Original Article
The diagnosis of Kawasaki disease among Nigerian children: a nightmare for the caregivers and the doctors
Abstract
Background: The epidemiology of Kawasaki disease (KD) in developing countries is largely undefined although very few cases have been reported giving the impression that the condition is rare. The study aims to enumerate the presenting features, challenges encountered in the diagnosis and management of the subjects, the outcome of the subjects and increase awareness of KD among health practitioners in the sub region.
Method: Prospective audit of patients that presented at one public hospital and three private hospitals in Lagos over a period of five years from January 2011 to December 2016. All patients diagnosed with KD in the above setting using the diagnostic criteria by the American Heart Association were included in the study. Echocardiography was done to determine the presence of a cardiac involvement. The main outcome measures were the incidence of KD, time to diagnosis, use of intravenous immunoglobulin (IVIG), cardiac features and outcome.
Results: Eight cases of KD were identified and no mortality was seen. Cardiac complication of coronary dilatation was seen in 37.5% of the cases. The time from onset of fever to time of diagnosis ranged between three and nine days. IVIG was not readily available and when available was beyond the reach of common men.
Conclusions: The prevalence of KD is largely unknown in Nigeria with a poor index of suspicion, late referral and hence late commencement of interventions and possibly missed diagnosis are common. Coronary dilatation is common among the subjects but with a good outcome. IVIG is not readily available and expensive in Nigeria as well as in the neighboring countries.
Method: Prospective audit of patients that presented at one public hospital and three private hospitals in Lagos over a period of five years from January 2011 to December 2016. All patients diagnosed with KD in the above setting using the diagnostic criteria by the American Heart Association were included in the study. Echocardiography was done to determine the presence of a cardiac involvement. The main outcome measures were the incidence of KD, time to diagnosis, use of intravenous immunoglobulin (IVIG), cardiac features and outcome.
Results: Eight cases of KD were identified and no mortality was seen. Cardiac complication of coronary dilatation was seen in 37.5% of the cases. The time from onset of fever to time of diagnosis ranged between three and nine days. IVIG was not readily available and when available was beyond the reach of common men.
Conclusions: The prevalence of KD is largely unknown in Nigeria with a poor index of suspicion, late referral and hence late commencement of interventions and possibly missed diagnosis are common. Coronary dilatation is common among the subjects but with a good outcome. IVIG is not readily available and expensive in Nigeria as well as in the neighboring countries.
