About 10-20% of patients with Kawasaki disease (KD) are unresponsive to intravenous immunoglobulin (IVIg) and are at increased risk of coronary artery abnormalities (CAAs). Early identification is critical to initiate aggressive therapies, but available scoring systems lack sensitivity in non-Japanese populations. We investigated the accuracy of 3 Japanese scoring systems and studied factors associated with IVIg unresponsiveness in a large multiethnic French population of children with KD to build a new scoring system. Children admitted for KD between 2011-2014 in 65 centers were enrolled. Factors associated with second line-treatment; i.e. unresponsiveness to initial IVIg treatment, were analyzed by multivariate regression analysis. The performance of our score and the Kobayashi, Egami and Sano scores were compared in our population and in ethnic subgroups. Overall, 465 children were reported by 84 physicians; 425 were classified with KD (55% European Caucasian, 12% North African/ Middle Eastern, 10% African/Afro-Caribbean, 3% Asian and 11% mixed). Eighty patients (23%) needed second-line treatment. Japanese scores had poor performance in our whole population (sensitivity 14-61%). On multivariate regression analysis, predictors of secondary treatment after initial IVIG were hepatomegaly, ALT level ≥30 IU/L, lymphocyte count <2400/mm 3 and time to treatment <5 days. The best sensitivity (77%) and specificity (60%) of this model was with 1 point per variable and cutoff ≥2 points. The sensitivity remained good in our 3 main ethnic subgroups (74-88%). We identified predictors of IVIg resistance and built a new score with good sensitivity and acceptable specificity in a non-Asian population. Kawasaki disease (KD) is the leading cause of acquired heart disease in childhood in developed countries 1. The level of coronary artery involvement mainly determines the prognosis of this systemic vasculitis affecting predominantly young children, although pericarditis, myocarditis and valvular dysfunction are not uncommon 1,2. Occasionally, KD can be complicated during the acute phase by shock syndrome 3 , macrophage activation syndrome 4 , or myocardial infarction 1. Although the mortality rate is relatively low during the acute phase, sudden death due to myocardial ischemia could occur many years later in children or adults with coronary artery sequelae 1. The efficacy of early treatment with intravenous immunoglobulin (IVIg) is well established 5,6 and has reduced the prevalence of coronary artery abnormalities (CAAs) from 26-30% to 2.5-5% at 1 month after disease onset 6,7. However, 30% to 40% of KD patients develop coronary dilatations within the first days of the disease 8. In addition,

The genital candidiasis is one of the pathogenic demonstrations of yeast. Candida albicans is the most frequent species; it is usually isolated in 85 to 90% from the vaginal mycoses (Odds et al. 1988).Vaginal candidiasis affects females at least once during their lifetime, at an estimated rate of 70 to 75%, of whom 40 to 50% will experience a recurrence (Sobel 1999).In Nicaragua, we know very little about the prevalence and incidence of vaginal candidiasis and no study of the biology of C. albicans has been carried out. In this country, diagnosis of vaginal candidiasis is mainly based on the clinical presentation. Laboratories of the hospitals and health centres (peripheral laboratories) carry out only the microscopic diagnosis from the vaginal fluid. In the laboratory of the National Centre of Diagnosis and Reference of Nicaragua (CNDR), the yeast identification is based on the observation of the microscopic aspects, culture and biochemical tests.Most of the genetic studies revealed that C. albicans is predominantly clonal (Pujol et al. 1993, Helstein et al. 1993, Lockhart et al. 1995, Xu et al. 1999. Some authors have proposed that clonal propagation with a remaining capacity of recombination, shape the population structure of C. albicans (Caugant & Sandven 1993, Gräser et al. 1996, Tibayrenc 1997 Southern blot hybridization with the moderately repetitive DNA Ca3 probe, not only clustered moderately related isolates in a similar fashion but also afforded similar levels of resolution of microevolution within a clonal population.The goal of this study was to use the RAPD method to examine the patterns of yeast genetic diversity among women with vaginitis from a single geographic area. We were specifically interested to know the frequency of yeast in vulvovaginal secretions. We also compared the conventional methods of yeast diagnosis from vaginal samples used in Nicaragua and yeast culture method. MATERIALS AND METHODSThe vaginal swabs were taken from 106 women exhibiting symptoms of vulvovaginitis, who were attended in the outpatient ward of the CNDR in Managua, Nicaragua, between June and August 1997. Swabs were processed by the method routinely used for the detection of germinated yeast pathogens: microscopic examination of wet mount, with a 10% potassium hydroxide (KOH) preparation, and the Gram's stain. Samples were inoculated into Sabouraud-glucose agar, supplemented with chloramphenicol, and were incubated at 37°C for 48 h. For identification of C. albicans, isolates were placed in foetal calf serum for 4 h to test for the production of germ tubes and were incubated on Rice-Agar-Tween (RAT ® ) BioMérieux Laboratories, France for 48 h to induce chlamydospores. All yeast isolates were preliminary identified to the species level according to the CHROMagar Albicans® Test (Mycoplasme International, Toulon, France). This medium contains a chromogene substrate for immediate identification of C. albicans (green), C. tropicalis (metallic blue), C. glabrata (pink) and C. krusei (pale pink). Yeast species were conf...

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Background KD is the main vasculitis affecting children before 5 years and the leading cause of acquired heart disease in childhood. The epidemiologic characteristics of KD are few reported in Europe and especially in France within a population from different ethnic backgrounds. Even IVIG is still the standard treatment of KD; the management of patients at risk for cardiac complications may change toward reinforced (and new) therapeutic approaches. Objectives Kawanet is a clinical and biological data repository aimed to define the epidemiological characteristics of KD, in France. Kawanet will compare clinical characteristics between distinct ethnic backgrounds and will define risk factors for resistance to standard treatment (IVIG) and for cardiac complications Methods Targeted institutional physicians received information on a national registry for KD. All patients suspected with KD and seen since January 2011 were eligible to enter the study. An eCRF was implemented in a web secured database (CLEANWeb). IRB approval and authorization for data storage were obtained. Results 419 cases were entered into the registry and complete information was available for 351 of them, in January 2014. Patients (57% males/43% females) were enrolled by 77 physicians from 52 centres: they originated from 5 main ethnical backgrounds: 67% European Caucasian, 15% afro-Caribbean, 13% Eastern Caucasian or North African, 4% Asian and 1% of mixed ancestry. The median age at diagnosis was 2.4y (3m-26y). A family history of KD was present in 5 patients. The clinical symptoms were (%): conjunctivitis 85, cheilitis 83, diffuse exanthema 74, fever ≥5 days 63, oral erythema 61, modification of the extremities 57, cervical adenopathy 49, oedema 47, raspberry tongue 45, desquamation 40, seat erythema 26 and perineal desquamation 17. Cardiac complications were reported in 186/328 patients (42%): coronary dilatation 28%, pericarditis 17%, coronary aneurysm 4%, and myocarditis 3%. At diagnosis of 351 patients: 135 had complete KD according to the AAC definition, 56 were incomplete, 118 doubtful and 42 not classified. 327/331 (99%) patients received IVIG, 20% (n=64) required 2 courses, and 5 patients 3 courses. 11% required steroids, 93% received Aspirin and 1 Anti-TNF. The mean delay between fever onset and treatment was 6 days. Conclusions The awareness on KD appears very high in France, even the completed forms are relatively rare (38%). The rate of coronary abnormalities was elevated, in comparison to other series even though 1/3 of patients receiving IVIG had doubtful diagnosis of KD. The IVIG resistance rate was 20%. Factors associated with IVIG resistance in our population are currently analysed Acknowledgements To the French KD study group Supported by a grant from the French ministry of health: PHRCN2009 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3534