Skip to main content
Erschienen in: Wiener klinische Wochenschrift 7-8/2018

23.02.2018 | original article

Challenges in early diagnosis of Kawasaki disease in the pediatric emergency department: differentiation from adenoviral and invasive pneumococcal disease

verfasst von: Lorna Stemberger Maric, MD, PhD, Neven Papic, MD, PhD, Mario Sestan, MD, Ivica Knezovic, MD, Professor Goran Tesovic, MD, PhD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 7-8/2018

Einloggen, um Zugang zu erhalten

Summary

Early recognition and distinction of Kawasaki disease (KD) from other febrile infectious diseases is one of the biggest challenges in pediatric emergency departments (PED). The aim of this study was to assess the utility of clinical findings and routinely used laboratory parameters for early discrimination between KD, invasive pneumococcal disease (IPD) and adenovirosis (AdV). A retrospective, cross-sectional study of children aged 3–36 months consecutively admitted to the PED and diagnosed with either KD (n = 110), AdV (n = 440) or IPD (n = 122) was conducted. At first presentation to the PED, 56.3% of KD patients had none or only one clinical criterion, 31% of patients with AdV and 11% with IPD had > 2 criteria. The levels of platelets (Plt), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were higher and white blood cells (WBC) significantly lower in KD than in IPD and AdV group. The WBC < 20 ×109/l showed a sensitivity of 80.9% and specificity of 79.7% in comparison to AdV. The ROC curve showed a significant, but low sensitivity for AST, ALT and Plt. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) did not show any significant diagnostic accuracy. Significant association between incomplete KD and rash, WBC < 20 ×109 and Plt > 400 ×109/L compared to AdV and conjuctivitis, rash and Plt > 400 × 109/L, was found. Due to the time delay and nonspecific early presentation, differentiating KD from IPD and AdV is challenging. Tools used for identification of patients at risk for severe bacterial infections in PED lack sensitivity for identification of KD cases. New biomarkers are warranted for distinction of KD from IPD or AdV.
Literatur
1.
Zurück zum Zitat Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: occurrence, management, and outcomes. Pediatrics. 2000;105(1 Pt 3):260–6.PubMed Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: occurrence, management, and outcomes. Pediatrics. 2000;105(1 Pt 3):260–6.PubMed
4.
Zurück zum Zitat Harnden A, Alves B, Sheikh A. Rising incidence of Kawasaki disease in England: analysis of hospital admission data. BMJ. 2002;324(7351):1424–5.CrossRefPubMedPubMedCentral Harnden A, Alves B, Sheikh A. Rising incidence of Kawasaki disease in England: analysis of hospital admission data. BMJ. 2002;324(7351):1424–5.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA, Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association, American Academy of Pediatrics. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. 2004;114(6):1708–33. https://doi.org/10.1542/peds.2004-2182.CrossRefPubMed Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA, Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association, American Academy of Pediatrics. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. 2004;114(6):1708–33. https://​doi.​org/​10.​1542/​peds.​2004-2182.CrossRefPubMed
10.
Zurück zum Zitat Ferone EA, Berezin EN, Durigon GS, Finelli C, Felicio MC, Storni JG, Durigon EL, Oliveira DB. Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection. J Pediatr (Rio J). 2014;90(1):42–9. https://doi.org/10.1016/j.jped.2013.05.005.CrossRef Ferone EA, Berezin EN, Durigon GS, Finelli C, Felicio MC, Storni JG, Durigon EL, Oliveira DB. Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection. J Pediatr (Rio J). 2014;90(1):42–9. https://​doi.​org/​10.​1016/​j.​jped.​2013.​05.​005.CrossRef
13.
Zurück zum Zitat Falcini F, Ozen S, Magni-Manzoni S, Candelli M, Ricci L, Martini G, Cuttica RJ, Oliveira S, Calabri GB, Zulian F, Pistorio A, La Torre F, Rigante D. Discrimination between incomplete and atypical Kawasaki syndrome versus other febrile diseases in childhood: results from an international registry-based study. Clin Exp Rheumatol. 2012;30(5):799–804.PubMed Falcini F, Ozen S, Magni-Manzoni S, Candelli M, Ricci L, Martini G, Cuttica RJ, Oliveira S, Calabri GB, Zulian F, Pistorio A, La Torre F, Rigante D. Discrimination between incomplete and atypical Kawasaki syndrome versus other febrile diseases in childhood: results from an international registry-based study. Clin Exp Rheumatol. 2012;30(5):799–804.PubMed
15.
Zurück zum Zitat Okada Y, Minakami H, Tomomasa T, Kato M, Inoue Y, Kozawa K, Kimura H, Morikawa A. Serum procalcitonin concentration in patients with Kawasaki disease. J Infect. 2004;48(2):199–205.CrossRefPubMed Okada Y, Minakami H, Tomomasa T, Kato M, Inoue Y, Kozawa K, Kimura H, Morikawa A. Serum procalcitonin concentration in patients with Kawasaki disease. J Infect. 2004;48(2):199–205.CrossRefPubMed
16.
Zurück zum Zitat 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(5):453–6.CrossRefPubMed 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(5):453–6.CrossRefPubMed
18.
20.
Zurück zum Zitat Lee GM, Fleisher GR, Harper MB. Management of febrile children in the age of the conjugate pneumococcal vaccine: a cost-effectiveness analysis. Pediatrics. 2001;108(4):835–44.CrossRefPubMed Lee GM, Fleisher GR, Harper MB. Management of febrile children in the age of the conjugate pneumococcal vaccine: a cost-effectiveness analysis. Pediatrics. 2001;108(4):835–44.CrossRefPubMed
23.
Zurück zum Zitat Burns JC, Mason WH, Glode MP, Shulman ST, Melish ME, Meissner C, Bastian J, Beiser AS, Meyerson HM, Newburger JW. Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease. United States Multicenter Kawasaki Disease Study Group. J Pediatr. 1991;118(5):680–6.CrossRefPubMed Burns JC, Mason WH, Glode MP, Shulman ST, Melish ME, Meissner C, Bastian J, Beiser AS, Meyerson HM, Newburger JW. Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease. United States Multicenter Kawasaki Disease Study Group. J Pediatr. 1991;118(5):680–6.CrossRefPubMed
Metadaten
Titel
Challenges in early diagnosis of Kawasaki disease in the pediatric emergency department: differentiation from adenoviral and invasive pneumococcal disease
verfasst von
Lorna Stemberger Maric, MD, PhD
Neven Papic, MD, PhD
Mario Sestan, MD
Ivica Knezovic, MD
Professor Goran Tesovic, MD, PhD
Publikationsdatum
23.02.2018
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 7-8/2018
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-018-1324-1

Weitere Artikel der Ausgabe 7-8/2018

Wiener klinische Wochenschrift 7-8/2018 Zur Ausgabe

mitteilungen der gesellschaft der ärzte in wien

Veranstaltungstipps