Indian Academy of Pediatrics Position Paper on Kawasaki Disease
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Indian Academy of Pediatrics Position Paper on Kawasaki Disease BHASKAR SHENOY,1 SURJIT SINGH,2 M ZULFIKAR AHMED,3 PRIYANKAR PAL,4 SUMA BALAN,5 VIJAY VISWANATHAN,6 SAGAR BHATTAD,7 ANAND P RAO,8 MAITRI CHAUDHURI,9 DIGANT D SHASTRI10 AND SANTOSH T SOANS11 From Departments of 1Pediatrics, Manipal Hospitals, Bangalore, Karnataka; 2Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh; 3Department of Cardiology, Pushpagiri Medical College, Tiruvalla, Kerala; 4Department of Pediatric Rheumatology Institute of Child Health, Kolkata, West Bengal; 5Department of Rheumatology, Amrita Institute of Medical Sciences, Kochi, Kerala; 6Jupiter Hospital, Thane, Maharashtra; 7Aster CMI Hospital, Bangalore, Karnataka; 8Manipal Hospitals, Indira Gandhi Institute of Child Health, Bangalore, Karnataka; 9Department of Cardiology, Manipal Hospital, Bangalore, Karnataka; 10Killol Children Hospital, Surat, Gujarat; and 11AJ Institute of Medical Sciences, Mangalore, Karnataka; India. Correspondence to: Dr Bhaskar Shenoy, Head, Department of Pediatrics, Manipal Hospitals, Bangalore, Karnataka, India. [email protected] Objective: To formulate practice guidelines on diagnosis and management of Kawasaki disease (KD) for Indian children. Justification: KD is a systemic vasculitis that predominantly affects infants and children less than 5 years of age. Coronary artery abnormalities (CAA) develop in around 15-25% of untreated children with KD. Coronary artery involvement can lead to long-term cardiovascular implications such as development of premature coronary artery disease. Diagnosis of KD is essentially clinical based on recognition of a constellation of characteristic symptoms and signs. Timely diagnosis and initiation of intravenous immunoglobulin (IVIG) therapy is known to produce five-fold reduction in the incidence of CAA. As there is no confirmatory laboratory test for KD, the diagnosis may be missed if one is not familiar with the nuances of clinical diagnosis. Process: A committee was formed under the auspices of Indian Academy of Pediatrics in early 2018 for preparing guidelines on KD in Indian children. A meeting of the consultative committee was held in Mumbai, and a draft protocol was devised. All members scrutinized the recent publications on the subject and an attempt was made to arrive at a broad consensus. Published guidelines on the subject were also reviewed. Recommendations: The diagnosis is clinical and is aided by laboratory and 2D echocardiography. First line of therapy is IVIG, and should be started expeditiously once the diagnosis is made. Keywords: Coronary artery abnormalities, Diagnosis, Intravenous Immunoglobulin, Infliximab, Management. Published online: August 28, 2020; PII: S097475591600188
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awasaki Disease (KD) is an acute febrile illness that commonly affects children below 5 years of age. Classified under predominantly medium vasculitides, it has a predilection to involve coronary arteries. Ever since the first report by Dr. Tomisaku Kawasaki from Japan in
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