Pediatric Rheumatology Online Journal → July 2003 → Vasculitides → Kawasaki Disease → Abstract #137

KAWASAKI DISEASE IN INDIA

R. P. Khubchandani,¹ S. C. D'Souza.²

Pediatrics, Jaslok Hospital and Research Center, Mumbai, Maharashtra, India; ²Pediatrics, Breach Candy Hospital and Research Center, Mumbai, Maharashtra, India

Objectives: Despite a high Asian incidence of Kawasaki disease (KD), there is a paucity of reports from India. We report the first series of 6 children from Bombay and review Indian literature (PUBMED search), highlighting certain problems and unique features.
Case reports and review: Between March-October 2002, we diagnosed 6 children with KD using established clinical criteria.1 child aged 5 years with incomplete KD (cervical nodes, edema palms/soles and subsequent desquamation) presented initially with a febrile diarrheal illness and bilateral hemorrhagic pleural effusion. All our patients responded in 24 hours to standard IVIG (2 gms/kg) and aspirin therapy. Follow up Echocardiography at 6- 8 weeks was normal in all 6 patients.
OUR SERIES/COLLECTED INDIAN REPORTS TO DATE
Number of cases 6 / 33
Age range 3-6 years / 3 months-10 years
Male: Female 5:1 / 29:2 (2 not specified)
Incomplete cases 1 / 3
IVIG 6/24*
ECHO abnormalities 1** / 4***
Time to diagnosis (days) 6-14 / 7-77 (specified in 8 cases)
* 2 patients received 2gm/kg, remaining received divided doses in modified regimens
**Mitral regurgitation
***1- pericardial effusion with peripheral arterial and coronary aneurysms
3- coronary artery aneurysms

Conclusions: A mere 39 cases from the world's largest populace suggests underdiagnosis and consequent underreporting.
Lack of physician awareness and doctor hopping are major reasons for delayed diagnosis and therefore delayed therapy. Physicians unsensitized to KD are faced with the decision of prescribing the exorbitantly priced and scarce IVIG, often after the disease is beyond the tenth day.
Reactivation of the BCG scar is an unusual but impressive sign in younger patients. It should be sought in areas where universal BCG vaccination still prevails.
Recommendations: There is a need to heighten physician/ patient awareness about this condition. We have successfully initiated the formulation of a KD interest group as an activity of the local pediatric association with effect from January 2003 to disseminate awareness and encourage reporting to a registry.