Incomplete Kawasaki Disease in a 44-day-old baby

Kawasaki disease (KD) is an acute systemic vasculitisusually affecting children <5 years old. We report a 44-dayold baby who had persistent fever despite being onantibiotics for presumed sepsis. Erythema of BacillusCalmette-Guerin (BCG) scar and thrombocytosis were notedon day-2 of illness. Diagnosis of incomplete KD was madeon the 10th day of illness. Her fever resolved withintravenous immunoglobulin, but echocardiogram revealedcoronary artery aneurysm. High index of suspicion isrequired to diagnose KD in infants ≤3 months since it is rare and commonly presents with incomplete clinical features.The presence of unexplained fever for ≥5 days witherythema of BCG scar or thrombocytosis in infants shouldalert the clinicians of KD.

A Review of Acute Rheumatic Fever and Rheumatic Heart Disease Research in Malaysia

A total of 39 titles related to rheumatic fever or rheumatic heart disease in Malaysia were found with online literature search dating back to their inceptions and through 2014. Additional publications from conference journals were included. Nine papers were selected based on clinical relevance and future research implications. There were no population-based studies on the incidence or prevalence of ARF or RHD. In the 1980s, the incidence of admission due to ARF ranged from 2 to 21.1 per 100 000 paediatric admission per year. The burden of disease was significant in the adult population; 74.5% of patients with RHD were female, of which 77.1% were in the reproductive age group of 15-45 years old. Rheumatic mitral valve disease constituted almost half (46.7%) of all mitral valve repairs, ranging from 44.8 – 55.8 patients per year from 1997 – 2003. From 2010-2012, mitral valve interventions increased to 184 per year, of which 85.7% were mitral valve repair. In children with ARF, 25.4% - 41.7% had past history of rheumatic fever or RHD. In patients with rheumatic mitral valve disease undergoing surgical or medical interventions, only 6% reported history of ARF, none had history of GABHS pharyngitis or antibiotic prophylaxis. Only 44.7% of patients with RHD on follow-up were on intramuscular benzathine penicillin prophylaxis. Overall, there is scarcity of publications on ARF and RHD in Malaysia. Priority areas for research include determination of the incidence and prevalence of ARF and RHD, identification of high-risk populations, evaluation on the implementation and adherence of secondary preventive measures, identification of subclinical RHD especially amongst the high-risk population, and a surveillance system to monitor and evaluate preventive measures, disease progression and outcomes.