Korean J Pediatr.  2018 Feb;61(2):43-48. 10.3345/kjp.2018.61.2.43.

Discrimination of Kawasaki disease with concomitant adenoviral detection differentiating from isolated adenoviral infection

• Kim JH
• Kang HR
• Kim SY
• Ban JE

• KMID: 2452039
• DOI: http://doi.org/10.3345/kjp.2018.61.2.43

Abstract

PURPOSE
Human adenovirus infection mimics Kawasaki disease (KD) but can be detected in KD patients. The aim of this study was to determine the clinical differences between KD with adenovirus infection and only adenoviral infection and to identify biomarkers for prediction of adenovirus-positive KD from isolated adenoviral infection.
METHODS
A total of 147 patients with isolated adenovirus were identified by quantitative polymerase chain reaction. In addition, 11 patients having KD with adenovirus, who were treated with intravenous immunoglobulin therapy during the acute phase of KD were also evaluated.
RESULTS
Compared with the adenoviral infection group, the KD with adenovirus group was significantly associated with frequent lip and tongue changes, skin rash and changes in the extremities. In the laboratory parameters, higher C-reactive protein (CRP) level and presence of hypoalbuminemia and sterile pyuria were significantly associated with the KD group. In the multivariate analysis, lip and tongue changes (odds ratio [OR], 1.416; 95% confidence interval [CI], 1.151-1.741; P=0.001), high CRP level (OR, 1.039; 95% CI 1.743-1.454; P= 0.021) and sterile pyuria (OR 1.052; 95% CI 0.861-1.286; P=0.041) were the significant predictive factors of KD. In addition, the cutoff CRP level related to KD with adenoviral detection was 56 mg/L, with a sensitivity of 81.8% and a specificity of 75.9%.
CONCLUSION
Lip and tongue changes, higher serum CRP level and sterile pyuria were significantly correlated with adenovirus-positive KD.

Keyword

Kawasaki disease; Adenovirus; Infection

MeSH Terms

Adenoviridae
Adenoviridae Infections
Adenovirus Infections, Human
Biomarkers
C-Reactive Protein
Discrimination (Psychology)*
Exanthema
Extremities
Humans
Hypoalbuminemia
Immunization, Passive
Lip
Mucocutaneous Lymph Node Syndrome*
Multivariate Analysis
Polymerase Chain Reaction
Pyuria
Sensitivity and Specificity
Tongue
Biomarkers
C-Reactive Protein