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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