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

Abstract

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.