Characteristics of Kawasaki disease in older children.

OBJECTIVES: To evaluate characteristics of Kawasaki disease(KD) in older children in comparison with younger patients with the disease, and to improve the knowledge of clinicians on KD in older children.

METHODOLOGY: All children with a discharge diagnosis of KD at Wuhan Union Hospital from January, 2004 to May, 2010 were retrospectively reviewed.

RESULTS: A total of 113 patients were included in this study; 20 patients (17.7%) were ≥5 years old at the time of illness and 93 patients (82.3%) were <5 years old. The older children seemed to have longer total fever duration, pre-IVIG and post-IVIG fever duration than the younger children. The individual clinical criteria appeared later in the course of KD in older children than in the younger ones except cervical lymphadenopathy. The older age group had a higher incidence of cervical lymphadenopathy in comparison with the younger group (85.0% vs 51.6%). ESR was quite different between the older and younger groups (85.92 vs 67.27). Overall the older age group had a higher prevalence of additional IVIG treatment and coronary artery abnormalities (60.0% vs 32.2%) versus the younger age group.

CONCLUSION: For some reasons, KD in older children was difficult in early diagnosis and treatment. Also, older children may have a more marked inflammatory response and those treated with IVIG were more likely to require repeated IVIG treatment. And probably because of all these, older patients with KD had a higher prevalence of coronary artery abnormalities than the younger patients.