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Abstract O-59: KAWASAKI DISEASE SHOCK SYNDROME (KDSS) IN CHILDREN FROM 16 LATIN AMERICAN (LA) COUNTRIES A 5-YEAR RETROSPECTIVE MULTICENTER STUDY OF THE REKAMLATINA NETWORK (JANUARY 2009-DECEMBER 2013)

Vargas-Gutierrez, M.1; Li-Chan, S.2; del Águila, O.3; Garrido-García, L.M.4; Saltigeral-Simental, P.5; Yamazaki-Nakashimada, M.A.6; Rodríguez-Herrera, R.7; Avila-Aguero, M.L.8; Soriano-Fallas, A.9; Camacho-Badilla, K.9; Dueñas, L.10; Estripeaut, D.11; Luciani, K.12; Rodriguez-Quiroz, F.J.13; Camacho-Moreno, G.14; Gómez, V.15; Salgado, A.P.16; Tremoulet, A.H.17; Ulloa-Gutierrez, R.18Y. The REKAMLATINA-2 Study Group Investigators

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 25–26
doi: 10.1097/01.pcc.0000537401.47484.d0
Oral Abstracts
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1Hospital Nacional de Niños “Dr.Carlos Sáenz Herrera”, Unidad de Cuidados Intensivos Pediátricos, San José, Costa Rica

2Hospital Nacional de Niños “Dr.Carlos Sáenz Herrera”, Posgrado de Pediatría- Universidad de Costa Rica, San José, Costa Rica

3Hospital Edgardo Rebagliati, Infectología Pediátrica, Lima, Peru

4Instituto Nacional de Pediatría, Servicio de Cardiología Pediátrica, Ciudad de México, Mexico

5Instituto Nacional de Pediatría, Servicio de Infectología Pediátrica, Ciudad de México, Mexico

6Instituto Nacional de Pediatría, Servicio de Inmunología Clínica, Ciudad de México, Mexico

7Instituto Nacional de Pediatría, Medicina Interna Pediátrica, Ciudad de México, Mexico

8Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Servicio de Intectología Pediátrica, San José, Costa Rica

9Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Servicio de Infectología, San José, Costa Rica

10Hospital Nacional de Niños Benjamín Bloom, Servicio de Infectologia, San Salvador, El Salvador

11Hospital del Niño, Departamento de Enfermedades Infecciosas, Ciudad Panama, Panama

12Hospital de Especialidades Pediátricas de la Caja de Seguro Social, Infectología Pediátrica, Ciudad Panama, Panama

13Instituto Hondureño de Seguridad Social, Inmunología y Reumatología Pediátrica, Tegucigalpa, Honduras

14Hospital de la Misericordia, Infectología Pediátrica, Bogotá, Colombia

15Centro Médico Universidad Central del Este, Infectología Pediátrica, Santo Domingo, Dominican Republic

16Pontificia Universidad Católica de Chile, Infectología Pediátrica, Santiago, Chile

17University of California San Diego- Kawasaki Disease Research Center/Rady Children’s Hospital San Diego, Infectious Diseases- Department of Pediatrics, San Diego- CA, USA

18Hospital Nacional de Niños “Dr.Carlos Sáenz Herrera”, Servicio de Infectología Pediátrica, San José, Costa Rica

19Hospitales Participantes, Infectología- Reumatología- Cardiología- Pediatría- Inmunología, Latin American participant countries, Costa Rica

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Aims & Objectives:

KD is the leading cause of pediatric acquired cardiac disease in developed countries. KDSS occurs approximately in 5–7% of KD cases; however, its recognition is difficult even among experienced clinicians. We describe the first retrospective multinational multicenter study of KDSS in LA children.

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Methods

Retrospective descriptive study of pts with a discharge diagnosis of classic or incomplete (atypical) KD who met KDSS criteria at 39 main referral hospitals from 16 LA countries. Study period: January-1st-2009 to December-31st-2013.

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Results

Among 976 enrolled KD pts, 8(0.81%) developed a KDSS. Classic and incomplete (atypical) KD was diagnosed in 6(75%) and 2(25%) pts, respectively. 5(62.5%) were female pts. 5(62.5%) pts were <60 months of age. Median length of hospitalization was 14(8–35) days. Median length of fever at admission was 6(4–8) days. In 3(37.5%) pts, sepsis/shock but not KDSS was the initial admission diagnoses. Antibiotics were given in all 8 pts prior to both final KD and KDSS diagnoses. On admission, 5(62.5%) pts looked poorly perfused, 5(62.5%) had thrombocytopenia, and 6(75%) hypoalbuminemia. IVIG, aspirin and steroids were given in 8(100%), 7(87.5%), and 5(62.5%) pts respectively. A second dose of IVIG was required in 4(50%) pts. Baseline echocardiograms showed: coronary artery dilations and/or aneurysms, 2(25.0%) pts; pericardial effusion, 2(25.0%); valvular insufficiency, 2(25.0%). No deaths occurred.

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Conclusions

Our incidence of KDSS is lower than reports from developed countries. However, difficulties in diagnosing KD and KDSS, misdiagnosis with sepsis/shock, and the retrospective nature probably reveal underestimates. KDSS cases were associated with prolonged hospitalizations, high rates of antibiotic use, and IVIG-resistance.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies