Kawasaki disease and Henoch Schonlein purpura: changing trends at a tertiary care hospital in north India (1993-2008)

Abstract

The objective of the study was to evaluate the epidemiologic trends (1993-2008) in Kawasaki disease (KD) and Henoch Schonlein purpura (HSP) among children as seen in a tertiary care north Indian hospital. A hospital-based retrospective chart analysis of all the patients diagnosed with KD and HSP in our pediatric rheumatology clinic from January 1993 to December 2008 was performed. The diagnosis of KD and HSP was based on the American Heart Association and American College of Rheumatology criteria respectively. The collected data were analyzed for any yearly or seasonal trends in the incidence of the two diseases. KD was diagnosed in 196 patients (135 males, 61 females, ratio 2.21:1), while HSP was diagnosed in 209 patients (155 males, 54 females, ratio 2.87:1). The median age at the time of diagnosis was 5.1 +/- 3.04 years (range 4 months-14 years) for KD and 6.9 +/- 2.98 years (range 1-17 years) for HSP. Over this 16-year period, the number of patients diagnosed with KD progressively increased from 1993 to 2008 (p < 0.001, chi-square test) with a clear majority of these (162 cases, 82.6%) being diagnosed in the last 8 years. The number of children diagnosed with HSP progressively increased from 1993 to 1997, after which it has remained relatively uniform, and only 93 cases (44.5%) were diagnosed in the last 8-year period (p > 0.05, chi-square test). However, both the diseases exhibited a comparable seasonal trend in the distribution with a noticeable peak being discernible in the months of October and November. KD has shown a rising trend over the recent years in our hospital. Since 2004; the annual number of KD cases has outnumbered the HSP cases. Seasonal predilection is noticeable for both conditions. This is the first hospital-based report on epidemiological trends of KD and HSP from a developing country.