Presentation and Outcomes of Kawasaki Disease in Latin American Infants Younger Than 6 Months of Age: A Multinational Multicenter Study of the REKAMLATINA Network

Moreno E.; Garcia S.D.; Bainto E.; Salgado A.P.; Parish A.; Rosellini B.D.; Ulloa-Gutierrez R.; Garrido-Garcia L.M.; Dueñas L.; Estripeaut D.; Luciani K.; Rodríguez-Quiroz F.J.; del Aguila O.; Camacho-Moreno G.; Gómez V.; Viviani T.; Alvarez-Olmos M.I.; de Souza Marques H.H.; Faugier-Fuentes E.; Saltigeral-Simental P.; López-Medina E.; Miño-León G.; Beltrán S.; Martínez-Medina L.; Pirez M.C.; Cofré F.; Tremoulet A.H. · Frontiers in Pediatrics (2020) · DOI: 10.3389/fped.2020.00384

Resumen

Objective: To characterize the clinical presentation and outcomes of Kawasaki disease (KD) in infants <6 months of age as compared to those ≥6 months in Latin America. Methods: We evaluated 36 infants <6 months old and 940 infants ≥6 months old diagnosed with KD in Latin America. We compared differences in laboratory data, clinical presentation, treatment response, and coronary artery outcomes between the two cohorts. Results: The majority (78.1%) of infants and children ≥6 months of age were initially diagnosed with KD, as compared to only 38.2% of infants <6 months. Clinical features of KD were more commonly observed in the older cohort: oral changes (92 vs. 75%, P = 0.0023), extremity changes (74.6 vs. 57.1%, P = 0.029), and cervical lymphadenopathy (67.6 vs. 37.1%, P = 0.0004). Whether treated in the first 10 days of illness or after the 10th day, infants <6 months were at greater risk of developing a coronary artery aneurysm compared to KD patients ≥6 months treated at the same point in the course of illness [≤ 10 days (53.8 vs. 9.4%, P = 0.00012); >10 days (50 vs. 7.4%, P = 0.043)]. Conclusion: Our data show that despite treatment in the first 10 days of illness, infants <6 months of age in Latin America have a higher risk of developing a coronary artery aneurysm. Delay in the diagnosis leads to larger coronary artery aneurysms disproportionately in these infants. Thus, suspicion for KD should be high in this vulnerable population. © Copyright