Kawasaki-sjúkdómur á Íslandi 1996-2005, faraldsfræði og fylgikvillar

Abstract

OBJECTIVE: To analyze the epidemiology of Kawasaki disease in Icelandic children and its complications. METHODS: A retrospective analysis of all cases of Kawasaki disease and atypical Kawasaki disease in children in Iceland from 1996-2005. Chart records were reviewed and children diagnosed at Landspítali - University Hospital invited for a Follow up study with emphasis on heart complications. RESULTS: Thirty children were diagnosed with Kawasaki disease, annual incidence was 10.7/100.000 children <5 years of age. The boy:girl ratio was 2.3:1. All 30 children were treated with IVIG, without any major adverse events related to the treatment. The median time from the initial symptoms to treatment was six days (range 3-31 days). There was no mortality. Two children developed coronary aneurysms and three coronary ectasia. Follow up echocardiography was preformed in 23 of the children four to twelve years after Kawasaki disease. Two of the children still had coronary ectasia, and six (26%) had mitral regurgitation. CONCLUSIONS: The incidence of Kawasaki disease in Iceland was comparable to an earlier Icelandic study and reported incidence in the Nordic countries. Coronary involvement during the acute phase was mild, and all coronary aneurysm regressed. Serious cardiac complications were not seen. Children with Kawasaki disease in Iceland have favorable prognosis. Interestingly, mild mitral regurgitation and coronary ectasia were common at mid-term follow up.

Tilgangur: Markmið rannsóknarinnar var að athuga faraldsfræði og fylgi­kvilla Kawasaki-sjúkdóms hjá börnum á Íslandi. Efniviður/aðferðir: Afturskyggn rannsókn, frá ársbyrjun 1996 til ársloka 2005. Leitað var að börnum með Kawasaki-sjúkdóm eða óhefðbundinn Kawasaki-sjúkdóm. Þeim börnum sem greindust á Landspítala var boðin þátttaka í framhaldsrannsókn með áherslu á langtímaaukaverkanir á hjarta. Niðurstöður: Alls greindust 30 börn með Kawasaki-sjúkdóm á tímabilinu. Nýgengi var 10,7/100.000 hjá börnum <5 ára á ári og kynjahlutfall 2,3:1 (drengir:stúlkur). Öll börnin fengu meðferð með mótefnum í æð án alvarlegra fylgikvilla. Miðfjöldi daga frá upphafi veikinda til mótefnagjafar voru 6 dagar (spönn 3-31dagur). Í bráðafasa fengu tveir (6,7%) kransæðagúla og víkkun mældist á kransæðum þriggja barna (10%). Enginn sjúklingur lést. Við endurkomu, fjórum til 12 árum eftir veikindin, voru tveir enn með kransæðavíkkun og 6 með míturlokuleka (26%). Ályktanir: Nýgengi og kynjahlutfall var sambærilegt við fyrri íslenska rannsókn og rannsóknir frá Norðurlöndunum. Fá börn greindust með kransæðabreytingar í bráðafasanum, þær breytingar sem greindust gengu til baka í öllum tilvikum nema tveimur og engir alvarlegir fylgikvillar urðu af þeirra völdum. Horfur barna sem greinast með Kawasaki-sjúkdóm á Íslandi eru góðar, en athygli vekur hátt algengi míturlokuleka.