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

  • Author(s): Moreno, Elizabeth
  • Garcia, S Diana
  • Bainto, Emelia
  • Salgado, Andrea P
  • Parish, Austin
  • Rosellini, Benjamin D
  • Ulloa-Gutierrez, Rolando
  • Garrido-Garcia, Luis M
  • Dueñas, Lourdes
  • Estripeaut, Dora
  • Luciani, Kathia
  • Rodríguez-Quiroz, Francisco J
  • Del Aguila, Olguita
  • Camacho-Moreno, Germán
  • Gómez, Virgen
  • Viviani, Tamara
  • Alvarez-Olmos, Martha I
  • de Souza Marques, Heloisa Helena
  • Faugier-Fuentes, Enrique
  • Saltigeral-Simental, Patricia
  • López-Medina, Eduardo
  • Miño-León, Greta
  • Beltrán, Sandra
  • Martínez-Medina, Lucila
  • Pirez, Maria C
  • Cofré, Fernanda
  • Tremoulet, Adriana H
  • The REKAMLATINA-2 Study Group Investigators
  • et al.
Abstract

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.

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