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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

    https://doi.org/10.1136/annrheumdis-2018-213891

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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).

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      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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      Footnotes

      • Handling editor Josef S Smolen

      • Collaborators On behalf of the Spanish network for the study of Kawasaki disease, KAWA-RACE.

        Elisa Fernández-Cooke, Marisa Navarro, Cristina Calvo Rey, JordiAntón López, Judith Sánchez-Manubens, Ana Barrios Tascón, Esmeralda NuñezCuadros, David Moreno Perez, Javier Aracil Santos, María Martín Cantero, Esmeralda Nuñez Cuadros, Begoña Carazo Gallego, Leticia Isabel Martínez Campos, Fernando Sánchez García, Marisol Camacho Lovillo, Renata Marqués, Olaf Neth, Laura, Fernández Silveira, Miguel Sánchez Forte, Ángeles Ortega Montes, Beatriz Bravo Mancheño, Margarita Camacho, Antonio F Medina Claros, Carlos Salido,Rafael Chulian Cruz, María Torres Rico, Mª Ángeles Tejero Hernández, ElenaGómez Guzmán, Mª José Arroyo Marín, José Rumbao Aguirre, Mª José Lirola Cruz, Kety Maya Carrasco, Moisés Rodríguez González, Enrique Blanca Jover, Aida Ruiz López, José Uberos Fernández, María Mercedes Ibáñez Alcalde, Matilde Bustillo Alonso, Pilar Collado, Carmelo Guerrero Laleona, Lorenzo Jiménez Montañés, Ariadna Ayerza Casas, Bárbara Montes Zapico, Carlos Pérez Méndez, Javier Fernández Aracama, Lucia Rodríguez, María Aleida Ibáñez Fernández, Sandra Navarro Campo, Silvia Escribà Bori, María Concepción Mir Perelló, MªÁngeles de la Fuente Sánchez, Patricia Aparicio García, Carlos Briales, Joaquín Castilla Crespí, María Elena Colino Gil, Nerea Delgado Cabrera, Ana Bello Naranjo, Jesús Poch Páez, Moneyba García Yáñez, Montse González García, Elena Pereira Bezanilla, Beatriz Jiménez Montero, Olga Domínguez García, Begoña Losada Pinedo, Gema Iñigo Martín, Lucía María Escribano Gómez, Antonio Cepillo, Miguel Lillo Lillo, María Isabel Buedo, Laura del Rey, Elena Urbaneja Rodríguez, Sara Rellán Rodríguez, Teresa Cantero, Beatriz Plata Izquierdo, Luisa García-Cuenllas Álvarez, Ignacio Oulego Erroz, Elena Pérez Santaolalla, Carlos Alcalde Martín, Fernando Centeno Malfaz, Elena Pérez Gutiérrez, Marisol Jiménez Casso, Fredy Prada, Rosa Bou, Estibaliz Iglesias, Joan Calzada, Olga Calavia Garsaball, Marc Tobeña Rue, Gemma Giralt García, Silvia Yevenes Ruiz, Zulema Lobato, Neus Rius Gordillo, Montserrat Pascual Torres, María Méndez Hernández, Lourdes García, Sergio Flores Villar, Laura Minguell Domingo, Anna Ballester, Ana Miralles, Berta Pujol Soler, Anton Foguet Vidal, Pere SalaCastellví, Angelita Serrano Aguiar, José Manuel Siurana Rodríguez, Anna Sangorrin Iranzo, Roser Álvarez Pérez, Paula Ribes Cajas, Pere Genaró i Jornet, Ana Grande Tejada, Cristina Zarallo, Federico Martinón-Torres, Irene Rivero Calle, Antonio Justicia Grande, Beatriz Ruiz Saez, María López Sousa, Alejandro Souto Vilas, Bernardo López Abe, Elisa de Miguel Esteban, Bibiana Riaño Méndez, Daniel Blázquez, Pablo Rojo Conejo, Maribel González Tomé, Carlos Grasa Lozano, Belén Toral, Leticia Albert De la Torre, Jaime de Inocencio, Mar Santos, RafaelDíaz-Delgado de la Peña, Paz Collado Ramos, Alfredo Tagarro, Teresa Raga, Libertad Latorre, Sara Guillen, Ignacio Callejas Caballero, Luis Manuel Prieto Tato, María Fernanda Guzmán Monagas, Isabel Jiménez López, Sandra Villagrá, Viviana Arreo, RoiPiñeiro Pérez, María de la Parte, Enrique Villalobos Pinto, Daniel Clemente Garulo, Amalia Tamariz-Martes, Marta Llorente Romano, Belén Hernández Rupérez, Sonia Rodríguez Martin, Henar Rojo Sombrero, Estefanía García Cerro, Irene Maté Cano, Marta Villares Alonso, Marta Pilar Osuna Marco, Julia Jensen Veron, Cristina Zarallo, María Dolores Rodríguez Mesa, Santiago Rueda Esteban, José Tomás Ramos Amador, Cristina González Menchén, Ana Belén Jiménez Jiménez, Pilar Galán, DoloresPérez Campos, Mª Mercedes Bueno, David Crespo Marcos, Enrique Otheo de Tejada Barásoain, Walter Alberto Sifuentes Giraldo, María Luz Gámir Gámir, María JoséCilleruelo Ortega, Agustín López López, Cristina Sánchez Vaquerizo, Ana IsabelUsano Carrasco, Ester Moreno Gómez, Jaime Carrasco Colom, Olga Carvajal delCastillo, Beatriz Del Pozo Menéndez, Katie Badillo Navarro, Fernando Baquero, Lucía Deiros Bronte, Pablo Fernández Fraga, Nieves Domínguez, Beatriz Mercader Rodríguez, Francisco Castro García, Elena Vera Romero, Águeda Herrera Chamorro, Paula Alcañiz Rodríguez, Moisés Sorlí García, María Concepción Rex Nicolás, Ana Lorente Nicolás, Patricia Martínez Olorón, Beatriz Rocandio Cilveti, Amaia Berridi, Laura Santos-Díez Vázquez, Olaia Fernández, Amparo Pérez Tamarit, Inmaculada Calvo, Berta López, Mª Isabel González Fernández, Mª Carmen Otero, Manuel Oltra, Marta Dapena Archilés, Paco Sánchez, César Gavilán, Ignacio Izquierdo Fos, María Isabel Serrano Robles, Yolanda Herranz Sánchez.

      • Contributors All authors have contributed substantially to the development of this work and letter.

      • Funding KawaRace received a Grant from Spanish Society of Paediatric Rheumatology (SERPE).

      • Competing interests None declared.

      • Patient consent Not required.

      • Ethics approval Ethics Committee of Doce de Octubre University Hospital.

      • Provenance and peer review Not commissioned; externally peer reviewed.