FROM PEDIATRICS

Many children with Kawasaki disease (KD) have respiratory viruses and a positive viral polymerase chain reaction should not exclude a KD diagnosis, according to a new study.

Kawasaki disease is a major cause of heart disease in children, however a specific etiology has yet to be found. A viral cause is suspected because of its seasonal presentation, clinical symptoms, and evidence from previous studies.

Dr. Jessica Turnier and her colleagues of the University of Colorado Denver and Children’s Hospital Colorado, both in Aurora, wanted to determine the rate of viral infections with KD, and if this coinfection was linked to variances in cardiac outcomes or clinical presentation (Pediatrics. 2015, Aug 24. [doi: 10.1542/peds.2015-0950]).

A chart review was performed of patients diagnosed with KD from January 2009 to May 2013 and admitted to the Children’s Hospital Colorado. For patients suspected of having KD, it was the standard practice to obtain nasopharyngeal washes to detect the presence of 16 respiratory viruses.

During the study period, 222 patients were diagnosed with KD, and 86% (n = 192) had respiratory viral polymerase chain reactions (PCRs) obtained. These viral PCRs were positive in 42% of the 192 patients, with the most-common being enterovirus or rhinovirus (28%). Adenovirus, respiratory syncytial virus, and human metapneumovirus were found in 5% of patients.

The authors noted no significant differences in the clinical presentation of patients with KD whether or not they had concurrent viral infection. Upper respiratory infection was reported 63% (virus-positive KD) and 56% (virus-negative KD) of the time. Patients reported a recent history of gastrointestinal symptoms 67% (virus-negative KD) and 57% (virus-positive KD) of the time.

Furthermore, there were no differences between the groups with respect to C-reactive protein, erythrocyte sedimentation rate, WBC, frequency of coronary artery lesions, or immunoglobulin resistance.

Patients with positive viral results (11%) required care in the PICU more often than the viral-negative group (6%), but this was not significant. Incomplete KD was documented in 31% of viral-positive patients versus 25% in the viral-negative patients.

The authors conclude that patients with KD commonly have concurrent respiratory viral infections. They continued, “a large percentage of patients with KD have a concurrent or recent history of respiratory viral infections and [this study] suggests that clinicians should not dismiss the diagnosis of KD based on the presence of respiratory or gastrointestinal symptoms or solely on the results of a positive respiratory viral PCR test.”

The authors report no external funding sources or disclosures.

pdnews@frontlinemedcom.com

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