Conduct disorder

Novini vo pedijatrijata / Godi[na revija 2009
• Anemia 9 cases
• Elevation of ALT: 7
• PTL > 450 000: 12
• WBC >15 000: 11
• ERS >30mm/h: 10
• Urine WBC: 6
• LCS pleocytosis: 1
• Arthritis: 5
• Diarrhea: 4
As far as the diagnosis of KD was suspected the appropriate treatment protocol was
applied. Aspirin (initially dosage 60-80mg/kg/24h, followed by 5mg/kg/24h) was
used as single therapy in 4 cases. The aspirin treatment was prolonged up to
6weeks in cases without cardiac complications. Aspirin and Intravenous immunoglobulin
(2g/kg) were prescribed in 7 cases, while 1case where the diagnosis was
established retrospectively only symptomatic treatment was offered. The mean
time of hospitalization was 30.5 days with a range (15-45 days). All patients
responded well to i.v immunoglobulin therapy and no case of refractoriness was
observed.
The cardiac involvement is prescribed in 4 of our cases. The manifestations of cardiac
complications occurred were: Dilatation of left coronary artery in 1 case, dilatation
of right coronary artery in 1 case, myocarditis with depressed ventricular
contractility (23&24%) in 2 cases. All these complications except one, were recovered
during a 18 months following period. The long term sequel was an aneurism
of right coronary artery.
Discussion
KD is markedly more prevalent in Japan and in children of Japanese ethnicity, having
an annual incidence of 150 cases per 100,000 children younger than 5 years of age,
about 10 times more than in the United States. The rate of the disease in Europe is
the lowest one. Low incidence of KS in our country is similar with references from
the other European countries. (Annual rate of the disease: 0.11-0.22/100.000
children) except European ethnicity, one of the factor which seems to influence in
this low incidence, is misdiagnosis. Boys outnumbered girls in our study and this
matched even with the data of other authors. All of our cases had an age younger
than five comparable with many papers where this age group is found in over 70 %
of children. 2 Case fatality rate of our patients was zero, but a low mortality is
prescribed recently in many data. Virtually all deaths in patients who have KD result
from cardiac sequelae. However, sudden death from myocardial infarction (MI) may
occur many years later in individuals who developed coronary artery aneurysms and
Страна 23