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European Journal of Pediatrics

, Volume 172, Issue 3, pp 337–342 | Cite as

Clinical manifestations associated with Kawasaki disease shock syndrome in Mexican children

  • Luisa Berenise Gámez-González
  • Chiharu Murata
  • Mireya Muñoz-Ramírez
  • Marco Yamazaki-NakashimadaEmail author
Original Article

Abstract

Recently, there have been increasing reports of severe forms of Kawasaki disease (KD) associated with shock that have been managed in pediatric intensive care units. It has been suggested that KD is more severe in the Hispanic population. We conducted a study to determine the frequency of Kawasaki disease shock syndrome (KDSS) in our population and compared characteristics between patients with KD without shock and patients with KDSS. Data from 214 patients with KD treated in a tertiary pediatric hospital were collected during a 12-year period. We compared clinical and laboratory features of KD patients without shock and KDSS patients. Of 214 consecutive patients with KD, 11 (5 %) met the definition for KDSS. All of these patients received fluid resuscitation, seven (64 %) required inotropic treatment, and six (54 %), ventilatory support. On admission, seven of these patients (64 %) had an incomplete presentation of the disease, whereas in the group of patients without shock, the relative frequency of an incomplete presentation was 29 %. Twenty percent (3/11) of patients with KDSS presented giant coronary aneurysms versus none of 203 KD patients without shock (p = 0.001); myocardial infarction, 27 % (3/11), versus 1 % (2/203) (p = 0.001); and intravenous immunoglobulin (IVIG) resistance, 60 % (6/11), versus 12 % (24/203). Gastrointestinal manifestations in the acute phase occurred in 91 % of KDSS patients versus 30 % patients without shock (p = 0.001). Conclusion. Patients with KD presenting in shock seem to have an increase in gastrointestinal manifestations, incomplete presentation, IVIG resistance, and worse cardiac outcomes. Larger, prospective, multicentre studies should be carried out to corroborate these findings.

Keywords

Kawasaki disease Shock Gastrointestinal involvement IVIG resistance 

Notes

Acknowledgments

We are deeply thankful to Dr. Martín Cisneros and Dr. Alberto Unzueta for their critical review of the manuscript and insightful discussion.

Conflict of interest

The authors declare that they do not have any financial relationship with any sponsor regarding this manuscript.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Luisa Berenise Gámez-González
    • 1
  • Chiharu Murata
    • 2
  • Mireya Muñoz-Ramírez
    • 3
  • Marco Yamazaki-Nakashimada
    • 1
    Email author
  1. 1.Servicio de Inmunología ClínicaInstituto Nacional de PediatríaMexico D.F.Mexico
  2. 2.Departamento InvestigaciónInstituto Nacional de PediatríaMexico D.F.Mexico
  3. 3.Departamento Terapia IntensivaInstituto Nacional de PediatríaMexico D.F.Mexico

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