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Kawasaki disease and multisystem inflammatory syndrome in children. Differences, and similarities in a pediatric center in Mexico.

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Title: Kawasaki disease and multisystem inflammatory syndrome in children. Differences, and similarities in a pediatric center in Mexico.
Alternate Title: Enfermedad de Kawasaki y síndrome inflamatorio multisistémico en niños. Diferencias y similitudes en un centro pediátrico de México.
Authors: García-Domínguez, Miguel1 miguelgarcia.alergia@gmail.com, Anaya-Enríquez, Nancy2, Luque-Vega, Lynnete2, Canizales-Muñoz, Saúl3, Flores, Rosalino4, Tostado-Morales, Edgardo5, Torres, Cynthia G.6, Melchor, Vianey6, Quibrera, José7, Velázqueaz-Ríos, Carlos8, León-Ramírez, Ángel Rito8, Carreón-Guerrero, Juan Manuel8, Llausás-Magaña, Eduardo8
Source: Revista Alergia de Mexico. abr-jun2023, Vol. 70 Issue 2, p80-88. 9p.
Subjects: MUCOCUTANEOUS lymph node syndrome, SARS disease, CORONAVIRUS diseases, COMMUNICABLE diseases in children
Geographic Terms: MEXICO
Abstract (English): Objective: To evaluate the differences and similarities in clinical picture, laboratory findings and outcomes between children's with Kawasaki Disease (KD) versus multisystem inflammatory syndrome (MIS-C). Methods: We conducted a retrospective, comparative study from children with Kawasaki Disease (KD) hospitalized in Sinaloa Pediatric Hospital from January 1, 2004, to March 31, 2020, and patients with multisystem inflammatory syndrome (MIS-C) according with World Health Organization (WHO) case definition criteria between May 1, 2020 and May 31, 2021. Demographic characteristics, epidemiological data, clinical features, laboratory findings, type of treatment and clinical outcomes were compared among both groups. Results: Eighty-one patients were included (62 patients with KD and 19 with MIS-C). several clinical and laboratory differences were found among these two entities. Median age was lower in KD vs. MIS-C (25 vs 79 months). Those finding more frequent in KD were male gender (64.5 vs. 47.4%), Mucocutaneous features (93.5 vs. 63.2%): Oral changes (83.9 vs. 63.2%) and extremity changes (77.4 vs. 57.9%); complete form of KD was (75.8 vs. 47.4%), Coronary artery aneurysm (16.1 vs. 11.8%). Secondly, findings that were more frequent in MIS-C than KD were Gastrointestinal involvement (89.4 vs. 9.6%), shock (57.9 vs. 3.2%), neurological symptoms (63.1 vs. 11.2%), kidney involvement (52.6 vs. 16.1%), heart disease in general (52.9% vs 29%): Myocardial dysfunction (23.5 vs. 11.3%) and pericardial effusion (17.6 vs. 2.9%). Lymphocyte count (2.07 + 2.03 vs. 4.28 + 3.01/mm3), platelet count (197.89 + 187.51 vs. 420.37 + 200.08/mm3); serum albumin (2.29 + 0.65 vs. 3.33 + 0.06g/dL), and CPR (21.4 + 11.23 vs. 14.26 + 12.37 mg/dL). KD vs. MIS-C types of Treatment: IVIG (96.8 vs. 94.7%), systemic steroids (4.82 vs. 94.7%), IVIG resistance (19.4 vs. 15.8). Finally, mortality in KD was 0% and 5.3% in MIS-C. Conclusion: Similarities were found in both groups such as fever, rash, and conjunctivitis. Nevertheless, significant differences such as severity of clinical presentation with multi-organ involvement and worst inflammatory response were found more frequently in MIS-C group than KD group, requiring more fluid replacement, use of inotropic agents and higher steroids dosages. Also, mortality rate was higher in patients with MIS-C than patients with KD. Similar results have been observed in other studies where both disorders were compared. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Objetivo: Evaluar las diferencias y similitudes en el cuadro clínico, los hallazgos de laboratorio y desenlaces médicos de pacientes pediátricos con enfermedad de Kawasaki versus síndrome inflamatorio multisistémico. Métodos: Estudio comparativo y retrospectivo, efectuado en niños con enfermedad de Kawasaki, atendidos en el Hospital Pediátrico de Sinaloa, entre el 1 de enero de 2004 al 31 de marzo de 2020, y pacientes con síndrome inflamatorio multisistémico (según los criterios de la Organización Mundial de la Salud), del 1 de mayo de 2020 al 31 de mayo de 2021. Se evaluaron las características demográficas, epidemiológicos y clínicas, además de los hallazgos de laboratorio, tipo de tratamiento y desenlaces clínicos en ambos grupos. Resultados: Se incluyeron 81 pacientes: 62 con enfermedad de Kawasaki y 19 con síndrome inflamatorio multisistémico. Se encontraron varias diferencias clínicas y de laboratorio en ambas alteraciones. La mediana de edad fue menor en pacientes con enfermedad de Kawasaki versus síndrome inflamatorio multisistémico (25 vs 79 meses). La mayoría de los pacientes con enfermedad de Kawasaki fueron hombres (64.5 vs 47.4%), con características mucocutáneas (93.5 vs 63.2%): cambios orales (83.9 vs 63.2%) y cambios en las extremidades (77.4 vs 57.9%); la forma completa de enfermedad de Kawasaki fue 75.8 vs 47.4%, concomitante con aneurisma de la arteria coronaria (16.1 vs 11.8%). Los hallazgos más frecuentes en sujetos con síndrome inflamatorio multisistémico fueron: afectación gastrointestinal (89.4 vs 9.6 %), choque (57.9 vs 3.2%), síntomas neurológicos (63.1 vs 11.2%), afectación renal (52.6 vs 16.1%) y cardiopatías en general (52.9 vs 29%): disfunción miocárdica (23.5 vs 11.3%) y derrame pericárdico (17.6 vs 2.9%). La concentración media de linfocitos fue: 2.07 + 2.03 vs 4.28 + 3.01/mm3), plaquetas (197.89 + 187.51 vs 420.37 + 200.08/mm3); albúmina sérica (2.29 + 0.65 vs 3.33 + 0.06 g/dL) y PCR (21.4 + 11.23 vs 14.26 + 12.37 mg/dL). Los tratamientos en enfermedad de Kawasaki vs síndrome inflamatorio multisistémico: IVIG (96.8 vs 94.7%), corticosteroides sistémicos (4.82 vs 94.7%), resistencia a IVIG (19.4 vs 15.8). La mortalidad fue de 0 vs 5.3%. Conclusión: Se encontraron similitudes en cuanto a síntomas en ambos grupos (fiebre, exantema y conjuntivitis); no obstante, hubo diferencias significativas respecto de las manifestaciones clínicas, con afección multiorgánico y peor respuesta inflamatoria en pacientes con síndrome inflamatorio multisistémico, incluso mayor requerimiento de reposición de líquidos, administración de agentes inotrópicos, dosis más altas de corticosteroides, y elevada tasa de mortalidad. Estos resultados se han observado en otros estudios, donde se compararon ambos trastornos. [ABSTRACT FROM AUTHOR]
Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Kawasaki disease and multisystem inflammatory syndrome in children. Differences, and similarities in a pediatric center in Mexico.
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  Data: Enfermedad de Kawasaki y síndrome inflamatorio multisistémico en niños. Diferencias y similitudes en un centro pediátrico de México.
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  Data: <searchLink fieldCode="AR" term="%22García-Domínguez%2C+Miguel%22">García-Domínguez, Miguel</searchLink><relatesTo>1</relatesTo><i> miguelgarcia.alergia@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Anaya-Enríquez%2C+Nancy%22">Anaya-Enríquez, Nancy</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Luque-Vega%2C+Lynnete%22">Luque-Vega, Lynnete</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Canizales-Muñoz%2C+Saúl%22">Canizales-Muñoz, Saúl</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Flores%2C+Rosalino%22">Flores, Rosalino</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Tostado-Morales%2C+Edgardo%22">Tostado-Morales, Edgardo</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Torres%2C+Cynthia+G%2E%22">Torres, Cynthia G.</searchLink><relatesTo>6</relatesTo><br /><searchLink fieldCode="AR" term="%22Melchor%2C+Vianey%22">Melchor, Vianey</searchLink><relatesTo>6</relatesTo><br /><searchLink fieldCode="AR" term="%22Quibrera%2C+José%22">Quibrera, José</searchLink><relatesTo>7</relatesTo><br /><searchLink fieldCode="AR" term="%22Velázqueaz-Ríos%2C+Carlos%22">Velázqueaz-Ríos, Carlos</searchLink><relatesTo>8</relatesTo><br /><searchLink fieldCode="AR" term="%22León-Ramírez%2C+Ángel+Rito%22">León-Ramírez, Ángel Rito</searchLink><relatesTo>8</relatesTo><br /><searchLink fieldCode="AR" term="%22Carreón-Guerrero%2C+Juan+Manuel%22">Carreón-Guerrero, Juan Manuel</searchLink><relatesTo>8</relatesTo><br /><searchLink fieldCode="AR" term="%22Llausás-Magaña%2C+Eduardo%22">Llausás-Magaña, Eduardo</searchLink><relatesTo>8</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22Revista+Alergia+de+Mexico%22">Revista Alergia de Mexico</searchLink>. abr-jun2023, Vol. 70 Issue 2, p80-88. 9p.
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  Data: <searchLink fieldCode="DE" term="%22MUCOCUTANEOUS+lymph+node+syndrome%22">MUCOCUTANEOUS lymph node syndrome</searchLink><br /><searchLink fieldCode="DE" term="%22SARS+disease%22">SARS disease</searchLink><br /><searchLink fieldCode="DE" term="%22CORONAVIRUS+diseases%22">CORONAVIRUS diseases</searchLink><br /><searchLink fieldCode="DE" term="%22COMMUNICABLE+diseases+in+children%22">COMMUNICABLE diseases in children</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22MEXICO%22">MEXICO</searchLink>
– Name: Abstract
  Label: Abstract (English)
  Group: Ab
  Data: Objective: To evaluate the differences and similarities in clinical picture, laboratory findings and outcomes between children's with Kawasaki Disease (KD) versus multisystem inflammatory syndrome (MIS-C). Methods: We conducted a retrospective, comparative study from children with Kawasaki Disease (KD) hospitalized in Sinaloa Pediatric Hospital from January 1, 2004, to March 31, 2020, and patients with multisystem inflammatory syndrome (MIS-C) according with World Health Organization (WHO) case definition criteria between May 1, 2020 and May 31, 2021. Demographic characteristics, epidemiological data, clinical features, laboratory findings, type of treatment and clinical outcomes were compared among both groups. Results: Eighty-one patients were included (62 patients with KD and 19 with MIS-C). several clinical and laboratory differences were found among these two entities. Median age was lower in KD vs. MIS-C (25 vs 79 months). Those finding more frequent in KD were male gender (64.5 vs. 47.4%), Mucocutaneous features (93.5 vs. 63.2%): Oral changes (83.9 vs. 63.2%) and extremity changes (77.4 vs. 57.9%); complete form of KD was (75.8 vs. 47.4%), Coronary artery aneurysm (16.1 vs. 11.8%). Secondly, findings that were more frequent in MIS-C than KD were Gastrointestinal involvement (89.4 vs. 9.6%), shock (57.9 vs. 3.2%), neurological symptoms (63.1 vs. 11.2%), kidney involvement (52.6 vs. 16.1%), heart disease in general (52.9% vs 29%): Myocardial dysfunction (23.5 vs. 11.3%) and pericardial effusion (17.6 vs. 2.9%). Lymphocyte count (2.07 + 2.03 vs. 4.28 + 3.01/mm3), platelet count (197.89 + 187.51 vs. 420.37 + 200.08/mm3); serum albumin (2.29 + 0.65 vs. 3.33 + 0.06g/dL), and CPR (21.4 + 11.23 vs. 14.26 + 12.37 mg/dL). KD vs. MIS-C types of Treatment: IVIG (96.8 vs. 94.7%), systemic steroids (4.82 vs. 94.7%), IVIG resistance (19.4 vs. 15.8). Finally, mortality in KD was 0% and 5.3% in MIS-C. Conclusion: Similarities were found in both groups such as fever, rash, and conjunctivitis. Nevertheless, significant differences such as severity of clinical presentation with multi-organ involvement and worst inflammatory response were found more frequently in MIS-C group than KD group, requiring more fluid replacement, use of inotropic agents and higher steroids dosages. Also, mortality rate was higher in patients with MIS-C than patients with KD. Similar results have been observed in other studies where both disorders were compared. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (Spanish)
  Group: Ab
  Data: Objetivo: Evaluar las diferencias y similitudes en el cuadro clínico, los hallazgos de laboratorio y desenlaces médicos de pacientes pediátricos con enfermedad de Kawasaki versus síndrome inflamatorio multisistémico. Métodos: Estudio comparativo y retrospectivo, efectuado en niños con enfermedad de Kawasaki, atendidos en el Hospital Pediátrico de Sinaloa, entre el 1 de enero de 2004 al 31 de marzo de 2020, y pacientes con síndrome inflamatorio multisistémico (según los criterios de la Organización Mundial de la Salud), del 1 de mayo de 2020 al 31 de mayo de 2021. Se evaluaron las características demográficas, epidemiológicos y clínicas, además de los hallazgos de laboratorio, tipo de tratamiento y desenlaces clínicos en ambos grupos. Resultados: Se incluyeron 81 pacientes: 62 con enfermedad de Kawasaki y 19 con síndrome inflamatorio multisistémico. Se encontraron varias diferencias clínicas y de laboratorio en ambas alteraciones. La mediana de edad fue menor en pacientes con enfermedad de Kawasaki versus síndrome inflamatorio multisistémico (25 vs 79 meses). La mayoría de los pacientes con enfermedad de Kawasaki fueron hombres (64.5 vs 47.4%), con características mucocutáneas (93.5 vs 63.2%): cambios orales (83.9 vs 63.2%) y cambios en las extremidades (77.4 vs 57.9%); la forma completa de enfermedad de Kawasaki fue 75.8 vs 47.4%, concomitante con aneurisma de la arteria coronaria (16.1 vs 11.8%). Los hallazgos más frecuentes en sujetos con síndrome inflamatorio multisistémico fueron: afectación gastrointestinal (89.4 vs 9.6 %), choque (57.9 vs 3.2%), síntomas neurológicos (63.1 vs 11.2%), afectación renal (52.6 vs 16.1%) y cardiopatías en general (52.9 vs 29%): disfunción miocárdica (23.5 vs 11.3%) y derrame pericárdico (17.6 vs 2.9%). La concentración media de linfocitos fue: 2.07 + 2.03 vs 4.28 + 3.01/mm3), plaquetas (197.89 + 187.51 vs 420.37 + 200.08/mm3); albúmina sérica (2.29 + 0.65 vs 3.33 + 0.06 g/dL) y PCR (21.4 + 11.23 vs 14.26 + 12.37 mg/dL). Los tratamientos en enfermedad de Kawasaki vs síndrome inflamatorio multisistémico: IVIG (96.8 vs 94.7%), corticosteroides sistémicos (4.82 vs 94.7%), resistencia a IVIG (19.4 vs 15.8). La mortalidad fue de 0 vs 5.3%. Conclusión: Se encontraron similitudes en cuanto a síntomas en ambos grupos (fiebre, exantema y conjuntivitis); no obstante, hubo diferencias significativas respecto de las manifestaciones clínicas, con afección multiorgánico y peor respuesta inflamatoria en pacientes con síndrome inflamatorio multisistémico, incluso mayor requerimiento de reposición de líquidos, administración de agentes inotrópicos, dosis más altas de corticosteroides, y elevada tasa de mortalidad. Estos resultados se han observado en otros estudios, donde se compararon ambos trastornos. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – SubjectFull: SARS disease
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