[Kawasaki disease in children--9 years experience].
OBJECTIVE
The aim of the study was assessment of the course and treatment of Kawasaki disease on the basis of own experience.


METHODS
Between November 1995 and December 2004 Kawasaki disease (KD) was diagnosed in 30 patients, (20 boys, 10 girls). The median age in acute stage was 20 months (range 1-96 months). Patients were divided into 4 groups (gr) according to changes in coronary arteries (CA). Group 1 (N=13) without CA aneurysms (CAA), group II (N=5) with small (<5mm) CAA. Group III (N=5) with medium (5-8mm) CAA, group IV (N=7) with giant (>8mm) CAA. Echocardiographic examination was performed in all patients. In echocardiographic examination the following were observed: CAA and valvar insufficiency in 15 patients, left ventricle enlargement in 3 patients, pericardial effusion in 6 patients. The treatment was intravenous immunoglobulin and aspirin in all patients, steroid treatment in 2 patients methylprednisolone, in 2 patients prednisone, in l patient hydrocortisone. The anti-inflammatory treatment was started after 10 days of illness in 66.7% of patients. Thrombi in CAA were treated in 6 patients, the treatment was: in all tissue - type plasminogen activator iv and intracoronary in 2 patients; heparin in all; enoxaparine in 3 patients; abciximab in 2 patients; acenocumarol and aspirin in all. Coronary angiographies were performed in 2 patients in acute stage of disease for thrombolytic therapy and in 4 patients during follow-up. Myocardial perfusion was assessed in SPECT (Single Photon Emission Computed Tomography) in 6 patients. Two children with giant CAA died during the first 8 months of acute stage (6.7%), 2 patients we lost from follow-up. 26 patients are in follow-up.


RESULTS
during anti-inflammatory treatment (immunoglobulin, aspirin, steroid treatment) loss of fever, normalization of inflammatory markers, and no side effect, were observed except for 1 patient treated with methylprednosolone with thrombi in CAA during treatment and no side effects during treatment. During the follow-up period CAA regressed in 5 patients (35.7%), CAA became smaller in 7 patients (50%), CAA were the same in 2 patients (14.3%). Changes in echocardiographic examination: valvar insufficiency, left ventricle enlargement, pericardial effusion, disappeared during follow-up. Perfusion defects were observed in 4 patients in SPECT. In coronary angiography changes were observed in coronary arteries in 4 patients.


CONCLUSIONS
1. Kawasaki disease was diagnosed in 66.7% children after 10 days of illness. 2. Coronary artery aneurysms were found in 56.6% treated children. 3. Regression of CAA was observed in 37.5% patients mainly with small CAA. They became smaller in 50% cases mainly with medium and giant CAA. 4. Mortality rate was 6.7% and concerned children with giant CAA; they died during the first 8 months of illness. 5. Thrombolytic treatment of thrombi in CAA (rt-PA, heparin, enoxaparine, abciximab, acenocumarol, aspirin) was safe and successful. 6. In all patients with medium and giant CAA in the acute stage, changes were observed in echocardiographic, angiographic examination and myocardial perfusion during follow-up.
Kowalczyk
Monika
M
Klinika Kardiologii, Instytut Pomnik Centrum Zdrowia Dziecka, Al. Dzieci Polskich 20, 03-719 Warszawa, Poland.
Kawalec
Wanda
W
Daszkowska-York
Jadwiga
J
Turska-Kmieć
Anna
A
Brzezińska-Rajszys
Grazyna
G
Sobielarska
Dorota
D
Ziółkowska
Lidia
L
Kościesza
Andrzej
A
Jagiełłowicz
Dorota
D
Mirecka-Rola
Alicja
A
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D011044:Poland; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D001241:Aspirin