Neurological manifestation of Brazilian spotted fever in childhood.

Rocky Mountain Spotted Fever is a rickettsial disease caused by the bacteria Rickettsia rickettsii. In Brazil, the disease is known as Brazilian spotted fever (BSF), being the most significant tick-borne disease in the country. Among the affected patients, only 5% of cases occur in children aged one to nine years. Typical symptoms of the disease are fever, rash, headache and digestive symptoms. Neurological manifestations such as seizures, aphasia and hemiparesis have been described in few patients. This study aimed to describe the case of an infant diagnosed with BSF who presented severe signs of neurological manifestation.

Missed opportunities in the prevention and diagnosis of pediatric tuberculosis: a scoping review.

OBJECTIVES: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. METHODS: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18 years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. RESULTS: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. CONCLUSIONS: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken.

Neurological manifestation of Brazilian spotted fever in childhood

ABSTRACT Rocky Mountain Spotted Fever is a rickettsial disease caused by the bacteria Rickettsia rickettsii. In Brazil, the disease is known as Brazilian spotted fever (BSF), being the most significant tick-borne disease in the country. Among the affected patients, only 5% of cases occur in children aged one to nine years. Typical symptoms of the disease are fever, rash, headache and digestive symptoms. Neurological manifestations such as seizures, aphasia and hemiparesis have been described in few patients. This study aimed to describe the case of an infant diagnosed with BSF who presented severe signs of neurological manifestation.

Neuro-COVID-19 With or Without the Multisystem Inflammatory Syndrome (MIS-C): A Single-Center Study : COVID-19: Neurologic Manifestations in Children.

This study evaluates the range of neurological manifestation in children with COVID-19 (neuro-COVID-19) both with and without the multisystem inflammatory syndrome (MIS-C) and the persistence of symptoms after hospital discharge. The study was conducted as a prospective study of children and adolescents under 18 years of age who were admitted to a children's hospital for infectious diseases from January 2021 to January 2022. The children had no previous neurological or psychiatric disorders. Out of the 3021 patients evaluated, 232 were confirmed to have COVID-19 and 21 of these patients (9%) showed neurological manifestations associated with the virus. Of these 21 patients, 14 developed MIS-C, and 7 had neurological manifestations unrelated to MIS-C. There was no statistical difference regarding the neurological manifestations during hospitalization and outcomes between patients with neuro-COVID-19 who had or did not have MIS-C, except for seizures that occurred more frequently in patients with neuro-COVID-19 without MIS-C (p-value = 0.0263). One patient died, and 5 patients still had neurological or psychiatric manifestations at discharge, which persisted for up to 7 months. The study highlights that SARS-CoV-2 infection can affect the central and peripheral nervous system, particularly in children and adolescents with MIS-C, and that it is crucial to be vigilant for long-term adverse outcomes, as the neurological and psychiatric effects of COVID-19 in children are emerging during an important stage of brain development.

Children with sickle cell disease and severe COVID-19 presenting single nucleotide polymorphisms in innate immune response genes - A case report.

Here we report three clinical cases of children with sickle cell disease (SCD) and severe COVID-19 who evolved with complications during hospitalization or after discharge. They present single nucleotide polymorphisms in tlr-7 and tirap genes, identified from 37 patients under 16 years old hospitalized from September 2020 to May 2021 in the Hospital João Paulo II, Belo Horizonte, Brazil. They presented significant complications of SCD as acute chest syndrome, splenic sequestration, and pain crisis during hospitalization or up to 2 months after SARS-CoV-2 infection. They all required transfusion of concentrated red blood cells and hospitalization in a reference hospital to care for children with SCD.

Impact of six years of routine varicella vaccination on the disease-related hospitalizations at Minas Gerais, Brazil.

INTRODUCTION: The varicella vaccine was first introduced into the Brazilian immunization schedule in September 2013 as a single dose for children aged 15 months. In 2018, a second dose was recommended for individuals between 4 and 6 years old. This study aims to assess the impact of routine varicella vaccination on the number and profile of hospitalized varicella patients during the single dose period, as well as in the first two years after the adoption of the second dose. METHODS: An observational retrospective study was conducted in an infectious disease pediatric hospital, in Minas Gerais, Brazil. Clinical as well as epidemiological data from patients hospitalized due to varicella between 2010 and 2019 were collected. Patients were split into groups based on the vaccine introduction: pre-vaccine period, single dose and two-dose period. They were compared by age, sex, reason for admission, illness-related complications and clinical outcome. RESULTS: There were 1193 admissions due to varicella during the studied period. When compared with the pre-vaccine period, the number of hospitalizations decreased in 61.5% during the single-dose regime, reaching 95.2% in the two-dose period. Hospitalization rates decreased in all age groups, including non-vaccinated individuals such as those younger than 12 months (92.1%). As for reasons of admission, secondary bacterial skin infections were perceived to be the most common cause (>70%). A reduction was also seen in admission of immunocompromised or HIV positive patients (84.8%). CONCLUSION: The collected data shows a significant impact in the number of hospital admissions due to varicella after six years of the implementation of the vaccine, positively affecting both vaccinated and non-vaccinated individuals. Further reduction was seen after the second dose was initiated, but its true impact will only be understood fully after a longer period of continuous vaccination.

Hemophagocytic lymphohistiocytosis and visceral leishmaniasis in children: a series of cases and literature review.

OBJECTIVE: Hemophagocytic lymphohistiocytosis syndrome (HLHS) is characterized by an immunological hyperactivation of cytotoxic T cells, natural killer cells, and macrophages, leading to the secretion of proinflammatory cytokines. HLHS associated with Visceral Leishmaniasis might be difficult to diagnose once symptoms are similar, resulting in the death of untreated patients. Our aim is to describe a series of cases of Visceral Leishmaniasis with HLHS admitted to a referral hospital for infectious diseases. CASE DESCRIPTION: All 115 cases of Visceral Leishmaniasis referred to a referral center for pediatric infectious diseases were reviewed to identify the cases of HLHS. Five cases (4.5%) were confirmed with HLHS and they presented fever, splenomegaly, cytopenia, hypertriglyceridemia or hypofibrinogenemia, increased ferritin and hemophagocytosis in the bone marrow. COMMENTS: It important to rule out HLHS in children with infectious diseases that do not respond adequately to treatment or in patients with severe symptoms, especially in leishmaniasis endemic areas.

NUMBER OF CASES OF VARICELLA AND HOSPITALIZATION IN A PEDIATRIC REFERENCE HOSPITAL IN BRAZIL AFTER INTRODUCING THE VACCINE.

OBJECTIVE: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. METHODS: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians' medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. RESULTS: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. CONCLUSIONS: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

DIAGNOSTIC VALUE OF THE REACTION AT THE BACILLUS CALMETTE-GUÉRIN VACCINATION SITE IN KAWASAKI DISEASE.

OBJECTIVE: To describe the case of an infant - diagnosed with incomplete Kawasaki disease - who developed BCG scar reactivation. CASE DESCRIPTION: A 6-month-old patient was admitted to hospital with fever associated with ocular hyperemia, cervical lymphadenopathy, and hyperemic lips, and remained hospitalized for 12 days. The physical examination revealed an inflammatory reaction at the site of the BCG scar, leading to the diagnosis of incomplete Kawasaki disease. The patient was treated with venous immunoglobulin, but presented recurrence of Kawasaki disease, with subsequent onset of coronary artery disease. COMMENTS: BCG scar reactivation is an important finding in countries where the vaccine is routinely given and may be a useful marker for early diagnosis of Kawasaki disease, especially in its incomplete form.

Number of cases of varicella and hospitalization in a pediatric reference hospital in brazil after introducing the vaccine / Avaliação do número de casos e do perfil de internações por varicela em hospital pediátrico após a introdução da vacina

ABSTRACT Objective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians' medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

RESUMO Objetivo: Avaliar o número de casos e o perfil das internações por varicela após a introdução da vacina quádrupla viral na rede pública. Métodos: Estudo retrospectivo conduzido em hospital pediátrico referência em doenças infectocontagiosas na Região Sudeste do Brasil. Foram avaliados os casos com diagnóstico clínico de varicela, registrados em prontuário por médico pediatra, de janeiro de 2011 até junho de 2016. As internações foram classificadas em grupo pré-vacinal e grupo pós-vacinal, com base na data de introdução da vacina (setembro de 2013). Os grupos foram comparados em relação a: faixa etária, sexo, tempo de hospitalização, causas da internação, complicações hospitalares, tempo da internação em terapia intensiva e desfecho clínico. Resultados: Foram documentadas 830 internações, 543 no período pré-vacinal e 287 no pós-vacinal, ocorrendo redução de 47,1% nas internações (p<0,001). Em ambos os períodos, notou-se um perfil similar das internações, predominantemente: sexo masculino; faixa etária de um a cinco anos; por causas secundárias (principalmente infecções de pele); evoluindo com melhora clínica e alta hospitalar. Em relação ao número de óbitos, ocorreram seis no período pré-vacinal e dois no pós-vacinal. Conclusões: A manutenção do perfil das internações era esperada, visto que o trabalho não comparou crianças vacinadas com não vacinadas, e sim internações pré e pós-vacinais. Observou-se, em concordância com a literatura, queda substancial no número de internações por varicela.

Diagnostic value of the reaction at the bacillus calmette-guérin vaccination site in kawasaki disease / Utilidade diagnóstica da reação do sítio de vacinação bacillus calmette-guérin na doença de kawasaki

ABSTRACT Objective: To describe the case of an infant - diagnosed with incomplete Kawasaki disease - who developed BCG scar reactivation. Case description: A 6-month-old patient was admitted to hospital with fever associated with ocular hyperemia, cervical lymphadenopathy, and hyperemic lips, and remained hospitalized for 12 days. The physical examination revealed an inflammatory reaction at the site of the BCG scar, leading to the diagnosis of incomplete Kawasaki disease. The patient was treated with venous immunoglobulin, but presented recurrence of Kawasaki disease, with subsequent onset of coronary artery disease. Comments: BCG scar reactivation is an important finding in countries where the vaccine is routinely given and may be a useful marker for early diagnosis of Kawasaki disease, especially in its incomplete form.

RESUMO Objetivo: Descrever o caso de um lactente - com diagnóstico de Doença de Kawasaki incompleta - que desenvolveu reativação da cicatriz da vacina BCG. Descrição do caso: Um paciente de 6 meses de idade foi admitido no hospital com febre, associada à hiperemia ocular, linfadenomegalia cervical e fissuras labiais, permanecendo hospitalizado por 12 dias. Apresentava, no exame físico, reação inflamatória no local da cicatriz da vacina BCG, tendo sido feito o diagnóstico de Kawasaki incompleto. O paciente foi tratado com imunoglobulina venosa, mas apresentou recorrência da doença, com posterior surgimento de coronariopatia. Comentários: A reativação da BCG é um achado importante na doença de Kawasaki em países onde a vacina é aplicada de forma rotineira e pode ser um marcador útil para o diagnóstico precoce da doença de Kawasaki, principalmente em sua forma incompleta.

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system.

The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1 st , 2004, to December 1 st , 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB.

Yellow fever in children and adolescents previously immunized in Minas Gerais State, Brazil.

Background - Yellow fever (YF) is a viral hemorrhagic fever that is transmitted by arthropods. It can occur with little symptomatic manifestations to the most fulminant forms. The most effective way to avoid YF is through vaccination. There is a lack of information about the immune response of the vaccine in childhood. Methods - We described children and adolescents with YF who had been previously immunized in Minas Gerais State from July 2017 to June 2018. Results - 527 cases of YF were observed representing an incidence of 7.6/100,000 inhabitants. Only 26 patients (4.9%) were ≤ 20 years and 501 (95.1%) were > 20 years. Only 9 vaccinated patients were ≤ 20 years and 15 were > 20 years. 34.6% (9/26) of YF patients ≤ 20 years were previously vaccinated and 3% (15/501) of those > 20 years (p < 0.001). The median age at vaccination was 1 year between those ≤ 20 years and 31 years between those > 20 years (p = 0.002). Among 9 vaccinated children and adolescents ≤ 20 years, age ranged from 7 to 18 years, the most described symptoms were fever (88%), headache (77%), myalgia (77%), and abdominal pain (66%). All patients recovered from the disease and none died. Conclusion - Prior YF vaccination may be associated with mild forms of the disease in children and adolescents. YF vaccination in the first years of life may be associated with poor vaccine response and high infection rates in this group as it fail to seroconvert a significant proportion of infants.

Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review / Fatores de risco associados aos desfechos da meningite bacteriana pediátrica: uma revisão sistemática

Abstract Objective: The aim of this study was to systematically review the literature and answer the following central question: "What are the risk factors associated with worse clinical outcomes of pediatric bacterial meningitis patients?" Methods: The articles were obtained through literary search using electronic bibliographic databases: Web of Science, Scopus, MEDLINE, and LILACS; they were selected using the international guideline outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. Results: The literature search identified 1,244 articles. After methodological screening, 17 studies were eligible for this systematic review. A total of 9,581 patients aged between 0 days and 18 years were evaluated in the included studies, and several plausible and important prognostic factors are proposed for prediction of poor outcomes after bacterial meningitis in childhood. Late diagnosis reduces the chances for a better evolution and reinforces the importance of a high diagnostic suspicion of meningitis, especially in febrile pictures with nonspecific symptomatology. S. pneumoniae as a causative pathogen was demonstrated to be related to clinical severity. Conclusions: Early prediction of an adverse outcome may help determine which children require more intensive or longer follow-up and may provide the physician with rationale for parental counseling about their child's prognosis in an early phase of the disease.

Resumo Objetivo O objetivo deste estudo é revisar sistematicamente a literatura e responder à seguinte questão central: "Quais são os fatores de risco associados a piores desfechos clínicos de pacientes pediátricos com meningite bacteriana?". Métodos Os artigos foram obtidos através de pesquisa bibliográfica, nas bases de dados eletrônicas Web of Science, Scopus, Medline e Lilacs, e selecionados com diretriz internacional delineada pela abordagem Prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Resultados A pesquisa bibliográfica identificou 1.244 artigos. Após a triagem metodológica, 17 estudos foram considerados elegíveis para esta revisão sistemática. Foram avaliados 9.581 pacientes até 18 anos nos estudos incluídos e vários fatores prognósticos plausíveis e importantes são propostos para a previsão de desfechos piores após meningite bacteriana na infância. O diagnóstico tardio reduz as chances de uma melhor evolução e reforça a importância de uma alta suspeita diagnóstica de meningite, especialmente em quadros febris com sintomatologia inespecífica. S. pneumoniae como patógeno causador demonstrou estar relacionado à gravidade clínica. Conclusões A previsão precoce de um desfecho clínico desfavorável pode ajudar a determinar quais crianças necessitam de uma abordagem mais invasiva ou seguimento mais prolongado e pode fornecer ao médico a justificativa para o aconselhamento dos pais sobre o prognóstico de seu filho em uma fase inicial da doença.

T-cells producing multiple combinations of IFNγ, TNF and IL10 are associated with mild forms of dengue infection.

Multifunctional interleukin 10 (IL10)+ Th1 cells have been implicated in favorable evolution of many infectious diseases, promoting an efficacious immune response while limiting immunopathology. Here, we investigated the presence of multifunctional CD4+ and CD8+ T-cells that expressed interferon gamma (IFNγ), IL10 and tumor necrosis factor (TNF), or its combinations during dengue infection. Peripheral blood mononuclear cells (PBMCs) from outpatients with dengue (mild dengue forms) and hospitalized patients (or patients with dengue with warning signs and severe dengue) were cultured in the presence of envelope (ENV) or NS3 peptide libraries of DENV during critical (hospitalization period) and convalescence phases. The production of IFNγ, IL10 and TNF by CD4+ and CD8+ T-cells was assessed by flow cytometry. Our data show that patients with mild dengue, when compared with patients with dengue with warning signs and severe dengue, presented higher frequencies of multifunctional T-cells like NS3-specific IFNγ/IL10-producing CD4+ T-cells in critical phase and NS3- and ENV-specific CD8+ T-cells producing IFNγ/IL10. In addition, NS3-specific CD8+ T-cells producing high levels of IFNγ/TNF and IFNγ/TNF/IL10 were also observed in the mild dengue group. We observed that multifunctional T-cells produced higher levels of cytokines as measured by intracellular content when compared with single producer T-cells. Importantly, multifunctional CD4+ and CD8+ T-cells producing IFNγ, TNF and IL10 simultaneously displayed positive correlation with platelet levels, suggesting a protective role of this population. The presence of IL10+ Th1 and IL10+ Tc1 multifunctional cells was associated with mild dengue presentation, suggesting that these cells play a role in clinical evolution of dengue infection.

Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review.

OBJECTIVE: The aim of this study was to systematically review the literature and answer the following central question: "What are the risk factors associated with worse clinical outcomes of pediatric bacterial meningitis patients?" METHODS: The articles were obtained through literary search using electronic bibliographic databases: Web of Science, Scopus, MEDLINE, and LILACS; they were selected using the international guideline outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. RESULTS: The literature search identified 1,244 articles. After methodological screening, 17 studies were eligible for this systematic review. A total of 9,581 patients aged between 0 days and 18 years were evaluated in the included studies, and several plausible and important prognostic factors are proposed for prediction of poor outcomes after bacterial meningitis in childhood. Late diagnosis reduces the chances for a better evolution and reinforces the importance of a high diagnostic suspicion of meningitis, especially in febrile pictures with nonspecific symptomatology. S. pneumoniae as a causative pathogen was demonstrated to be related to clinical severity. CONCLUSIONS: Early prediction of an adverse outcome may help determine which children require more intensive or longer follow-up and may provide the physician with rationale for parental counseling about their child's prognosis in an early phase of the disease.

Perinatal Yellow Fever: A Case Report.

An outbreak of yellow fever in Brazil made it possible to assess different presentations of disease such as perinatal transmission. A pregnant woman was admitted to hospital with yellow fever symptoms. She was submitted to cesarean section and died due to fulminant hepatitis. On the sixth day, the newborn developed liver failure and died 13 days later. Yellow fever polymerase chain reaction was positive for both.

Study of Complications of Varicella-Zoster Virus Infection in Hospitalized Children at a Reference Hospital for Infectious Disease Treatment.

OBJECTIVES: Varicella is a disease with potentially severe complications. We aimed to investigate characteristics of hospitalized children with varicella in Brazil in the prevaccine period and to identify predictors for requiring intensive care treatment. METHODS: A prospective cohort study was conducted from May 2011 to April 2014. Patients up to 13 years of age with varicella diagnosis were included. Information was collected through interview and review of medical records. Logistic regression analysis was performed. RESULTS: A total of 669 patients were admitted. The median age of subjects was 2.7 years (range 0-14 years) with a predominance of boys (56.6%). The main causes of hospitalization were bacterial complications (77.7%), viral complications (11.4%), and at-risk patients (10.9%). Main bacterial complications were skin infection and pneumonia. Main viral complications were herpes zoster, cerebellitis, and encephalitis. Most at-risk patients used corticosteroids or had a diagnosis of leukemia. At-risk patients were hospitalized earlier (P < .01) and remained hospitalized for longer periods (P = .03). A total of 44 patients (6.6%) were admitted to the ICU, and 5 (0.8%) died of septic shock. Thrombocytopenia was associated with more severe illness in patients with bacterial infections (P = .001). The long-time interval between onset of infection and admission was associated with the need for intensive care in all groups (P = .007). CONCLUSIONS: Secondary bacterial infection is the main cause of hospitalization, and thrombocytopenia in these patients leads to worse outcomes. Difficulties of access to the health system and delay in medical care are determining factors of greater severity in this population.

O desafio diagnóstico da doença de Kawasaki incompleta / The diagnosis challenge of the incomplete Kawasaki disease

Objetivo: a doença de Kawasaki é uma vasculite sistêmica aguda autolimitada que acomete vasos de médio e pequeno calibres, preferencialmente as artérias coronárias. Os pacientes que não apresentam todos os critérios necessários para o diagnóstico são classificados como portadores da forma incompleta. Este trabalho descreve criança com a forma incompleta da doença de Kawasaki, ressaltando os aspectos clínicos e laboratoriais que possam ser de auxílio no diagnóstico da doença. Descrição do caso: paciente masculino, seis anos de idade, com febre, mialgia e sinais meníngeos admitido no hospital com diagnóstico de meningite. Apresentava hiperemia conjuntival bilateral ehemorragia conjuntival. A punção lombar evidenciou pleocitose e elevação da proteinorraquia. Iniciado tratamento para meningoencefalite, com desaparecimento da febre e dos sinais meníngeos. No terceiro dia de internação manifestou insuficiência cardíaca e quatro dias após a febre ressurgiu, persistindo por sete dias. A pesquisa de foco infecciosoera negativa. Após a defervescência da febre, o ecocardiograma revelou coronárias dilatadas. Diagnosticada a síndrome de Kawasaki incompleta. No mesmo dia, foi observada descamação laminar nas pontas dos dedos das mãos. Discussão: a síndrome de Kawasaki incompleta deve ser considerada em toda criança com febre prolongada por mais de cinco dias sem foco aparente, associado a algumas das principais manifestações típicas. O diagnóstico tardio representa alto risco de coronariopatias.

Objectives: Kawasaki disease is an acute self-limiting systemic vasculitis that affects medium and small caliber vessels, preferably the coronary arteries. Patients who do not present all the necessary criteria for diagnosis are classified as bearers of the incomplete form. This study describes a child with the incomplete form of Kawasaki disease emphasizing the clinical and laboratory aspects that may be of aid in the disease diagnosis. Case description: male patient, six years old, with fever, myalgia, and meningeal signs admitted to the hospital with a diagnosis of meningitis. He presented bilateral conjunctival hyperemia and conjunctival hemorrhage. The spinal tap showed pleocytosis and elevated proteinorachy. Started treatment for meningoencephalitis, with the disappearance of fever and meningeal signs. On the third day of hospitalization expressed heart failure, and the fever reemerged four days after persisting for seven days. The research of infection was negative. After fever defervescence, the echocardiogram revealed dilated coronary. The incomplete Kawasaki syndrome was diagnosed. On the same day, laminar desquamation was observed at fingertips. Discussion: the incomplete Kawasaki syndrome should be considered in every child with prolonged fever for more than five days without apparent focus, associated with some of the main typical manifestations. The late diagnosis represents higher risk for coronary artery disease.