Kawasaki disease in children from Dubai, United Arab Emirates (2012–2020): a single-centre retrospective clinical case series

Kawasaki disease (KD) is an acute systemic vascular disease predominantly affecting children aged 6 months to 5 years.1 Incidence of KD in children <5 years is reported to be higher in East Asian children (eg, Japan 218.6/100 000; South Korea 113.1/100 000) compared with North American (19.0/100 000) and European (UK 8.4/100 000) children.1 The majority of KD research has focused on East Asian, European and North American populations. There is a dearth of clinical data for the Middle East region.

We conducted a retrospective case series of all paediatric patients with KD (n=27) admitted to a private tertiary care hospital in Dubai (United Arab Emirates; UAE) between 01 January 2012 and 31 December 2020. The American Heart Association guidelines for KD2 were used to classify (1) Typical (complete) or atypical (incomplete) KD3 and (2) Cardiac abnormalities based on echocardiography performed on all patients by a paediatric cardiologist (see table 1 for cut-offs). Twenty-seven patients with KD were admitted over the 9-year study period (see online supplemental table 1). Male to female ratio was 2.9:1 and the median age for all patients with KD was 2.0 years (male 2.0 years; female 3.0 years). Majority of the patients were either Asian (n=10) or Middle Eastern (n=7), typical (complete) KD presentation was most common (n=23) and KD hospital admissions were most frequent during the winter (n=11). High-dose intravenous immunoglobulins (IVIG) alone or in combination was the most common initial treatment prescribed (n=18); however, eight patients did not initially receive IVIG and this may have been due to a delay in KD diagnosis (table 1). Twelve patients had no coronary artery abnormalities (CAA) and 12 patients had mild CAA (table 1).

Male predominance (ie, 2.9:1) is consistent with other studies conducted in the Middle East region (Saudi Arabia 1.9:1;4 Jordan 3.9:1; table 2)5 and East Asia (Japan 1.3:1).1 Median age of presentation (ie, 2.0 years) was identical to England and Ireland, slightly higher than in the USA (1.5 years), and lower than in Italy and Canada (3.0 years and 3.3 years, respectively).1 Asian was the most common ethnicity among our sample, possibly reflecting the UAE population structure. However, previous research reported Asian ethnicity as a KD risk factor in Hawaii (50.4/100 000 children <5 years of age)1 and in other Asian populations worldwide.6 In line with previous work, we observed that most patients presented with typical (complete) KD7 and there were a higher number of cases in winter similar to seasonal peaks in Japan,1 Saudi Arabia4 and the USA.1 Cardiac involvement is the most important feature of KD and CAA developed in ~25% of untreated patients.1 Fourteen patients (52%) developed mild or moderate CAA which was similar to a study in Jordan (41%).5 Twelve patients did not develop any cardiac complications (one patient with missing data) and there were no non-cardiac complications or deaths (table 1). This is most likely due to prompt identification and treatment which prevented progression to further complications, especially non-cardiac complications.

Study strengths were the inclusion of all patients with KD over a 9-year period in the cosmopolitan city of Dubai. However, this was a retrospective single-site study and findings may not accurately represent KD epidemiology across the whole city of Dubai or the entire UAE. Missing data limited our ability to explore the potential role of family history. Our study suggests that the clinical presentation of KD in the UAE is similar to that of other patients in the Middle East (table 2) and also from East Asian, European and North American countries. The recently proposed KD Arab Initiative (Kawarabi) should provide future data to help improve the diagnosis, care and outcomes of children with KD across different Arab nations and ethnicities.7

Supplementary files

Supplementary PDF 1

Supplementary PDF 2

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Footnotes

• Contributors: Study conception and design: SH; Data collection: RS; Analysis and interpretation of results and draft manuscript preparation: RS, SH, AJA, TL. All authors reviewed the results and approved the final version of the manuscript.

• Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Competing interests: None declared.

• Provenance and peer review: Not commissioned; externally peer reviewed.

• Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Ethics statements

Patient consent for publication:

Not applicable.

Ethics approval:

This study was reviewed and approved by the Mohammed Bin Rashid University Institutional Review Board, Dubai Healthcare City Regulatory Research Ethics Committee, and Mediclinic Middle East Research Ethics Committee (#MBRU-IRB-SRP-2020-11). There are no major ethical concerns as this study involved de-identified secondary data.

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References

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