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Kawasaki disease in infants 3 months of age and younger: a multicentre Spanish study
  1. Carlos Daniel Grasa1,
  2. Elisa Fernandez-Cooke1,
  3. Judith Sánchez-Manubens2,3,
  4. Jordi Antón2,
  5. David Crespo4,
  6. Moneyba García5,
  7. Agustín López6,
  8. María José Lirola Cruz7,
  9. Rafael Díaz-Delgado de la Peña8,
  10. Cristina Calvo9
  11. On behalf of the Spanish network for the study of Kawasaki disease, KAWA-RACE
    1. 1 Department of Paediatric Infectious Diseases, Doce de Octubre University Hospital, Madrid, Spain
    2. 2 Department of Paediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
    3. 3 Department of Paediatric Rheumatology, Hospital Parc Tauli, Sabadell, Spain
    4. 4 Department of Paediatric Cardiology, Fundación Hospital Alcorcón, Alcorcon, Spain
    5. 5 Department of General Paediatrics, Hospital Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas, Spain
    6. 6 Department of Paediatric Rheumatology, Hospital Puerta de Hierro, Majadahonda, Spain
    7. 7 Department of Paediatríc Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain
    8. 8 Department of Paediatric Infectious Diseases, Hospital Severo Ochoa, Leganes, Spain
    9. 9 Cristina Calvo Rey - Pediatrics Infectious Diseases, La Paz University Hospital, Madrid, Spain
    1. Correspondence to Dr Elisa Fernandez-Cooke, Department of Pediatrics Infectious Diseases, Doce de Octubre University Hospital, Madrid 28041, Spain; elisafcooke{at}gmail.com

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    Kawasaki disease (KD) is a multisystem vasculitis of small and medium vessels typical of childhood. Timely treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery abnormalities (CAAs) from 25% to approximately 4%.1 Asian studies have focused on infants under 3 months of age, but there are no published data about these patients from Western countries.2 3

    We reviewed 621 patients under 16 years old with a diagnosis of KD between 2011 and 2016 from a multicentre study in Spain (KAWA-RACE study); 84 hospitals participated throughout the country.

    We found seven children under 90 days (1.13%), with a male predominance (6 of 7). Five presented irritability, but only two fulfilled the criteria for complete KD (table 1).1 The following were the main laboratory findings (median, IQR): highest C reactive protein (CRP) 24 mg/L (8.48–31.4), highest erythrocyte sedimentation rate 79 mm (70–105.5), maximum and minimum platelet count 900 ×10^9/L (682–1 117) and 506 ×10^9/L (449–612), minimum haemoglobin 10 g/dL (9–10.8), maximum leucocytes 21 ×10^9/L (16.45–23.37), minimum sodium 135.5 mEq/L (133–137.5), and minimum albumin 2.9 mg/dL (2.6–3.4).

    View this table:
    Table 1

    Diagnosis, symptoms, cardiological and microbiological findings

    In three cases, a viral infection was diagnosed and four patients presented with CAA, but no other echocardiographic findings were detected (table 1).

    The median time interval since fever onset to IVIG administration was 8 days. All patients responded well to the first dose of IVIG, and only one received concomitant intravenous steroids because he was considered to be at high risk for IVIG resistance. All CAAs were transient and resolved during follow-up (table 1).

    Epidemiology is different in Western countries when compared with Asian …

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