Diagnosis of incomplete kawasaki disease in infants based on an inflammation at the bacille calmette-guérin inoculation site

Abstract

Background and objectives: This study was intended to test how the inflammation at the Bacille Calmette-Guérin (BCG) inoculation site (BCGitis) can be a useful a diagnostic feature of Kawasaki disease (KD).

Subjects and methods: All subjects were infants at the time of admission, and had received BCG vaccination during their neonatal period. There were 54 patients with complete KD (group 1) and 29 patients with incomplete KD (group 2). All 83 patients had BCGitis during the acute phase of illness. Data regarding the coronary artery diameters in 31 age-matched controls were used for comparison.

Results: The 2 patient groups did not differ in clinical and laboratory variables. During the acute phase, the median z scores of the left anterior descending coronary artery (LAD) diameter were 0.20, 0.42, and -0.48 in groups 1, 2, and control respectively, and that of right coronary artery (RCA) diameters were -0.15, -0.16, and -1.17 respectively. The z scores in both patient groups were greater than those in controls (p=0.0014 in LAD and p<0.0001 in RCA between group 1 and controls; p=0.0023 in LAD and p<0.0001 in RCA between group 2 and controls). A similar pattern was observed during the subacute and convalescent phases.

Conclusion: BCGitis is a useful feature in the diagnosis of incomplete KD in infants who received BCG vaccine during neonatal period.

Keywords: Coronary vesseles; Mucocutaneous Lymph Node Syndrome.

Fig. 1

Z-scores of the diameters of coronary arteries (left main coronary artery in A, left anterior descending artery in B, and right coronary artery in C) during 3 phases of illness. ^*p<0.05, complete presentation group vs. incomplete presentation group, ^†p<0.05, complete presentation group vs. controls, ^‡p<0.05, incomplete presentation group vs. controls.

Fig. 2

Flow diagram of the application of the American Heart Asscociation (AHA) algorithm in patients with incomplete Kawasaki disease (KD). CRP: Creactive protein, ESR: erythrocyte sedimentation rate, Echo: echocardiography, OR: odds ratio.