Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Discrimination of Kawasaki disease with concomitant adenoviral detection differentiating from isolated adenoviral infection

  • Kim, Jong Han (Department of Pediatrics, Hallym University Medical Center) ;
  • Kang, Hye Ree (Department of Pediatrics, Hallym University Medical Center) ;
  • Kim, Su Yeong (Department of Pediatrics, Hallym University Medical Center) ;
  • Ban, Ji-Eun (Department of Pediatrics, Ewha Womans University College of Medicine)
  • 투고 : 2017.02.07
  • 심사 : 2017.09.17
  • 발행 : 2018.02.15
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초록

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.

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참고문헌

  1. Jordan-Villegas A, Chang ML, Ramilo O, Mejias A. Concomitant respiratory viral infections in children with Kawasaki disease. Pediatr Infect Dis J 2010;29:770-2. https://doi.org/10.1097/INF.0b013e3181dba70b
  2. Chang LY, Lu CY, Shao PL, Lee PI, Lin MT, Fan TY, et al. Viral infections associated with Kawasaki disease. J Formos Med Assoc 2014; 113:148-54. https://doi.org/10.1016/j.jfma.2013.12.008
  3. Turnier JL, Anderson MS, Heizer HR, Jone PN, Glode MP, Dominguez SR. Concurrent respiratory viruses and Kawasaki disease. Pediatrics 2015;136:e609-14. https://doi.org/10.1542/peds.2015-0950
  4. Kim JH, Yu JJ, Lee J, Kim MN, Ko HK, Choi HS, et al. Detection rate and clinical impact of respiratory viruses in children with Kawasaki disease. Korean J Pediatr 2012;55:470-3. https://doi.org/10.3345/kjp.2012.55.12.470
  5. Rocholl C, Gerber K, Daly J, Pavia AT, Byington CL. Adenoviral infections in children: the impact of rapid diagnosis. Pediatrics 2004; 113(1 Pt 1):e51-6. https://doi.org/10.1542/peds.113.1.e51
  6. Tabain I, Ljubin-Sternak S, Cepin-Bogovic J, Markovinovic L, Knezovic I, Mlinaric-Galinovic G. Adenovirus respiratory infections in hospitalized children: clinical findings in relation to species and serotypes. Pediatr Infect Dis J 2012;31:680-4. https://doi.org/10.1097/INF.0b013e318256605e
  7. Kwon HJ, Rhie YJ, Seo WH, Jang GY, Choi BM, Lee JH, et al. Clinical manifestations of respiratory adenoviral infection among hospitalized children in Korea. Pediatr Int 2013;55:450-4. https://doi.org/10.1111/ped.12108
  8. Sun Q, Jiang W, Chen Z, Huang L, Wang Y, Huang F, et al. Epidemiology and clinical features of respiratory adenoviral infections in children. Eur J Pediatr 2014;173:441-4. https://doi.org/10.1007/s00431-013-2188-z
  9. Okano M, Thiele GM, Sakiyama Y, Matsumoto S, Purtilo DT. Adenovirus infection in patients with Kawasaki disease. J Med Virol 1990; 32:53-7. https://doi.org/10.1002/jmv.1890320109
  10. Barone SR, Pontrelli LR, Krilov LR. The differentiation of classic Kawasaki disease, atypical Kawasaki disease, and acute adenoviral infection: use of clinical features and a rapid direct fluorescent antigen test. Arch Pediatr Adolesc Med 2000;154:453-6. https://doi.org/10.1001/archpedi.154.5.453
  11. Barton LL. Differentiation of adenoviral infection and Kawasaki disease. Arch Pediatr Adolesc Med 2001;155:96-7.
  12. Shike H, Shimizu C, Kanegaye JT, Foley JL, Schnurr DP, Wold LJ, et al. Adenovirus, adeno-associated virus and Kawasaki disease. Pediatr Infect Dis J 2005;24:1011-4. https://doi.org/10.1097/01.inf.0000183769.31951.1e
  13. Jaggi P, Kajon AE, Mejias A, Ramilo O, Leber A. Human adenovirus infection in Kawasaki disease: a confounding bystander? Clin Infect Dis 2013;56:58-64. https://doi.org/10.1093/cid/cis807
  14. Song E, Kajon AE, Wang H, Salamon D, Texter K, Ramilo O, et al. Clinical and virologic characteristics may aid distinction of acute adenovirus disease from Kawasaki disease with incidental adenovirus detection. J Pediatr 2016;170:325-30. https://doi.org/10.1016/j.jpeds.2015.11.021
  15. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017;135:e927-99. https://doi.org/10.1161/CIR.0000000000000484
  16. Lehmann C, Klar R, Lindner J, Lindner P, Wolf H, Gerling S. Kawasaki disease lacks association with human coronavirus NL63 and human bocavirus. Pediatr Infect Dis J 2009;28:553-4. https://doi.org/10.1097/INF.0b013e31819f41b6

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  3. Kawasaki Disease Complicated by Salmonella oranienburg Coinfection vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/5584514
  4. Association between Mycoplasma pneumoniae Infection and Coronary Artery Aneurysm in Children with Kawasaki Disease vol.31, pp.1, 2018, https://doi.org/10.5812/ijp.104737