The problem of late diagnosis of Kawasaki disease: description of a series of 19 cases

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 10 9 /l), decreased hemoglobin (100.0 ± 8.9 g/l) and thrombocytosis (630.6 ± 215.5 x 10 9 /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.