Contemporary Diagnosis, Management, and Early Outcomes in Children with Kawasaki Disease in Romania: A Single-Center Experience

Abstract

Background: Kawasaki disease (KD) is an acute inflammatory vasculitis with a particularly high incidence of coronary artery complications and constitutes a significant cause of acquired heart disease in children and young adults. Methods: We conducted a retrospective analysis of consecutive patients aged 0-18 years hospitalized at the "Prof. Dr. Matei Balş" National Institute of Infectious Diseases in Bucharest with Kawasaki disease over a period of 6 years (2018-2023). Results: A total of 25 children were discharged from hospital with this diagnosis during the analyzed period. The mean age was 2.9 years, and 56% were boys. Fever ≥5 days was present in all cases, and the most frequent additional sign was the presence of oral changes. Patients were treated according to in-effect guidelines with intravenous immunoglobulin (IVIG) (100%) and acetylsalicylic acid (68%). Only two cases were considered IVIG resistant and received a second IVIG infusion. Only mild cardiovascular changes were noted in echocardiography: mild coronary artery dilatation (21.7% of cases), mild valvular regurgitation, and small pericardial effusion. Infants displayed less inflammation and higher percentages of leukocytosis, developed an increase in platelet count sooner, received IVIG faster, and had longer hospital stays. Outcomes were generally favorable, and 92% of children were discharged, while the two remaining patients were transferred to other centers. No deaths were recorded. Conclusions: To our knowledge, this is the largest contemporary Romanian cohort of Kawasaki disease published to date, outlining the local diagnostic process, therapeutic strategies, and early outcomes of Kawasaki disease.

Keywords: IVIG; Kawasaki; Romania; aspirin; coronary artery lesions; echocardiography; prolonged fever.

Figure 1

Seasonality of Kawasaki disease showing a peak during cold months.

Figure 2

Frequency of main clinical features in KD cases, n = 25.

Figure 3

Evaluation of prolonged febrile illness. Values expressed as percent of cases tested and diagnostic yield (percent of positives from number of tests). * Viruses: adenovirus; coronavirus 229; coronavirus HKU1; coronavirus NL63; coronavirus OC43; MERS-CoV; SARS-CoV-2; human metapneumovirus; human rhinovirus/enterovirus; influenza A and B; parainfluenza virus 1, 2, 3, and 4; respiratory syncytial virus. Bacteria: Bordetella parapertussis (IS1001), Bordetella pertussis (ptxP), Chlamydia pneumoniae, Mycoplasma pneumoniae. ** Cytomegalovirus IgM, IgG; Epstein–Barr IgM; adenovirus IgM, Coxsackie virus IgM; urlian IgM; echovirus IgM; herpes simplex virus 1 + 2 IgM, HIV 1 + 2; parvo B19 virus IgM; morbillivirus IgM, IgG; rubella IgM, IgG; SARS-CoV-2. *** IL-1, IL-6, PAI-1, and TNF-alpha.

Figure 4

Main cardiovascular changes.