title: Clinical manifestations associated with Kawasaki disease shock syndrome in Mexican children.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Servicio de Inmunología Clínica, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C Col. Insurgentes Cuicuilco, Mexico D.F., Mexico.
authors.forename: Luisa Berenise
authors.initials: LB
authors.lastname: Gámez-González
authors.forename: Chiharu
authors.initials: C
authors.lastname: Murata
authors.forename: Mireya
authors.initials: M
authors.lastname: Muñoz-Ramírez
authors.forename: Marco
authors.initials: M
authors.lastname: Yamazaki-Nakashimada
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008800:Mexico; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D015995:Prevalence; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome