Difficult to diagnose Kawasaki disease in first week of illness

Kawasaki disease (KD) is a difficult diagnosis to make in a young child in the first week of an illness with fever as a symptom (Doctor suspended for improperly treating baby; June 29).

The most important diagnostic criterion of KD is high fever for at least five days.

Other symptoms, like the muco-cutaneous signs and lymph node enlargement in the neck become obvious at different times and with varying degrees of severity. Some of these symptoms may not always be present, making the diagnosis of KD even more challenging.

Laboratory tests are not specific and may be normal if carried out in the first few days of the illness.

Even echocardiography to check for coronary artery involvement is not a definitive test because 80 per cent of the patients do not have coronary artery issues.

Severe coronary arterial complication is very rare. But timely treatment in the first 10 days does not totally eliminate it.

Viral and bacterial infections that cause fever and rash occur far more frequently. They closely mimic KD.

To add to the complexity of the diagnostic issue is the variable immunological host response to the invading virus.

Scientific evidence shows that abnormal antibody, produced as a response to the viral infection in some patients, causes damage to the small and medium sized blood vessels of the body. This variable response and the degree of damage account for the protean and variable manifestation of KD.

Unnecessary referral and erroneous diagnosis of KD results in significantly costly investigations and inappropriate treatment.

When a viral infection can be confirmed as a case of KD remains an enigma.

But as a paediatrician who has been managing patients with KD for the last 40 years and learnt from Dr Tomisaku Kawasaki - the doctor who first observed the disease - I can testify that many patients can be confidently diagnosed only after the first week of illness.

Therefore, I urge the tribunal of the Singapore Medical Council to consider withdrawing the harsh punishment of suspension from practice for three months on Dr Chia Foong Lin.

William C.L. Yip (Dr)

Adjunct Professor,

National University of Singapore

A version of this article appeared in the print edition of The Straits Times on July 05, 2017, with the headline 'Difficult to diagnose Kawasaki disease in first week of illness'. Print Edition | Subscribe