Objectives: To analyze the clinical characteristics of scrub typhus (ST) initially misdiagnosed as KAWASAKI DISEASE (KD) in children.Methods: This study was conducted through a review of medical records of children with ST from March 2005 to June 2015.Results: Among182 incomplete KD patients, 11 patients were ST. Red lips, strawberry tongue, and BCGsite redness were not reported.Presence of eschars was reported in 5 patients. Group 1 patients (n=6) were initially treated by using intravenous immunoglobulin (IVIG) and amongthem, one patient had an eschar after IVIG use. Group 2 patients (n=5) were also initially diagnosed as KD but were not treated because eschar was detected in four patients before use of IVIG. One patient had no eschar but had a positive serologic test before IVIG use.Conclusions: When children have symptoms similar to KD but without red lips and strawberry tongue, clinicians should search for an eschar and perform serologic tests for ST.

Background: KAWASAKI DISEASE (KD) is an acute systemic vasculitis that generally affects children. Patients with KD do not show all typical clinical symptoms of the DISEASE. Objectives: Considering various studies in diagnosing the gastrointestinal symptoms of KD and the lack of similar studies in Iran, we aimed to investigate the frequency of gastrointestinal problems in patients with KD who referred to Imam Hossein hospital of Isfahan from 2012 to 2017. Methods: In a retrospective cross-sectional study, we examined the medical records of all 1-14-year-old patients with KD who were hospitalized from 2012 to 2017. The inclusion criteria included patients with a definite diagnosis of complete or incomplete KD, a hospitalization record in Imam Hossein children hospital, and no other systemic disorders. In the case of incomplete information, the patient’ s record was excluded from the study. Results: A considerable percentage of KD patients presented with the complaint of gastrointestinal symptoms such as abdominal pain (17. 4%), diarrhea (16. 9%), and vomiting (28. 9%). None of the patients had fecal occult blood or abnormal stool examination and evidence of pancreatitis. Conclusions: The most prevalent gastrointestinal symptoms were vomiting, abdominal pain, and diarrhea. If the diagnosis of KD is made early in KD patients complaining of gastrointestinal symptoms, unnecessary diagnostic procedures will be omitted, and the economic burden will be reduced on society and family.

Background & Aims: Kawazaki DISEASE (kd) is one of most common vasculitis in children. We report the clinical features and management of patients with Kawazaki DISEASE in West Azarbaijan, between 1999 to 2005. The kids were diagnosed on the basis of standard diagnostic criteria.Materials & Methods: Forty-two children (22 girls and 20 boys.) fulfilled the diagnostic criteria. The mean age was 3/8= 3/3 years old (range 0/2 -13 years) clustering was seen during the winter months; fever, redness of lip and tongue, and skin rush was common (%86, %93), but lymph adenopathy and extremities changes was seen only in %64. %62 cases.Results: Thrombocytosis was present in %88 of the patients, %93 patients received ivig. Cardiac abnormalities in %12. There was no mortality in frequent complications and manifestations. Gull bladder hydrops, gangrene of finger, aseptic meningitis, and hepatitis were observed.Conclusion: Kawazaki DISEASE needs to be considered in different diagnosis of all children with persistent unexplained fever.

KAWASAKI DISEASE is an acute febrile systemic DISEASE with unknown etiology that often affects children younger than 5 years of age. Common symptoms are fever, noninfectious conjunctivitis, inflammation of the mucous membranes and macular skin complications. Severe abdominal pain is a non-common symptom of the DISEASE. Abdominal pain can be reduced with medical and conservative treatment. The patient is a 4-year-old female who referred with fever and severe abdominal pain. She underwent an unnecessary appendectomy due to lack of timely diagnosis. With careful attention to the uncommon symptoms of the DISEASE and early administration of intravenous immunoglobulin and control of coronary aneurysm, the child was discharged with good condition.

The charts of 27 patients with KAWASAKI DISEASE (KD) admitted to Nemazee Hospital in Shiraz from January 1991 to October 1998 were reviewed to identify the results of mean peroxides index (MPXI) values, a measure of neutrophil staining intensity, obtained by the Technicon H1 analyzer (Technicon Instruments Corp., Tarrytown, NY) within the first 10 days of the illness; 2 separate groups of patients were assessed as control subjects: 27 DISEASE control (DC) children with fever plus one other KD criterion; and 27 laboratory control (Le) subjects with nonfebrile disorders interpreting also as a normal reference population. Compared with control groups, patients with KD had lower quantities of MPXI [(Meani±SD, -11.71±5.87 in KD group) vs. (1.53±4.30; p<0.001 in DC group, and 1.74±6.52, p<0.001 in LC group)]. Depending on the location of the cut-off point expressed on an interval scale, this test had the ability to be 100% specific (if MPXI<-6.0) and 100% sensitive (if MPXI>0).Considering the low prevalence of hereditary myeloperoxidase (MPO) deficiency (1 in 2000), measurement of MPXI, when performed as part of a complete count on an automated hematology instrument, could be counted as an important adjunct to clinical evaluation and also according to the low values of MPXI inpatients with KD, it can be included among the acquired causes of MPO deficiency.

Background: KAWASAKI DISEASE is an acute febrile systemic vasculitis with unknown etiology. The aim of this study was investigating the epidemiology of KAWASAKI DISEASE in Golestan province.Methods: In a retrospective case series study, records of all patients with a diagnosis of KAWASAKI DISEASE from Sep 2005 to the end of Oct 2012 hospitalized in Taleghani hospital were reviewed. Data were analyzed with the SPSS 16. P values of less than 0.05 were considered significant.Findings: 51 patients entered the study including 58.8% males and 41.17% females. Children were between 2 months and 10 years old and included 39 typical and 12 atypical KAWASAKI. The mean age of typical and atypical was 32.1 and 15.2 months respectively; the mean time for the beginning symptoms before admission was 6.7 days in typical and 7.1 days in atypical. Time from admission to receive IVIG in typical and atypical was reported 25 and 116 hours. More clinical signs among typical cases were skin rash 76.9%, lips and oral mucosa change 66.6% and conjunctivitis 64.1% and in the atypical cases were rash 41.6%, cough 33.3, rhinorrhea 33.3% and diarrhea 33.3%.Among the laboratory findings in the typical group CRP was positive in 88.2%, ESR>35 in 79.5% and anemia in 63.2% cases and in the atypical group, CRP was positive in 91.7%, anemia in 91.7% and AST in 63.6%.Echocardiography was performed in 42 cases and 5 patients had abnormal findings that one case was atypical.Conclusion: The clinical symptoms in typical and atypical KAWASAKI were conjunctivitis, rash, desquamation, scaling, unilateral lymphadenopathy, lips and oral change; among laboratory findings in atypical cases, anemia was more common than typical cases. Cardiac complications were significantly lower than other studies.