Profile of Kawasaki Disease in Adolescents: Is It Different?

Najib Advani, Lucyana Alim Santoso, Sudigdo Sastroasmoro

Abstract


Background: there is clearly growing population of young adults with potentially important coronary artery disease after Kawasaki disease (KD) during childhood, and cardiologist must be prepared to take care for them. As Kawasaki disease in adolescent and adult is rare and under-recognized, it is important to study data on patient presentations which may permit development of diagnostic criteria and treatment guidelines for this age group.This study aimed to compare the clinical profile of KD between adolescents (>10 years of age) and children ≤10 years. Methods: This is a cross sectional study. A total of 1150 KD cases (age 1-192 months) during the period of January 2003-December 2016 were analyzed. The clinical profile of subjects aged >10 years (adolescents) and  ≤10 years (children) at acute phase of KD were compared. Results: we found 17 cases of KD in adolescents among 1150 total cases (1.5%). Incomplete KD was more often seen in adolescents compared to children ≤ 10 years of age (59% vs. 29%). Some clinical features were more frequently seen in children than in adolescents, e.g. conjunctivitis (85% in ≤ 10 years of age vs. 65% in > 10 years), mucosal changes (94% vs. 77%), rash (86% vs. 59%), and hand/foot changes (68% vs. 41%). While other clinical features were more often seen in adolescents, e.g., cervical lymphadenopathy (82% vs. 39%) and coronary dilatation (47% vs. 29%). Laboratory results (hemoglobin, leukocytes, erythrocyte sedimentation rate and C-reactive protein) did not differ much between the two groups. Conclusion: Kawasaki disease in adolescents has some different clinical profile from that of younger age. Majority of adolescent patients have incomplete presentation. Some clinical features such as conjunctivitis, mucosal changes, rash, and hand/foot changes are more often seen in children ≤ 10 years compared to in adolescents, while cervical lymphadenopathy and coronary dilatation are more frequently seen in adolescents. The ratio of male to female is much higher in adolescents.

Keywords


Kawasaki disease; adolescents

References


Kawasaki T. Acute febrile mucocutaneous lymph node syndrome with accompanying specific peeling of the fingers and the toes. Jap J Allergy. 1967;16:178-22.

Advani N. Kawasaki disease: risk factors for the development of coronary aneurysms, their clinical course, and number and quality of the endothelial progenitor cells. Dissertation. Jakarta: Universitas Indonesia. 2014.

Kato H, Sugimura T, Akagi T, et al. Long-term consequences of Kawasaki disease: a 10-21 year follow up study of 594 patients. Circulation. 1996;94:1379-85.

Morens DM, Anderson LJ, Hurwitz ES. National surveillance of Kawasaki disease. Pediatrics. 1980;65:21-5.

Yanagawa H, Yashiro M, Nakamura Y, Kawasaki T, Kato H. Epidemiologic pictures of Kawasaki disease in Japan: from the nationwide incidence survey in 1991 and 1992. Pediatrics. 1995;95:475-9.

Makino N, Nakamura Y, Yashiro M, et al. Descriptive epidemiology of Kawasaki disease in Japan, 2011-2012: from the results of the 22nd nationwide survey. J Epidemiol. 2015;25:239-45.

Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment and long-term management of Kawasaki disease. Circulation. 2004;110:2747-71.

Momenah T, Sanatani S, Potts J, Sandor GG, Human DG, Patterson MW. Kawasaki disease in the older child. Pediatrics. 1998;102:7.

Gersony WM. The adult after Kawasaki disease, the risk for late coronary events. J Am Coll Cardiol. 2009;54:1921-3.

Shimizu C, Sood A, Lau HD, et al. Cardiovascular pathology in 2 young adults with sudden unexpected death due to coronary aneurysms from Kawasaki disease in childhood. Cardiovasc Pathol. 2015:24:310-6.

Burns JC, Shike H, Gordon JB, Malhotra A, Schoenwetter M, Kawasaki T. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol. 1996;28;253-7.

Fukazawa R, Ogawa S. Long-term prognosis of patients with Kawasaski disease: At risk for future atherosclerosis? J Nippon Med Sch. 2009;76:124-33.

Stockheim JA, Innocentini N, Shulman ST. Kawasaki disease in older children and adolescents. J Pediatr. 2000;137:250-2.

Seve P, Stankovic K, Small A, Durand DV, Merchand G, Broussolle C. Adult Kawasaki disease: report of two cases and literature review. Semin Arthritis Rheum. 2005:34:785-92.


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