The problem of late diagnosis of Kawasaki disease: description of a series of 19 cases
https://doi.org/10.21518/ms2025-038
Abstract
Introduction. Kawasaki disease (KD) is the most common cause of acquired heart disease in children. Diagnosis of CD is based on the clinical manifestations of the disease, however, a number of its features and low awareness of doctors can make diagnosis difficult.
Aim. To study epidemiological indicators, patient routing and clinical and laboratory features of the course of Kawasaki disease in children hospitalized at the City Children’s Hospital No. 1 of Kazan with this diagnosis in the period 2015–2022.
Materials and methods. An empirical description of a patient case series was conducted on a group of 19 children hospitalized with a diagnosis of full-blown CD.
Results and discussion. Late periods of diagnosis were identified (14.4 ± 7.3 days) and administration of intravenous immunoglobulin at a dose of 2 g/kg body weight (16.1 ± 7.9 days, the mode of the indicator was the 13th day), as well as a large percentage detection of coronary anomalies in the study group (68%, n = 13) and residual coronary anomalies at discharge (32%, n = 6). The referral diagnosis was correct only in 21% of cases; most often, the diagnosis of an infectious disease was made at the prehospital stage and in 79% of cases antimicrobial drugs were prescribed. At the prehospital stage, patients were diagnosed with rash syndrome (84%), changes in the oral mucosa (74%) and conjunctivitis (63%). Laboratory abnormalities in all patients before hospitalization were typical for Kawasaki disease: accelerated erythrocyte sedimentation rate (41.4 ± 14.3 mm/ hour), increased C-reactive protein (98.2 ± 47.6 mg/l), leukocytosis (23.0 ± 8.4 x 109/l), decreased hemoglobin (100.0 ± 8.9 g/l) and thrombocytosis (630.6 ± 215.5 x 109/l).
Conclusions. The study included only children with the full form of CD; therefore, the most likely reason for the late diagnosis is the low level of awareness of the disease criteria among non-rheumatological doctors. It is required to conduct educational activities among pediatricians, infectious disease specialists, and general practitioners to increase alertness for the purpose of early diagnosis of CD.
About the Authors
I. Ya. LutfullinRussian Federation
Ildus Ya. Lutfullin - Cand. Sci. (Med.), Associate Professor of the Department of Pediatrics and Neonatology named after Professor E.M. Lepsky, Kazan SMA; Associate Professor of the Department of Propaedeutics of Childhood Diseases and Faculty Pediatrics, Kazan SMU.
36, Butlerov St., Kazan, 420012; 36, Butlerov St., Kazan, 420012; 49, Butlerov St., Kazan, 420012
A. I. Safina
Russian Federation
Asiya I. Safina - Dr. Sci. (Med.), Professor, Honored Doctor of the Republic of Tatarstan, Head Department Pediatrics and Neonatology named after prof. E.M. Lepsky.
36, Butlerov St., Kazan, 420012
M. M. Sadykov
Russian Federation
Marat M. Sadykov - Dr. Sci. (Med.), Associate Professor, Excellence in Healthcare of Russia, Honored Doctor of the Republic of Tatarstan, Professor of the Department of General Hygiene with a course in Radiation Hygiene, Kazan SMU; Chief Physician, City Children’s Hospital No. 1
49, Butlerov St., Kazan, 420012; 125а, Dekabristov St., Kazan, 420034
M. O. Askarova
Russian Federation
Marina O. Askarova - Rheumatologist, Department of Pediatrics No. 1.
125а, Dekabristov St., Kazan, 420034
V. S. Filatov
Russian Federation
Vladimir S. Filatov - Cand. Sci. (Med.), Deputy Minister of Health of the Republic of Tatarstan – Head of the Health Department for the city of Kazan, Department of Health in Kazan.
14, Maxim Gorky St., Kazan, 420015
O. V. Sharipova
Russian Federation
Olga V. Sharipova - Deputy Chief Physician for Medical Affairs.
125а, Dekabristov St., Kazan, 420034
K. A. Makarova
Russian Federation
Ksenia A. Makarova - Rheumatologist, Head of Pediatrics Department No. 1.
125а, Dekabristov St., Kazan, 420034
S. Yu. Yumasheva
Russian Federation
Svetlana Yu. Yumasheva - Rheumatologist, Department of Pediatrics No. 1.
125а, Dekabristov St., Kazan, 420034
E. A. Kuzmina
Russian Federation
Elena A. Kuzmina - Deputy Chief Physician for Organizational and Methodological Work.
125а, Dekabristov St., Kazan, 420034
E. I. Udachina
Russian Federation
Elina I. Udachina - Cand. Sci. (Med.), Head of the Admissions Department.
125а, Dekabristov St., Kazan, 420034
M. A. Daminova
Russian Federation
Maria A. Daminova - Cand. Sci. (Med.), Associate Professor of the Department Pediatrics and Neonatology named after prof. E.M. Lepsky, Kazan SMA; Associate Professor of the Department of Laboratory Diagnostics with a course in Pediatrics, Institute of Fundamental Medicine and Biology, KFU.
36, Butlerov St., Kazan, 420012; 18, Bldg. 1, Kremlevskaya St., Kazan, 420008
E. L. Rashitova
Russian Federation
Elina L. Rashitova - Resident Hematologist.
1, Samora Mashel St., Moscow, 117198
M. M. Kostik
Russian Federation
Mikhail M. Kostik - Dr. Sci. (Med.), Professor of the Department of Hospital Pediatrics, Pediatric Rheumatologist.
2, Lithuanian St., St Petersburg, 194100
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Review
For citations:
Lutfullin IY, Safina AI, Sadykov MM, Askarova MO, Filatov VS, Sharipova OV, Makarova KA, Yumasheva SY, Kuzmina EA, Udachina EI, Daminova MA, Rashitova EL, Kostik MM. The problem of late diagnosis of Kawasaki disease: description of a series of 19 cases. Meditsinskiy sovet = Medical Council. 2025;(1):238-245. (In Russ.) https://doi.org/10.21518/ms2025-038