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


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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    • "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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    ABSTRACT: Background: Kawasaki disease is an acute systemic vasculitis that predominantly affects young children and is rarely seen in adults. In the recent years, there have been a few cases in the literature reporting similar clinical picture in adults, especially in those with concurrent HIV, which lead us to present our findings and explore the illness further. Case report: A 20-year-old African American female with congenital human immunodeficiency virus (HIV) infection, presented to the ER with complaints of chronic fatigue, fever (T max 103°F), arthralgia and sore throat since 2-3 weeks. She also had generalized pain, swelling and erythema of both hands and feet as well as conjunctival erythema with watery discharge since the same duration. An extensive infectious disease and rheumatologic work up in the hospital was negative. She had two prior admissions for similar complaints in less than a year with minimal response to NSAID and prednisone. The patient was started on a 5-day course of IV Immunoglobulin and Aspirin for suspected Kawasaki-like disease (KLD). She responded well and her symptoms resolved in a few days, strengthening our diagnosis. Conclusion: It is a challenging task to diagnose Kawasaki-like disease in HIV infected adults due to a high likelihood of opportunistic infections or possible hypersensitivity to any one of the plethora of prescribed medications. A high suspicion of KLD is advised in HIV infected adults with severe immunosuppression and unexplained fever lasting. >. 5 days to ensure timely diagnosis and treatment.
    Full-text · Article · Dec 2015
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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.
    Full-text · Article · Jul 2014 · International Journal of Pediatric Otorhinolaryngology
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