Although KD is the leading cause of pediatric acquired heart disease in many countries, there are few published studies from Latin America (LA). We describe the epidemiology, clinical aspects and treatment of the first multicenter retrospective study of KD in ch from Pan as part of the REKAMLATINA-2 Network surveillance study of KD in LA.
Methods:5-year retrospective descriptive study of patients (pts) with a hospital discharge diagnosis of KD attended at 3 main pediatric hospitals in Pan. Study period: Jan-1-2009 to Dec-31-2013.
Results: 112 pts were analyzed, 62 (55.4%) were male. All were hospitalized; mean length of hospitalization was 5 (2-23) days. Median age at admission was 19 (2-134) months. Distribution by age groups was: <6 months, 3 (2.7%) pts; <24m, 66 (58.9%) pts; <5yrs, 97(86.7%) pts. Mean duration of fever at admission was 6 (2-30) days. Prior to KD final diagnosis, 69.3% pts received antibiotics for other presumed diagnoses. 1 (0.9%) pt had recurrent KD. 105 (93.8%) pts received IVIG: 1 dose, 98 (93.3%), and 2 doses, 7 (6.7%), respectively. Among those pts treated with IVIG at admission, 15.2% had >10 days of fever. Aspirin, steroids and infliximab were given in 97.3%, 6.4% and 0% pts, respectively. Baseline echocardiogram (ECHO) was performed in 104 (92.9%) pts, absent in 4 (3.6%) and unknown in 4 (3.6%) pts. On initial ECHO, 12/104 (11.5%) pts had >1 abnormalities documented, of which coronary artery lesions (CALs) were detected in 4 (3.8%) pts. A 2nd and 3rdfollow-up ECHO was performed only in 89 (79.5%) and 50 (44.6%) pts, of which an abnormality was documented in 7.9% and 6% pts, respectively. Incomplete/atypical KD was diagnosed in 44 (39.3%) pts. No deaths occurred.
Conclusion: The high rate of antibiotic misuse prior to final KD diagnosis as well as the number of pts who received IVIG treatment after >10 days of fever, suggests that KD unawareness and late recognition is a significant problem in Pan ch. A concerning number of pts did not have an admission and follow-up ECHOs performed, which suggests that the real proportion of CAL in these ch is underestimated and adequate and strict follow-up of these pts must be urgently implemented.