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
California/Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States.
Pontificia Universidad Católica de Chile, Santiago, Chile.
Front Pediatr. 2020 Jul 16;8:384. doi: 10.3389/fped.2020.00384. eCollection 2020.
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. 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. 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%, = 0.0023), extremity changes (74.6 vs. 57.1%, = 0.029), and cervical lymphadenopathy (67.6 vs. 37.1%, = 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%, = 0.00012); >10 days (50 vs. 7.4%, = 0.043)]. 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.
为了描述拉丁美洲6个月以下婴儿与6个月及以上婴儿川崎病（KD）的临床表现和结局。我们评估了拉丁美洲36名6个月以下和940名6个月及以上被诊断为KD的婴儿。我们比较了两组队列在实验室数据、临床表现、治疗反应和冠状动脉结局方面的差异。6个月及以上的婴儿和儿童中，大多数（78.1%）最初被诊断为KD，而6个月以下婴儿中这一比例仅为38.2%。KD的临床特征在较大队列中更常见：口腔改变（92%对75%，P = 0.0023）、肢体改变（74.6%对57.1%，P = 0.029）和颈部淋巴结病（67.6%对37.1%，P = 0.0004）。无论在疾病的前10天内还是第10天后接受治疗，6个月以下婴儿与在疾病相同阶段接受治疗的6个月及以上KD患者相比，发生冠状动脉瘤的风险更高[≤10天（53.8%对9.4%，P = 0.00012）；>10天（50%对7.4%，P = 0.043）]。我们的数据表明，尽管在疾病的前10天内进行了治疗，但拉丁美洲6个月以下婴儿发生冠状动脉瘤的风险更高。诊断延迟在这些婴儿中不成比例地导致更大的冠状动脉瘤。因此，对于这一脆弱人群应高度怀疑KD。
