Article

Spatial and Temporal Clustering of Kawasaki Syndrome Cases

Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 10/2008; 27(11):981-5. DOI: 10.1097/INF.0b013e31817acf4f
Source: PubMed

ABSTRACT

The etiology of Kawasaki syndrome (KS) remains unknown despite 30 years of intensive search for an agent. Epidemiologic clues to a possible infectious etiology include the seasonal distribution of cases, the previous occurrence of epidemics, the clinical features of the syndrome that mimic other infectious rash/fever illnesses in children, the self-limited nature of the illness, and the peak age incidence in the toddler years.
We examined the epidemiology and spatial and temporal distribution of KS cases in San Diego County, California during the 6-year period from 1998 to 2003. Clustering in space and time was analyzed using geo-referenced data with the K-function, the local G-statistic, and Knox statistic.
A total of 318 patients were identified through active surveillance. The overall annual incidence was 21.7/100,000 in children <5 years, with rates in whites, white Hispanics, and Asian/Pacific Islanders of 15.3, 20.2, and 45.9/100,000, respectively. The Knox test showed significant clustering of cases within the space-time interval of 3 km and 3-5 days.
This is the first study of KS cases to use geo-referenced point pattern analysis to detect spatial and temporal clustering of KS cases. These data suggest that an infectious agent triggers the immunologic cascade of KS.

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Available from: ncbi.nlm.nih.gov
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    • "Dr. Tomisaku Kawasaki first described muco-cutaneous Lymph Node Syndrome or Kawasaki Disease in Japan in 1967[1]. Since then, there has been a documented increase on the recognition of KD both in Japan[2,3]and west countries, including the United States456. KD is a clinical diagnosis defined by unexplained fever of >5 days in duration along with 4 out of the following 5 physical findings: (1) bilateral non-exudative conjunctivitis (limbus is spared); (2) oral pharyngeal changes: injected or fissured lips, strawberry tongue or injected pharynx; (3) polymorphic exanthema; (4) changes in peripheral extremities: (a) acute phase: erythema, and/or indurating edema of the palms and soles; (b) convalescent phase:desquamation from finger tips and (5) non-suppurative cervical lymphadenopathy > 1.5 cm[7]. In addition to the above criteria, tests for infectious (Streptococcal or Staphylococcal toxic shock syndrome, Leptospirosis, Epstein–Barr Virus (EBV) and Parvovirus B19) and non-infectious etiologies (drug hypersensitivity reactions, serum sickness) must be ruled out. "
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    • "The etiology remains unknown, though there are clues to possible infectious etiology. The syndrome tends to occur in clusters and the clinical presentation with rash, fever and lymph node enlargement mimics infectious diseases [2]. About 20% of untreated patients will develop coronary manifestations due to vasculitis. "
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    ABSTRACT: Kawasaki disease is an acute systemic vasculitis of childhood. The diagnosis is based on clinical criteria. Prognosis with adequate treatment is favorable. Untreated patients, however, may develop coronary manifestations predisposing to acute myocardial infarction. Retropharyngeal edema is a rare but known manifestation of Kawasaki disease. We present a case series of four Kawasaki patients presenting with clinical findings for retropharyngeal abscess and the magnetic resonance imaging findings of these patients, diagnosed during a six week period. To our knowledge, this is the first systematic report of cervical MRI findings of Kawasaki patients.
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