Kawasaki disease: clinical experience in a university hospital

OBJETIVO: A doença de Kawasaki é uma vasculite sistêmica aguda de etiologia desconhecida. Seu diagnóstico baseia-se em critérios clínicos. O objetivo deste estudo foi descrever os casos de pacientes com doença de Kawasaki internados no Hospital Universitário da Universidade de São Paulo entre janeiro/2000 e junho/2008. MÉTODOS: Dentre todos os pacientes internados na Enfermaria de Pediatria no período acima, foram selecionados aqueles cujo CID de alta foi doença de Kawasaki. Realizou-se estudo descritivo por meio da análise dos prontuários dessas crianças. RESULTADOS: Foram encontrados 18 casos. A média de internações foi de 2,1 casos/ano. A idade variou de três meses a nove anos. A proporção meninos:meninas foi 1:1,25. Receberam outros diagnósticos prévios 17 pacientes, sendo escarlatina em 2/3 dos casos. O tempo de febre antes do diagnóstico variou de cinco a 11 dias. Nove crianças apresentaram quatro sinais sugestivos de doença de Kawasaki; oito apresentaram cinco sinais e uma apresentou dois sinais, o que foi considerado doença de Kawasaki incompleta. Receberam gamaglobulina 15 crianças (entre o sexto e o décimo dias de evolução) e 11 (73%) ficaram afebris após infusão da medicação. Os demais tiveram febre até 24 horas após a administração. Todos os pacientes realizaram ecocardiograma e três apresentaram aneurisma leve da coronária. CONCLUSÕES: A doença de Kawasaki é habitualmente confundida com outras doenças, o que causa retardo no tratamento e aumento no risco de complicações cardíacas.OBJECTIVE: Kawasaki disease is an acute systemic vasculitis of unknown etiology. Its diagnosis is based on clinical criteria. This study aimed to describe Kawasaki disease cases treated at the University Hospital of Universidade de São Paulo, from January/2000 to June/2008. METHODS: Among all patients admitted to the pediatric ward during this period, patients whose discharge ICD was Kawasaki disease were selected. A descriptive study was carried out by analyzing the records of these children. RESULTS: 18 cases were found, with an average of 2.1 cases/year. Patients varied from three to nine years old. The boys/girls ratio was 1/1.25. Seventeen patients had previously been misdiagnosed with other diseases, being 2/3 of them scarlet fever. Prior to diagnosis, fever had persisted for five to 11 days. Nine patients showed four suggestive signs of Kawasaki disease, eight patients showed five signs, and one patient had two suggestive signs, which was considered as incomplete Kawasaki disease. Gammaglobulin was administered to 15 children (between the 6th-10th day of the disease), with 11 (73%) of them having no fever following the administration. The other ones had fever for up to 24 hours following gammaglobolin use. All patients were evaluated by echocardiograms, and three of them showed mild coronary aneurysm. CONCLUSIONS: Kawasaki disease is usually misdiagnosed, thereby delaying treatment and increasing the risk of heart

Cat-scratch disease presenting as multiple hepatic lesions: case report and literature review

Although infectious diseases are the most prevalent cause of fevers of unknown origin (FUO), this diagnosis remains challenging in some pediatric patients. Imaging exams, such as computed tomography (CT) are frequently required during the diagnostic processes. The presence of multiple hypoattenuating scattered images throughout the liver associated with the history of cohabitation with cats should raise the suspicion of the diagnosis of cat-scratch disease (CSD), although the main etiologic agent of liver abscesses in childhood is Staphylococcus aureus. Differential diagnosis by clinical and epidemiological data with Bartonella henselae is often advisable. The authors report the case of a boy aged 2 years and 9 months with 16-day history of daily fever accompanied by intermittent abdominal pain. Physical examination was unremarkable. Abdominal ultrasound performed in the initial work up was unrevealing, but an abdominal CT that was performed afterwards disclosed multiple hypoattenuating hepatic images compatible with the diagnosis of micro abscesses. Initial antibiotic regimen included cefotaxime, metronidazole, and oxacillin. Due to the epidemiology of close contact with kittens, diagnosis of CSD was considered and confirmed by serologic tests. Therefore, the initial antibiotics were replaced by clarithromycin orally for 14 days followed by fever defervescence and clinical improvement. The authors call attention to this uncommon diagnosis in a child presenting with FUO and multiple hepatic images suggestive of micro abscesses

Meningoencefalite concomitante a herpes zoster oftálmico em escolar previamente hígido

INTRODUÇÃO O vírus Varicella-Zoster é o agente da varicela, doença auto-limitada comum \ud da faixa etária pediátrica. Cerca de 20% dos casos evoluem com herpes zoster em algum \ud momento da vida, devido a reativação do vírus dos gânglios nervosos ou reexposição. O \ud envolvimento do ramo oftálmico do nervo trigêmio, defido como zoster oftálmico, tem como \ud complicação mais descrita a nevralgia pós-herpética, podendo evoluir com outras alterações \ud locais agudas e tardias. Meningoencefalites concomitante a herpes zoster são pouco descritas na \ud literatura. DESCRIÇÃO DO CASO Paciente de 9 anos, com antecedente de varicela com 1 ano \ud de idade, com queixa de vômitos e cefaléia há dois dias, associada a queda do estado gerale \ud hiporexia. Referiu aparecimento de lesões vesico-bolhosas dolorosas em região periorbitária \ud esquerda há 1 dia e evoluiu com agitação psicomotora e confusão mental. No exame físico de \ud entrada apresentava-se sonolento, com lesões vesico-bolhosas em dermátomo do ramo oftálmico \ud do nervo trigêmio, sem sinais de irritação meníngea ou déficits motores, sem alterações visuais \ud ou oculares. Realizada tomografia de crânio e eletroencefalograma sem alterações. Coletado \ud líquor que revelou líquido límpido e incolor, com aumento de celularidade às custas de \ud linfócitos, glicorraquia normal, bacterioscopia negativa e culturas negativas. Feita hipótese \ud diagnóstica inicial de herpes zoster oftálmico complicado com meningoencefalite e introduzido \ud aciclovir. Paciente evoluiu bem, com melhora do estado geral, remissão dos sintomas \ud neurológicos e melhora das lesões de pele. Evidenciado PCR positivo para o vírus varicela-zoster \ud (VVZ) no líquor. DISCUSSÃO Encontramos poucas descrições na literatura de herpes zoster \ud oftálmico associado à alterações neurológicas. A presença da PCR positiva no liquor foi \ud fundamental para o diagnóstico. CONCLUSÃO O VVZ pode reativar na forma de herper \ud zoster oftálmico e acometer o sistema nervoso central. Apesar de evento raro em crianças, \ud especialmente nas imunocompetentes, a presença da PCR positiva liquor confirmou a \ud meningoencefalite

The impact of varicella vaccination on varicella-related hospitalization rates: global data review

Abstract Objective: To describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. Data source: We identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. Data synthesis: 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4%&#8211;99.2% reduction in hospitalization rates in children younger than four years, 6&#8211;14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1&#8211;4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1&#8211;4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1&#8211;4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1&#8211;4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7%&#8211;73.8% decrease (general population), coverage of 60%&#8211;95%. Conclusions: The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data

The impact of varicella vaccination on varicella-related hospitalization rates: global data review

Abstract Objective: To describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. Data source: We identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. Data synthesis: 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4%–99.2% reduction in hospitalization rates in children younger than four years, 6–14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1–4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1–4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1–4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1–4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7%–73.8% decrease (general population), coverage of 60%–95%. Conclusions: The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data