Browsing by Author "Faugier-Fuentes, Enrique"

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    Presentation and Outcomes of Kawasaki Disease in Latin American Infants Younger Than 6 Months of Age: A Multinational Multicenter Study of the REKAMLATINA Network
    (2020) Moreno, Elizabeth; Garcia, S. Diana; Bainto, Emelia; Salgado, Andrea P.; Parish, Austin; Rosellini, Benjamin D.; Ulloa-Gutierrez, Rolando; Garrido-Garcia, Luis M.; Duenas, Lourdes; Estripeaut, Dora; Luciani, Kathia; Rodriguez-Quiroz, Francisco J.; del Aguila, Olguita; Camacho-Moreno, German; Gomez, Virgen; Viviani, Tamara; Alvarez-Olmos, Martha, I; de Souza Marques, Heloisa Helena; Faugier-Fuentes, Enrique; Saltigeral-Simental, Patricia; Lopez-Medina, Eduardo; Mino-Leon, Greta; Beltran, Sandra; Martinez-Medina, Lucila; Pirez, Maria C.; Cofre, Fernanda; Tremoulet, Adriana H.
    Objective:To characterize the clinical presentation and outcomes of Kawasaki disease (KD) in infants Methods: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. Results: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%,P= 0.0023), extremity changes (74.6 vs. 57.1%,P= 0.029), and cervical lymphadenopathy (67.6 vs. 37.1%,P= 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%,P= 0.00012); >10 days (50 vs. 7.4%,P= 0.043)]. Conclusion: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.
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    Use of Adjunctive Therapy in Acute Kawasaki Disease in Latin America
    (2020) Fortuna-Reyna, Brenda; Bainto, Emelia V.; Ulloa-Gutiérrez, Rolando; Garrido-García, Luis M.; Estripeaut, Dora; del Águila, Olguita; Gómez, Virgen; Faugier-Fuentes, Enrique; Miño-León, Greta; Beltrán, Sandra; Cofré, Fernanda; Chacón-Cruz, Enrique; Saltigeral-Simental, Patricia; Martínez-Medina, Lucila; Dueñas, Lourdes; Luciani, Kathia; Rodríguez-Quiroz, Francisco J.; Camacho-Moreno, Germán; Viviani, Tamara; Álvarez-Olmos, Martha I.; de Sousa Marques, Heloisa Helena; López-Medina, Eduardo; Pirez, María C.; Tremoulet, Adriana H.; Borzutzky Schachter, Arturo; Kawasaki Disease REKAMLATINA Network Study Group
    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