2259. Kawasaki Disease (KD) in Children (Ch) Older Than 5 Years of Age Among 20 Latin American (LA) Countries: A Prospective Multinational Multicenter Study of the REKAMLATINA Network
Session: Poster Abstract Session: Pediatric Potpourri
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Poster KD _5 years REKAMLATINA. ID Week 2016 .pdf (946.6 kB)
  • Background:KD diagnosis at extreme age groups is difficult. Worldwide, approximately 20% of KD cases occur in ch >5 years; however, publications focusing on this age group are scarce. We describe the epidemiology, clinical aspects and treatment of the first prospective LA multinational study of KD in this age group.

    Methods:Ongoing prospective study of patients (pts) with a discharge diagnosis of KD attended at 53 main pediatric/general LA referral hospitals, period June-1-2014 to March-31-2016.

    Results: Among 481 eligible KD pts, 82 (17.0%) were >5 years as follows: 5-<9 years, 67 (81.7%) pts; 9-<13 yrs, 15 (18.3%) pts. Median age at admission was 77 (60-155) months. 50 (61.0)% were male. 79 (96.3%) pts were hospitalized; mean length of hospitalization was 5 (2-21) days. Mean days of fever at admission were 7 (1-22) days; 19.8% had other non-KD admission diagnosis. 2 (2.4%) had recurrent KD. Prior to KD diagnosis, 55 (67.1%) pts received >1 antibiotics for other presumed diagnoses. Only 3/69 (4.3%) pts had BCG scar changes (erythema, edema, crust, and/or ulcer) by clinical history and/or physical examination. Baseline echocardiogram was performed in all pts, of which an abnormality was documented in 28 (34.1%) pts. Coronary artery dilatations and/or aneurysms were detected in 8/82 (9.8%) pts. IVIG was given in 75 (91.5%) pts: 1 dose, 62 (82.7%); 2 doses, 12 (16%); and 3 doses, 1 (1.3%) pts. Among those pts treated with IVIG on admission, 9 (12%) pts had >10 days of fever. Aspirin, steroids and infliximab were given in 80 (97.6%), 28 (34.2%), and 3 (3.7%) pts, respectively. Incomplete/atypical KD was diagnosed in 15 (18.3%) pts. No deaths occurred.

    Conclusion: In LA ch >5years of age, KD is associated with a late clinical diagnosis, significant rates of antibiotic misuse for other suspected diagnosis, and a considerable proportion of early cardiac abnormalities. For this age group, BCG scar changes are very uncommon and therefore are not very useful for clinical suspicion of the disease.

    Rolando Ulloa-Gutierrez, MD1, Luis M Garrido-García, MD2, Dora Estripeaut, MD3, Francisco J Rodríguez, MD4, Patricia Saltigeral-Simental, MD5, Olguita Del Águila, MD6, Greta Miño, MD7, Marco T Luque, MD8, Adrián Collia, MD9, Enrique Faugier-Fuentes, MD10, Heloisa Helena De Sousa Marques, MD11, Martha I Álvarez-Olmos, MD12, Kathia Luciani, MD13, María C Pirez, MD14, Fernanda Cofre, MD15, German Camacho-Moreno, MD16, Virgen Gomez, MD17, Marco a Yamazaki-Nakashimada, MD18, Diana López-Gallegos, MD19, Angélica Calvache-Burbano, MD7, María L Avila-Aguero, MD1, Giannina Izquierdo, MD20, Kattia Camacho-Badilla, MD1, Alejandra Soriano-Fallas, MD1, Kathia Valverde, MD1, Raymundo Rodriguez-Herrera, MD21, Enrique Chacon-Cruz, MD22, Antonio Fernández, MD23, Lucila Martínez-Medina, MD24, Luisa Berenise Gámez-González, MD25, Lourdes Dueñas, MD26, Paola Pérez-Camacho, MD27, Carlos Grazioso, MD28, Lorena Franco, MD29, Nora Bueno, MD30, Sandra Beltán, MD31, Jorge a Vázquez Narváez, MD32, Andrea P Salgado, MD33, Adriana H. Tremoulet, MD, MAS34 and The REKAMLATINA-1 Study Group Members, (1)Servicio De Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica, (2)Servicio De Cardiología Pediátrica, Instituto Nacional de Pediatría (INP), Ciudad de México, Mexico, (3)Infectious Diseases, Hospital del Niño, Panamá, Panama, (4)Servicio De Inmunología Pediátrica, Hospital de Especialidades Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, (5)Servicio De Infectología Pediátrica, Instituto Nacional de Pediatría (INP), Ciudad de México, Mexico, (6)Unidad De Infectología Pediátrica, Hospital Rebagliati, Lima, Peru, (7)Servicio De Infectología Pediátrica, Hospital del Niño "Francisco de Ycaza Bustamente", Guayaquil, Ecuador, (8)Servicio De Infectología Pediátrica, Hospital Escuela Universitario, Tegucigalpa, Honduras, (9)Servicio De Pediatría, Sanatorio Mater Dei, Buenos Aires, Argentina, (10)Servicio De Reumatología Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico, (11)Hospital das Clínicas- University of São Paulo, São Paulo, Brazil, (12)Servicio De Infectología Pediátrica, Fundación Cardio Infantil, Bogotá, Colombia, (13)Hospital de Especialidades Pediátricas de la Caja de Seguro Social, Panamá, Panama, (14)Servicio De Infectología Pediátrica, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay, (15)Infectious Diseases, Hospital de Niños Roberto Del Río, Santiago, Chile, (16)Servicio De Infectología Pediátrica, Hospital de la Misericordia, Bogotá, Colombia, (17)Infectious Diseases Department, Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic, (18)Clinical Immunology Department, Instituto Nacional de Pediatría (INP), Ciudad de México, Mexico, (19)Department of Pediatrics, Hospital Infantil Privado, Ciudad de México, Mexico, (20)Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Universidad de Chile, Santiago, Chile, (21)Pediatrics Department, Instituto Nacional de Pediatría (INP), Ciudad de México, Mexico, (22)Pediatrics, Hospital General de Tijuana, Tijuana, Baja-California, Mexico, (23)Pediatrics Department, Hospital del Niño "Francisco de Ycaza Bustamente", Guayaquil, Ecuador, (24)Department of Pediatrics, Centenario Hospital Miguel Hidalgo, Aguas Calientes, Mexico, (25)Servicio De Alergología e Inmunología, Hospital Infantil de Chihuahua, Chihuahua, Mexico, (26)Servicio De Infectología Pediátrica, Hospital Benjamín Bloom, San Salvador, El Salvador, (27)Department of Pediatrics, Fundación Valle del Lili, Cali, Colombia, (28)Servicio De Infectología Pediátrica, Sanatorio Nuestra Señora del Pilar/Hospital General San Juan de Dios, Ciudad Guatemala, Guatemala, (29)Servicio De Reumatología Pediátrica, Hospital Infantil Municipal de Córdoba, Córdoba, Argentina, (30)Servicio De Cardiología Pediátrica, Hospital Infantil Municipal de Córdoba, Córdoba, Argentina, (31)Servicio De Infectología Pediátrica, Clínica Colsanitas, Bogotá, Colombia, (32)Servicio De Infectología Pediátrica, Hospital Infantil de Morelia “Eva Sámano de López Mateos”, Morelia, Mexico, (33)Servicio De Infectología Pediátrica, Pontificia Universidad Catolica de Chile, Santiago, Chile, (34)Pediatrics, University of California, San Diego, La Jolla, CA

    Disclosures:

    R. Ulloa-Gutierrez, None

    L. M. Garrido-García, None

    D. Estripeaut, None

    F. J. Rodríguez, None

    P. Saltigeral-Simental, None

    O. Del Águila, None

    G. Miño, None

    M. T. Luque, None

    A. Collia, None

    E. Faugier-Fuentes, None

    H. H. De Sousa Marques, None

    M. I. Álvarez-Olmos, None

    K. Luciani, None

    M. C. Pirez, None

    F. Cofre, None

    G. Camacho-Moreno, None

    V. Gomez, None

    M. A. Yamazaki-Nakashimada, None

    D. López-Gallegos, None

    A. Calvache-Burbano, None

    M. L. Avila-Aguero, None

    G. Izquierdo, None

    K. Camacho-Badilla, None

    A. Soriano-Fallas, None

    K. Valverde, None

    R. Rodriguez-Herrera, None

    E. Chacon-Cruz, None

    A. Fernández, None

    L. Martínez-Medina, None

    L. B. Gámez-González, None

    L. Dueñas, None

    P. Pérez-Camacho, None

    C. Grazioso, None

    L. Franco, None

    N. Bueno, None

    S. Beltán, None

    J. A. Vázquez Narváez, None

    A. P. Salgado, None

    A. H. Tremoulet, None

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