Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015.

OBJECTIVE: Kawasaki disease (KD) is an increasingly common vasculitis with risk of coronary artery aneurysms (CAAs). The last UK survey was in 1990, whereas current epidemiology, treatment patterns and complication rates are unknown. The aim of this study was to address this knowledge gap. METHODS: A British Paediatric Surveillance Unit survey in the UK and Ireland from 1 January 2013 to 28 February 2015 ascertained demographics, ethnicity, seasonal incidence, treatment and complication rates. RESULTS: 553 cases were notified: 389 had complete KD, 46 had atypical KD and 116 had incomplete KD; 2 were diagnosed at postmortem with an incidence of 4.55/100 000 children under 5 years, with a male to female ratio of 1.5:1 and a median age of 2.7 years (2.5 months-15 years). Presentation was highest in January and in rural areas. Most were white (64%), and Chinese and Japanese Asians were over-represented as were black African or African mixed-race children. 94% received intravenous immunoglobulin (IVIG). The overall CAA rate was 19%, and all-cardiac complications affected 28%. Those with CAA received IVIG later than in those without (median 10 days vs 7 days). Those under 1 year had fewer symptoms, but the highest CAA rate (39%). Overall 8 of 512 cases (1.6%) had giant CAA, and 4 of 86 cases (5%) under 1 year of age developed giant CAA. Mortality from KD was 0.36%. CONCLUSIONS: The UK and Ireland incidence of KD has increased and is more frequently seen in winter and rural areas. Delayed IVIG treatment is associated with CAA, suggesting earlier and adjunctive primary treatment might reduce complications to prevent CAA, particularly in the very young.

Mothers, babies and vitamin D: old disease, new problem.

Neonatologists and paediatricians have a crucial role working with mothers at the most nutritionally challenged point in their lives and that of their infants. This position of responsibility is particularly important in tackling the re-emerging problem of hypovitaminosis D. In this overview the role of vitamin D, its contribution to pathology in those to whom we provide a service and possible actions will be considered.

Managing toxic shock syndrome.

A recent case review showed that nurses play an important role in diagnosing toxic shock syndrome (TSS). It is a rare, and potentially fatal condition, which may develop in individuals of all ages. The average A&E nurse will probably only encounter a single case. However, front-line nurses will usually be the first to meet the patient with this condition. Some knowledge of TSS is important because early diagnosis and treatment may save lives.

Staphylococcal vaccines.

Vaccination has proved relatively unsuccessful against the common mammalian commensal bacteria Staphylococcus, despite almost a century of experimentation. Recent progress in clinical trials, animal models and molecular laboratories offers hope that these organisms might be partially or wholly controlled by augmenting host responses.

The use of herbal remedies in Jamaica

A survey of paediatric inpatients at the Tropical Metabolism Research Unit in the University Hospital, Kingston, Jamaica demonstrates that 71 percent had been treated with herbal remedies before their presentation to the medical services. The risks of the high prevalence of such medication in children are outlined, and two remedies in particular are highlighted because of their potential toxicity. (AU)

Frankincense and myrrh as remedies in children

Two cases of therapy with frankincense and myrrh in children are presented. The long history of this unusual treatment is outlined, demonstrating that for several millenia such agents have been employed in a number of medical contexts, as well as in the perfume and incence industries. Myrrh has found recent pharmacological application in the reduction of cholesterol and triglycerides, as predicted by several traditional therapies. (AU)