Persistence of rash or other nonfebrile symptoms for 10 days or longer after resolution of fever in children with Kawasaki disease was associated with a 16-fold increased risk of coronary artery abnormalities in a large retrospective Japanese study.
The study involved 217 children who were hospitalized with Kawasaki disease and treated with intravenous immunoglobulin at the National Center for Child Health and Development in Tokyo from 2008 through the first half of 2010.
Conjunctivitis, body rash, strawberry tongue or lip erythema, and swelling or redness of the extremities were each present in 92%-98% of the children. Cervical lymph node swelling was present in three-quarters of them.
These nonfebrile symptoms persisted for a median of 3 days after resolution of fever. All nonfever symptoms resolved within less than 10 days after fever resolution in 95% of subjects, Dr. Sayaka Fukuda said at the annual meeting of the Pediatric Academic Societies.
Of the 11 children with any nonfebrile symptom persisting for at least 10 days after resolution of fever, 7 (64%) developed coronary artery abnormalities, compared with just 8 of 206 (3.9%) of those whose nonfebrile symptoms all resolved less than 10 days after fever ended, said Dr. Fukuda of the Tokyo center.
She and her coinvestigators next plan to study how best to manage Kawasaki disease patients who are treated with IVIG and then discharged with persistent nonfebrile symptoms.
Dr. Fukuda declared having no financial conflicts.
Additional Resources
Guidelines from the National Institutes of Health:
www.nlm.nih.gov/medlineplus/ency/article/000989.htm
EULAR recommendations for vaccination in paediatric patients with rheumatic diseases:
Ann. Rheum. Dis. 2011 Aug. 3 (doi:10.1136/ard.2011.150193)
American Heart Association Scientific Statement: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young: