Kawasaki disease in Australia, 1993-95

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Abstract
AIM To describe the epidemiology, management, and rate of cardiac sequelae of Kawasaki disease in Australia. DESIGN Cases were notified to the Australian Paediatric Surveillance Unit, an active national surveillance scheme, from May 1993 to June 1995. RESULTS 139 cases of Kawasaki disease were confirmed. In 1994, the annual incidence was 3.7/100 000 children < 5 years old. Sixteen children were not admitted to hospital. Coronary artery abnormalities were reported in 35 (25%) children. Two patients were diagnosed at postmortem examination. Sixty six per cent of patients were diagnosed within 10 days of onset and 81% of these received intravenous gammaglobulin within 10 days. Forty five of the notified children did not fulfil the study criteria because of streptococcal infection or insufficient clinical criteria. One child with streptococcal infection had coronary artery dilatation. CONCLUSION Diagnosis of Kawasaki disease was delayed beyond 10 days in one third of patients, and almost 20% of children who could have received gammaglobulin within 10 days did not. The distinction between Kawasaki disease, streptococcal infection, and other possible diagnoses is problematic in some children. A substantial proportion of children with Kawasaki disease does not receive intravenous gammaglobulin within 10 days of symptom onset Treatment should be given on clinical grounds regardless of the results of streptococcal throat cultures and serology More research is needed to clarify the significance of the type, timing, and prognosis of the echocardiographic coronary artery abnormalities seen in Kawasaki disease Until diagnostic tests are available for Kawasaki disease, the challenge is to encourage early diagnosis and management without promoting inappropiate use of treatments