Epidemiological Features and Clinical Study of Kawasaki Disease in Iran


Kawasaki disease (KD) is an acute febrile systemic vasculitis of unknown etiology and the major cause of pediatric acquired cardiac disease worldwide, particularly in developed countries. This study characterizes the epidemiologic and clinical features of KD in the Pediatric Rheumatology Department service in a general hospital. 120 patients with the diagnosis of KD between 1990 and 2009 were enrolled. We investigated the epidemiologic and clinical features of coronary artery involvement of the patients. Frequency of many parameters including age, sex, season, clinical and laboratory findings, response to treatment, and complications of the patients determined. During the 20-year study period, 120 patients <15 years of age were admitted for KD. Among them, 39.2% were at the extremes of the age spectrum, with 2.5% <6 months and 36.7% >5 years of age, male to female ratio of 1.3:1 and the classic KD to incomplete KD ratio of 3.1:1. KD recurred in 5% of all cases. It occurred most frequently in the winter and least frequently in the summer. The occurrence of coronary artery abnormalities (CAA) was 4.2%. Kawasaki disease should be considered in any pediatric patients with a prolonged refractory febrile illness in order to prevent CAA formation.

1. Burns JC, Glodé MP. Kawasaki syndrome. Lancet 2004;364:533-44.
2. Barron KS. Kawasaki disease in children. Curr Opin Rheumatol 1998;10:29-37.
3. Kawasaki T. Acute febrile mucocutaneous lymph dose syndrome: Clinical observations of 50 cases. Jpn J Allergy 1967;16:178-222.
4. Falcini F. Kawasaki disease. Curr Opin Rheumatol 2006;18:33-38.
5. Hirata S, Nakamura Y, Matsumoto K,Yanagawa H. Long-term consequences of Kawasaki disease among first-year junior high school students. Arch Pediatr Adolesc Med 2002;156:77-80.
6. Fulton DR, Newburger JW. Long-term cardiac sequelae of Kawasaki disease. Curr Rheumatol Rep 2000;2:324-9.
7. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-71.
8. Watanabe T. Acute renal failure in Kawasaki disease. Pediatr Nephrol 2003;18:200.
9. Watanabe T, Iwabuchi H, Abe T. Rhabdomyolysis in a patient with Kawasaki disease. Eur J Pediatr 2003;162:891-892.
10. Levy M, Koren G. Atypical Kawasaki disease: analysis of clinical presentation and diagnostic clues. Pediatr Infect Dis J 1990;9:122-6.
11. Newburger JW, Taubert KA, Shulman ST, Rowley AH, Gewitz MH, Takahashi M, et al. Summary and abstracts of the seventh international Kawasaki disease symposium: December 4–7, 2001, Hakone, Japan. Pediatr Res 2003;53:153-7.
12. Young CoCDit. Diagnostic guidelines for Kawasaki disease. Circulation 2001;103:335-6.
13. Silva AA, Maeno Y, Hashmi A, Smallhorn JF, Silverman ED, McCrindle BW. Cardiovascular risk factors after Kawasaki disease: a case-control study. J pediatr 2001;138:400-5.
14. Research Committee on Kawasaki Disease (1984). Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo: Ministry of Health and Welfare, 1983:1-10.
15. Hashemian H, Karambin MM. Kawasaki Disease: An Epidemiological and Clinical Study. Acta Med Iran 2009;47:455-7.
16. Nakamura Y, Yashiro M, Uehara R, Oki I, Watanabe M, Yanagawa H. Epidemiologic features of Kawasaki disease in Japan: results from the nationwide survey in 2005-2006. J Epidemiol 2008;18:167-72.
17. Holman RC, Curns AT, Belay ED, Steiner CA,Schonberger LB. Kawasaki syndrome hospitalizations in the United States, 1997 and 2000. Pediatrics 2003;112:495-501.
18. Cai Z, Zuo R, Liu Y. Characteristics of Kawasaki disease in older children. Clin Pediatr 2011;50:952-6.
19. Yanagawa H, Nakamura Y, Yashiro M, Uehara R, Oki I, Kayaba K. Incidence of Kawasaki disease in Japan: the nationwide surveys of 1999-2002. Pediatr int 2006;48:356-61.
20. Park YW, Han JW, Park IS, Kim CH, Cha SH, Ma JS, et al. Kawasaki disease in Korea, 2003–2005. Pediatr Infect Dis J 2007;26:821-3.
21. Chang LY, Chang IS, Lu CY, Chiang BL, Lee CY, Chen PJ, et al. Epidemiologic features of Kawasaki disease in Taiwan, 1996–2002. Pediatrics 2004;114:e678-82.
22. Du ZD, Zhao D, Du J, Zhang YL, Lin Y, Liu C, et al. Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004. Pediatr Infect Dis J 2007;26:449-451.
23. Ng YM, Sung RYT, So LY, Fong NC, Ho MHK, Cheng YW, et al. Kawasaki disease in Hong Kong, 1994 to 2000. Hong Kong Med J 2005;11:331-5.
24. Lynch M, Holman RC, Mulligan A, Belay ED, Schonberger LB. Kawasaki syndrome hospitalizations in Ireland, 1996 through 2000. Pediatr Infect Dis J 2003;22:959-962.
25. Manlhiot C, Yeung RS, Clarizia NA, Chahal N,McCrindle BW. Kawasaki disease at the extremes of the age spectrum. Pediatrics 2009;124:e410-5.
26. Kayiran SM, Dindar A, Gurakan B. An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study. Clinics 2010;65:1261-5.
27. Caballero-Mora F, Alonso-Martín B, Tamariz-Martel-Moreno A, Cano-Fernández J, Sánchez-Bayle M. Kawasaki disease in 76 patients. Risk factors for coronary artery aneurysms. An Pediatr (Barc) 2011;74:232-8.
28. Kordidarian R, Kazemi A, Nikyar A, Torfeh Nejad M. Assessing Kawasaki disease in children at Alzahra hospital (1995-1999). J Qazvin Univ Med Sci 2008;11:42-7.
29. Mosaiebi Z, Movahedian AH, Heidarzadeh M, Hojati M, Mousavi SGA. Evaluation of clinical and paraclinical findings of Kawazaki patients among children admitted in Kashan Shahid Beheshti hospital during 1998-2008. KAUMS J (FEYZ) 2010;14:249-55.
30. Singh S, Kawasaki T. Kawasaki Disease--An Indian Perspective. Indian Pediatr 2009;46:563-71.
31. Özdemir H, Çiftçi E, Tapısız A, İnce E, Tutar E, Atalay S,Doğru Ü. Clinical and epidemiological characteristics of children with Kawasaki disease in Turkey. J Trop Pediatr 2009;56:260-2.
32. Zulian F, Falcini F, Zancan L, Martini G, Secchieri S, Luzzatto C, et al. Acute surgical abdomen as presenting manifestation of Kawasaki disease. J pediatr 2003;142:731-5.
33. Von Planta M, Fasnacht M, Holm C, Fanconi S, Seger R. Atypical Kawasaki disease with peripheral gangrene and myocardial infarction: therapeutic implications. Eur J Pediatr 1995;154:830-834.
34. Tomita S, Chung K, Mas M, Gidding S, Shulman ST. Peripheral gangrene associated with Kawasaki disease. Clin Infect Dis 1992;14:121-6.
IssueVol 58, No 12 (2020) QRcode
: Kawasaki disease Coronary artery Febrile disease Epidemiology

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Akbariasbagh P, Talebiyan S, Aghighi Y, Raeeskarami R, Seyedhoseinpour A, Tabrizi A. Epidemiological Features and Clinical Study of Kawasaki Disease in Iran. Acta Med Iran. 58(12):625-630.