Abstract
Objective: To characterize the use of adjunctive therapy in Kawasaki disease (KD) in Latin America.Methods: The study included 1,418 patients from the Latin American KD Network (REKAMLATINA) treated for KD between January 1, 2009, and May 31, 2017.Results: Of these patients, 1,152 received only a single dose of IVIG, and 266 received additional treatment. Age at onset was similar in both groups (median 2 vs. 2.2 years, respectively). The majority of patients were male (58 vs. 63.9%) and were hospitalized with the first 10 days of fever (85.1 vs. 84.2%). The most common adjunctive therapy administered was steroids for IVIG-resistance, followed by additional doses of IVIG. The use of biologics such as infliximab was limited. KD patients who received adjunctive therapy were more likely to have a lower platelet count and albumin level as well as a higher Z score of the coronary arteries.Conclusion: This is the first report of adjunctive therapies for KD across Latin America. IVIG continues to be the initial and resistance treatment, however, steroids are also used and to a lesser extent, biological therapy such as infliximab. Future studies should address the barriers to therapy in children with acute KD throughout Latin America.
Highlights
Kawasaki disease (KD) is an acute systemic vasculitis in children
This study aimed to report the adjunctive therapies used to treat IVIG-resistant and high risk KD patients in Latin America
There were no significant differences in the number of leukocytes, hemoglobin concentration adjusted for age, erythrocyte sedimentation rate, C-reactive protein levels, alanine aminotransferase, or gammaglutamyl transpeptidase at the time of diagnosis between the two groups
Summary
Kawasaki disease (KD) is an acute systemic vasculitis in children. Publications about the epidemiology and available drugs and treatment schedules for children with acute KD in Latin America are scarce. One of the largest previous case summaries of children with KD in Mexico reported only 250 children in 32 years [5]. In a study of cases in Central America (Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama) Ulloa-Gutierrez et al found that from 2000 to 2010 there were only 11 reports from four countries, mostly consisting of single case reports and small series [6]. Costa Rica contributed the highest number of cases (124 cases over 13 years). No cases were reported for Nicaragua or Guatemala. No cases were reported for Nicaragua or Guatemala. [6]
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