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Characteristics and trends in diagnosis of Kawasaki disease outside the usual age range

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Abstract

Objective

To explore the trends in diagnosis of Kawasaki disease (KD) and determine the characteristics for patients outside the usual age range of 6 months to 4 years.

Method

A retrospective review of patients with KD identified in four epidemiological surveys spanning 20 years (1998–2017) in Shanghai was performed.

Results

A total of 8416 patients were included. All in all, 223 (2.6%) were aged 0 to 2 months, 639 (7.6%) were 3 to 5 months, 6556 (77.9%) were 6 months to 4 years, 915 (10.9%) were 5 to 9 years, and 83 (1.0%) were ≥ 10 years. The use of intravenous immunoglobulin increased in all extreme age groups, and delayed treatment rates decreased in all patients except in those aged 0 to 2 months and ≥ 10 years. The number of patients outside the usual age increased over time, but the proportion of these patients did not change significantly. They had more incomplete KD and coronary artery aneurysms (CAA), while those aged 0 to 2 months and ≥ 10 years had more delayed diagnoses in their respective age groups. The incidence of CAA was similar in younger and older children, but the former group had more cases of incomplete KD and abnormal laboratory parameters, while the latter group had longer duration of fever and was more difficult to diagnose promptly.

Conclusions

The proportion of KD outside the usual age range did not increase over time. Older and younger children have different clinical and laboratory characteristics.

Key Points

• The number of patients outside the usual age increased over time, but the proportion of these patients did not increase.

• Patients aged 0 to 2 months and ≥ 10 years had more delayed diagnoses in their respective age groups.

• Younger children had more cases of incomplete KD and abnormal laboratory parameters, while older children had longer duration of fever and were more difficult to diagnose promptly.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Lee KY, Hong JH, Han JW, Lee JS, Lee BC, Burgner D (2006) Features of Kawasaki disease at the extremes of age. J Paediatr Child Health 42(7–8):423–427. https://doi.org/10.1111/j.1440-1754.2006.00898.x

    Article  PubMed  Google Scholar 

  2. Rosario JM, Patel F, Levasseur K, Adams L (2019) Kawasaki at the extremes of age: thinking outside the box. Pediatr Emerg Care 35(12):e229–e231. https://doi.org/10.1097/PEC.0000000000001991

    Article  PubMed  Google Scholar 

  3. Minich LL, Sleeper LA, Atz AM, McCrindle BW, Lu M, Colan SD, Printz BF, Klein GL, Sundel RP, Takahashi M, Li JS, Vetter VL, Newburger JW, Pediatric Heart Network I (2007) Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics 120(6):e1434–e1440. https://doi.org/10.1542/peds.2007-0815

    Article  PubMed  Google Scholar 

  4. Pannaraj PS, Turner CL, Bastian JF, Burns JC (2004) Failure to diagnose Kawasaki disease at the extremes of the pediatric age range. Pediatr Infect Dis J 23(8):789–791. https://doi.org/10.1097/01.inf.0000134312.39744.a4

    Article  PubMed  Google Scholar 

  5. Li W, Zhang L, Huang P, Zhang Z (2019) Clinical features and mid-term follow-up in infants younger than 3 months with Kawasaki disease in a Chinese population. J Paediatr Child Health 55(5):523–527. https://doi.org/10.1111/jpc.14233

    Article  PubMed  Google Scholar 

  6. Grasa CD, Fernandez-Cooke E, Sanchez-Manubens J, Anton J, Crespo D, Garcia M, Lopez A, Lirola Cruz MJ, de la Diaz-Delgado Pena R, Calvo C, Spanish network for the study of Kawasaki disease K-R (2019) Kawasaki disease in infants 3 months of age and younger: a multicentre Spanish study. Ann Rheum Dis 78(2):289–290. https://doi.org/10.1136/annrheumdis-2018-213891

    Article  PubMed  Google Scholar 

  7. Satoh K, Wakejima Y, Gau M, Kiguchi T, Matsuda N, Takasawa R, Takasawa K, Nishioka M, Shimohira M (2018) Risk of coronary artery lesions in young infants with Kawasaki disease: need for a new diagnostic method. Int J Rheum Dis 21(3):746–754. https://doi.org/10.1111/1756-185X.13223

    Article  CAS  PubMed  Google Scholar 

  8. Yoon YM, Yun HW, Kim SH (2016) Clinical characteristics of Kawasaki disease in infants younger than six months: a single-center study. Korean Circ J 46(4):550–555. https://doi.org/10.4070/kcj.2016.46.4.550

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee EJ, Park YW, Hong YM, Lee JS, Han JW (2012) Epidemiology of Kawasaki disease in infants 3 months of age and younger. Korean Circ J 55(6):202–205. https://doi.org/10.3345/kjp.2012.55.6.202

    Article  Google Scholar 

  10. Chuang CH, Hsiao MH, Chiu CH, Huang YC, Lin TY (2006) Kawasaki disease in infants three months of age or younger. J Microbiol Immunol Infect 39(5):387–391

    PubMed  Google Scholar 

  11. Cai Z, Zuo R, Liu Y (2011) Characteristics of Kawasaki disease in older children. Clin Pediatr 50(10):952–956. https://doi.org/10.1177/0009922811409027

    Article  Google Scholar 

  12. Stockheim JA, Innocentini N, Shulman ST (2000) Kawasaki disease in older children and adolescents. J Pediatr 137(2):250–252. https://doi.org/10.1067/mpd.2000.105150

    Article  CAS  PubMed  Google Scholar 

  13. Momenah T, Sanatani S, Potts J, Sandor GG, Human DG, Patterson MW (1998) Kawasaki disease in the older child. Pediatrics 102(1):e7. https://doi.org/10.1542/peds.102.1.e7

    Article  CAS  PubMed  Google Scholar 

  14. Manlhiot C, Yeung RS, Clarizia NA, Chahal N, McCrindle BW (2009) Kawasaki disease at the extremes of the age spectrum. Pediatrics 124(3):e410–e415. https://doi.org/10.1542/peds.2009-0099

    Article  PubMed  Google Scholar 

  15. Kim SH, Kim KH, Kim DS (2009) Clinical characteristics of Kawasaki disease according to age at diagnosis. Indian Pediatr 46(7):585–590

    PubMed  Google Scholar 

  16. Xie LP, Yan WL, Huang M, Huang MR, Chen S, Huang GY, Liu F (2019) Epidemiologic features of Kawasaki disease in Shanghai from 2013 through 2017. J Epidemiol. https://doi.org/10.2188/jea.JE20190065

  17. Chen JJ, Ma XJ, Liu F, Yan WL, Huang MR, Huang M, Huang GY, Shanghai Kawasaki Disease Research G (2016) Epidemiologic features of Kawasaki disease in Shanghai from 2008 through 2012. Pediatr Infect Dis J 35(1):7–12. https://doi.org/10.1097/INF.0000000000000914

    Article  CAS  PubMed  Google Scholar 

  18. Ma XJ, Yu CY, Huang M, Chen SB, Huang MR, Huang GY, Shanghai Kawasaki Research G (2010) Epidemiologic features of Kawasaki disease in Shanghai from 2003 through 2007. Chin Med J 123(19):2629–2634

    PubMed  Google Scholar 

  19. Huang GY, Ma XJ, Huang M, Chen SB, Huang MR, Gui YH, Ning SB, Zhang TH, Du ZD, Yanagawa H, Kawasaki T (2006) Epidemiologic pictures of Kawasaki disease in Shanghai from 1998 through 2002. J Epidemiol 16(1):9–14. https://doi.org/10.2188/jea.16.9

    Article  PubMed  Google Scholar 

  20. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E, American Heart Association Rheumatic Fever E, Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Y, Council on C, Stroke N, Council on Cardiovascular S, Anesthesia, Council on E (2017) Prevention, diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 135(17):e927–e999. https://doi.org/10.1161/CIR.0000000000000484

    Article  PubMed  Google Scholar 

  21. Makino N, Nakamura Y, Yashiro M, Kosami K, Matsubara Y, Ae R, Aoyama Y, Yanagawa H (2019) Nationwide epidemiologic survey of Kawasaki disease in Japan, 2015-2016. Pediatr Int 61(4):397–403. https://doi.org/10.1111/ped.13809

    Article  PubMed  Google Scholar 

  22. Rowley AH, Shulman ST (2018) The epidemiology and pathogenesis of Kawasaki disease. Front Pediatr 6:374. https://doi.org/10.3389/fped.2018.00374

    Article  PubMed  PubMed Central  Google Scholar 

  23. Uehara R, Belay ED (2012) Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol 22(2):79–85. https://doi.org/10.2188/jea.je20110131

    Article  PubMed  PubMed Central  Google Scholar 

  24. Singh S, Vignesh P, Burgner D (2015) The epidemiology of Kawasaki disease: a global update. Arch Dis Child 100(11):1084–1088. https://doi.org/10.1136/archdischild-2014-307536

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to express our sincere gratitude to all of the hospitals and investigators involved in this work, including the Children’s Hospital of Fudan University (Guo-ying Huang, Qu-ming Zhao, Fang Liu, Wei-li Yan, Xiao-jing Ma, and Li-ping Xie), the Children’s Hospital of Shanghai Jiao Tong University (Min Huang, Ting-ting Xiao, Li-jian Xie, Wei Liu, and Xun-wei Jiang), Shanghai Children’s Medical Center (Mei-rong Huang, Shubao Chen, Ying Guo, and Xin-yi Xu), Xinhua Hospital of Shanghai Jiao Tong University (Sun Chen, Jia Shen, and Hui-ying Wang), Ruijin Hospital (Zhi-ya Dong and Cai-ping Zhang), the first People’s Hospital of Shanghai (Jian-guo Hong and Xiao-jian Zhou), the sixth People’s Hospital of Shanghai (Fen Liu, Liang-xia Wu, and Fu-juan Wang), the fifth People’s Hospital of Shanghai (Xiao-ming Wang and Fei Wang), Changhai Hospital (Shi-yan Cao), Shanghai Tongji Hospital (Xiao-xun Zhou), Shanghai tenth People’s Hospital (Li Gu and Yan-jie Chen), Renji Hospital (Yu Zhao), Jinshan Hospital of Fudan University (Ye Chen), Shanghai Jiangwan Hospital (Yu Chen), Shanghai Putuo District Center Hospital (Yu Xie), and American-Sino Women’s and Children’s Hospital (Guo-liang Teng and Ming-jun Zhang). In addition, the authors appreciate greatly the kind help from Conway Niu for preparing the manuscript.

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Funding

Innovation Unit of Chinese Academy of Medical Science (2018RU002).

Author information

Authors and Affiliations

  1. Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, China

    Qu-ming Zhao, Fang Liu & Guo-ying Huang

  2. Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China

    Min Huang

  3. Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Mei-rong Huang

  4. Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Sun Chen

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  1. Qu-ming Zhao
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  2. Min Huang
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  4. Sun Chen
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  5. Fang Liu
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  6. Guo-ying Huang
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Consortia

on behalf of the Shanghai Kawasaki Disease Research Group

Contributions

Drs. Huang GY and Liu F conceptualized and designed the study and finalized the manuscript. Dr. Zhao QM undertook data management and data analysis, and drafted the report. Drs. Ma XJ, Huang M, Huang MR, and Chen S critically reviewed and revised the manuscript and contributed important intellectual content. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Fang Liu or Guo-ying Huang.

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Ethical approval

The retrospective studies have been approved by the ethics committee in our hospital and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Zhao, Qm., Huang, M., Huang, Mr. et al. Characteristics and trends in diagnosis of Kawasaki disease outside the usual age range. Clin Rheumatol 40, 1515–1523 (2021). https://doi.org/10.1007/s10067-020-05361-4

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