exudates and Mucocutaneous-Lymph-Node-Syndrome

Data on the delayed diagnosis of (KD) is limited. This study aimed to determine the prevalence and trend of delayed diagnosis over time and identify the associated risk factors in Malaysia.. This retrospective, observational, population-based study involved all children with KD registered in Johor Kawasaki Clinical Registry over 10 years (January 2010 and December 2019). The prevalence of delayed diagnosis and its trend over time was calculated. Multivariable binary logistic regression was used to identify the independent risk factors for delayed diagnosis.. There were 556 cases of KD, with 28% having incomplete criteria, 11% atypical presentation, while 10% developed a coronary aneurysm. The overall prevalence of delayed diagnosis was 9.9% (95% confidence interval (CI): 7.6-12.7%). There was a statistically significant decrease in delayed diagnosis over time (P = 0.008), with the latest rate of 4.6%. The majority of delayed diagnoses were due to failure to diagnose the disease during the initial consultation. Independent risk factors for delayed diagnosis were children older than 1 year, diagnosis before 2015, atypical presentation, and incomplete KD, with adjusted odds ratios (ORs) of 2.7, 2.3, 4.3, and 3.6, respectively. Compared to early diagnosis of KD, delayed diagnosis was significantly associated with coronary aneurysms (27.3% vs. 8.2%, P < 0.001, OR 4.2, [95% CI: 2.1-8.3]).. One-tenth of cases of KD were diagnosed late, but it has improved over time. Children > 1 year, presenting with atypical presentation, and incomplete criteria are associated with late diagnosis.

Topics: Child; Child, Preschool; Coronary Aneurysm; Delayed Diagnosis; Humans; Immunoglobulins, Intravenous; Infant; Malaysia; Mucocutaneous Lymph Node Syndrome; Retrospective Studies

Topics: Aspirin; Diagnosis, Differential; Humans; Immunoglobulins, Intravenous; Infant; Malaysia; Mucocutaneous Lymph Node Syndrome; Retrospective Studies

Data on Kawasaki disease from tropical countries are scarce. Hence, this population-based study aims to determine the epidemiology, clinical characteristics, and outcome of Kawasaki disease in children enrolled in the Kawasaki disease registry between 2006 and 2019 in Southern Malaysia. Diagnosis of Kawasaki disease was made using standard criteria. Primary outcome measure was a coronary artery aneurysm. Multivariable logistic regression was used to analyze the associated risk factors for coronary artery aneurysm. There were 661 Kawasaki disease, with 27% incomplete and 11% atypical presentations. Male-to-female ratio was 2:1, and median age of diagnosis was 1.4 years (interquartile range 9 to 32 months). Incidence in children of less than 5 years was 14.8 (95% confidence interval [CI]: 13.6 to 16.0) per 100,000 population, higher in males (19/100,000) and Chinese (22/100,000), with a gradual increase from 5.7/100,000 in 2006 to 19.6/100,000 in 2019, p < 0.001. Incidence in children between 5 and 9 years old was 1.3 (95% CI: 0.9 to 1.6) per 100,000 population and remained stable over time. There was a seasonal pattern with peak incidence during the rainy season. Out of 625 intravenous immunoglobulins (IVIG)-treated Kawasaki disease, 7.4% were resistant, and 9% had coronary artery aneurysms. Atypical presentation, male sex, late diagnosis, and IVIG resistance were independent risk factors for coronary artery aneurysms.Conclusions: Despite the tropical climate, Kawasaki disease epidemiology is similar to non-tropic regions with seasonal patterns and a rising incidence. Atypical presentation, male sex, late diagnosis, and IVIG resistance were significantly associated with coronary artery aneurysms. What is Known: • Kawasaki disease predominantly occurs in males, children less than 5 years old, and the Asian population. • Male sex, late diagnosis, incomplete Kawasaki disease, and IVIG resistance were associated with coronary artery aneurysms. What is New: • In multi-ethnic Asian countries such as Malaysia, ethnic Chinese have a higher prevalence of Kawasaki disease compared to other ethnicities. • Kawasaki disease with atypical presentation can occur in both complete and incomplete Kawasaki disease and is significantly associated with a coronary artery aneurysm.

Topics: Asia; Child; Child, Preschool; Coronary Aneurysm; Female; Humans; Immunoglobulins, Intravenous; Infant; Malaysia; Male; Mucocutaneous Lymph Node Syndrome; Retrospective Studies

Kawasaki disease is an autoimmune disease that commonly affects children below the age of 5 years. It is a vasculitic disease of unknown aetiology effecting the skin, eyes, lymph nodes and mucosal layer. Intravenous Immunoglobulin (IVIG) and aspirin therapy are the mainstay treatment however a number of cases have been shown to be refractory to this treatment. Evidence regarding approach and treatment for such cases is limited. This case report is to share our experience in the management of Refractive Kawasaki disease at a district level.

Topics: Anti-Inflammatory Agents; Humans; Immunoglobulins, Intravenous; Infant; Malaysia; Male; Methylprednisolone; Mucocutaneous Lymph Node Syndrome

We report seven cases of Kawasaki disease (KD) who were admitted to Hospital University Sains Malaysia over a period of 8 years. The average age at the time of admission was 29.4 months and four of the children were boys. Five children had all six criteria for diagnosis. Ileus was present in three, and hydrops of the gall bladder and pneumonia in two each, but coronary artery dilatation was seen in only one patient. We also review all the cases of KD reported so far from Malaysia and compare the epidemiological data, clinical course and laboratory findings of the Malaysian patients with those from other parts of the world. The epidemiological and clinical features of Malaysians with KD differ from those seen in Singapore and Japan, but are similar to those seen in Thailand, Australia and North America. The incidence of cardiac complications is low in Malaysians.

Topics: Anti-Bacterial Agents; Aspirin; Cardiovascular Diseases; Child; Child, Preschool; Drug Therapy, Combination; Echocardiography; Female; Hospitalization; Humans; Infant; Malaysia; Male; Mucocutaneous Lymph Node Syndrome; Skin Diseases

Topics: Child; Child, Preschool; Female; Humans; Infant; Malaysia; Male; Mucocutaneous Lymph Node Syndrome; Retrospective Studies