title: Kawasaki disease in infants below 6 months: a clinical conundrum?
abstract: OBJECTIVE
  Kawasaki disease (KD) is a medium vessel vasculitis of childhood. In infancy KD is often characterized by incomplete and atypical forms. There is paucity of literature on KD in children below 6 months and there are no data from any developing country. This study defines the profile of children with KD below 6 months at our centre.
  
  
  METHODS
  During January 1994 to March 2015, 460 children were diagnosed with KD and 17 (3.6%) were below 6 months. Diagnosis was based on American Heart Association (AHA) criteria. All children were treated with intravenous immunoglobulin and aspirin; three also received infliximab.
  
  
  RESULTS
  Mucosal changes were present in 11 patients (64%); extremity changes in 11 (64%); rash in nine (53%); conjunctival injection in eight (47%); and cervical lymphadenopathy in three (17%). Irritability was noted in 15 patients (88%); four (23%) had respiratory symptoms; and two (11%) had bacille Calmette-Guérin scar reactivation. Fifteen (88%) had incomplete KD. Twelve patients were diagnosed beyond day 10 of illness. Thrombocytopenia was seen in four. Coronary artery abnormalities were present in six (35%) patients. Two children died from disease-related complications - one of these had giant coronary artery aneurysms.
  
  
  CONCLUSIONS
  Our data show that incomplete forms of KD are commonly seen in children below 6 months of age, thereby resulting in delayed diagnoses. Pediatricians need to have a high index of suspicion of KD when dealing with a young infant with unexplained fever beyond 5 days. The AHA criteria appear to be inadequate for diagnosing KD in infants below 6 months.
authors.affiliation: Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India. surjitsinghpgi@rediffmail.com, surjitsinghapc@gmail.com.
authors.forename: Surjit
authors.initials: S
authors.lastname: Singh
authors.affiliation: Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India.
authors.forename: Sikha
authors.identifier: http://orcid.org/0000-0002-1388-2933
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India.
authors.forename: Sagar
authors.initials: S
authors.lastname: Bhattad
authors.affiliation: Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India.
authors.forename: Deepti
authors.initials: D
authors.lastname: Suri
authors.affiliation: Allergy Immunology Unit, Advanced Pediatrics Centre, Chandigarh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rawat
authors.affiliation: Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manphool
authors.initials: M
authors.lastname: Singhal
authors.affiliation: Department ofCardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manojkumar
authors.initials: M
authors.lastname: Rohit
mesh_terms: D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D007223:Infant; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069285:Infliximab; D001241:Aspirin
keywords: Chandigarh; India; Kawasaki disease; below 6 months; diagnosis