# Early Diagnosis and Cardiac Complications of Kawasaki Disease in a Resource-Limited Regional Hospital

## TL;DR

This study examines the early diagnosis and treatment of Kawasaki disease in a regional hospital, showing prompt care reduced cardiac complications.

## Contribution

The study provides insights into managing Kawasaki disease in resource-limited settings with timely IVIG treatment.

## Key findings

- Prompt IVIG treatment reduced coronary artery aneurysm risk from 25% to 3%.
- Early diagnosis and treatment were achieved despite hospital limitations.
- CRP levels significantly decreased after IVIG administration.

## Abstract

Introduction

Kawasaki disease (KD) is a type of vasculitis that mainly affects young children and is treated effectively with intravenous immunoglobulin (IVIG) when given promptly. Coronary artery aneurysm (CAA) is the most significant complication, occurring in 25% of untreated cases. However, this risk drops to 3% with IVIG treatment. This study aims to describe the clinical characteristics and cardiac complications of children diagnosed with KD at Al Rustaq Hospital (ARH).

Methods

A retrospective study was conducted on children under 13 years of age diagnosed with KD between January 1, 2010 and December 31, 2023. Data were retrieved from the hospital’s electronic records using the ICD-10 diagnostic code and cross-checked with pharmacy records of IVIG administration. Anthropometric, clinical, radiological, and biochemical data were collected and analyzed.

Results

Fifty children were identified, including 27 males (54.0%). The median age at presentation was 24 months (IQR: 14-43), and the median duration of fever was four days (IQR: 3-6). Diagnosis and initiation of IVIG treatment occurred at a median of two days (IQR: 1-3). Eight children (16.0%) were resistant to the first dose of IVIG. No significant differences were found between IVIG-resistant and IVIG-responsive groups in terms of age at diagnosis, fever duration, timing of IVIG administration, CRP, serum albumin, or alanine aminotransferase levels. The median CRP level significantly decreased from 143.3 mg/L before IVIG to 62.4 mg/L after treatment (p < 0.001). Six children (12.0%) had CAA on initial echocardiography, with only three (6.0%) showing persistent CAA on follow-up echocardiography eight weeks later. No significant associations were observed between CAA development and age at diagnosis, fever duration, CRP levels, albumin levels, or timing of IVIG administration.

Conclusions

KD is rarely encountered in regional hospital settings. Nonetheless, patients at ARH presented early, and diagnosis and treatment were initiated promptly despite the limitations of a secondary care facility. This early recognition and rapid management likely contributed to reducing long-term cardiac complications in children with KD.