Varying clinical features of Turkish Kawasaki disease patients. Turk J Pediatr 2012;54:1-6.
21. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. 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. Circulation 2004;110:2747-2771.
22. Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, et al. Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 2007;49:421-6.
23. Arslanoglu Aydin E, Ertugrul I, Bilginer Y, Batu ED, Sonmez HE, Demir S, et al. The factors affecting the disease course in Kawasaki disease. Rheumatol Int 2019 May 28.
24. Kara SS, Güllü UU, Balaban İ. Kawasaki disease: An evaluation of pediatric patients in Erzurum. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi 2017; 7(2):113-120.
25. Chen S, Dong Y, Kiuchi MG, Wang J, Li R, Ling Z, et al. Coronary artery complication in Kawasaki disease and the importance of early intervention. JAMA Pediatr 2016;170:1156-1163.