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 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.