Clinical manifestations of Kawasaki disease: what are the significant parameters?
The initial differential diagnosis of Kawasaki disease (KD) from other acute febrile illnesses infants and children is particularly difficult in patients who exhibit incomplete criteria. The objective of this study was to determine the differences in the clinical and laboratory findings between KD patients and those who were initially sus- , pected of having KD but eventually had other diagnoses. One hundred and fourteen pediatric patients who were initially diagnosed with suspected KD were included. Eighteen cases were finally diagnosed with another disease. The only demographic data that were significantly different between the groups were body height and the duration of fever. The KD group exhibited more classical clinical criteria than those who were finally diagnosed with another disease. The erythrocyte sedimentation rate (ESR) and platelet count were significantly higher in the KD group than in the non-KD group. An ESR > or = 40 mm/hour had a diagnostic sensitivity of 90.5%, a specificity of 66.6%, a positive predictive value of 93.4%, and a negative predictive value of 57.1%. The incidence of coronary aneurysm in this study was 6.2%. There was no correlation between ESR and coronary aneurysm. We conclude that the clinical criteria are the basis for the diagnosis of Kawasaki disease but the ESR can be helpful in pediatric patients with acute febrile illness who do not exhibit all clinical criteria.
Chaiyarak
Kanoknaphat
K
Her Majesty's Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. kchaiyarak@yahoo.com
Durongpisitkul
Kritvikrom
K
Atta
Thitiya
T
Soongswang
Jarupim
J
Laohaprasitiporn
Duangmanee
D
Nana
Apichart
A
D001799:Blood Sedimentation; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D007239:Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity