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In response to your editorial(1) we present our observations on 26
children diagnosed with typical Kawasaki Syndrome (KS) conforming to
American Heart Association criteria in a coastal district of South
India between 1999 and 2006. All were referred, 30% (3/10) with
probable diagnosis of KS before 2004 and 62.5% (10/16) thereafter.
Mean age in years at presentation was 5 till 2004 and 3.5 thereafter
with equal sex ratio contrary to male predominance reported worldwide.
Though all children presented with fever, mean duration of fever prior
to referral were 8 and 6.5 days respectively in the two time frames.
Unilateral cervical lymphadenopathy was seen in 92%; nonpurulent
conjunctivitis and skin rash in 88%; oral mucosal changes in 85%. Of
the 81% with desquamation, 71% developed periungual and perianal
desquamation within 10 days of illness, similar to reported
observations(1). Arthralgia was present in 42%. Cardiac complications
were seen in 23% which included coronary artery dilatation in 3,
coronary artery aneurysm in 2 all of which regressed in the follow-up,
and congestive cardiac failure in 1 with unresolved mitral and
tricuspid regurgitation in the five year follow-up. Elevated ESR and
positive CRP were observed in 96% and 88% respectively. Thrombocytosis
was seen within 10 days in 73%. Intravenous immunoglobulin given to
73% of children was well tolerated with one requiring two doses of 2
g/kg. All received high dose aspirin during the acute phase followed
by low dose of 3-5 mg/kg/day for six weeks. There was no mortality.
On analysis of Indian case series totaling five or
more(1,2), there seems to be a concentration of cases in coastal
cities numbering to 206 (73%), against 75 from rest of India. The
highest incidence of KS from United States is from Hawaii and within
the continent from West Coast(3). Japan, Taiwan and Hong Kong account
for most cases of KS in Asia. In contrast, Great Britain and Australia
have very low incidence(4). A Washington study(5) in response to three
outbreaks of KS in close residential proximity to water bodies
recommends further studies exploring the relation of Kawasaki disease
occurring more in proximity to sea-shore!
Nutan Kamath,
Rathika Shenoy,
Department of Pediatrics,
Kasturba Medical College,
Mangalore, Karnataka, India.
E -mail: [email protected]
1. Kushner HI, Macnee R, Burns JC. Impressions of
Kawasaki syndrome in India. Indian Pediatr 2006; 43: 939-941.
2. Khubchandani RP, Chetna K. Kawasaki disease
registries reap results experience in Mumbai. Indian J Pediatr 2006;
73: 545-546.
3. Holman RC, Curns AT, Belay AD, Steiner CA,
Schonberger LB. Kawasaki syndrome hospitalizations in the United
States, 1997 and 2000. Pediatrics 2003; 112: 495-501.
4. Ng YM, Sung RYT, So LY, Fong NC, Ho MHK, Cheng
YW, et al. Kawasaki disease in Hong Kong 1994 to 2000. Hong
Kong Med J 2005; 11: 331-335.
5. Davis RL, Waller PL, Mueller BA, Dykewicz CA, Schonberger LB.
Kawasaki syndrome in Washington State: Race-specific incidence rates
and residential proximity to water. Arch Pediatr Adolesc Med 1995;
149: 66-69.
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