Relationship Between Kawasaki Disease, Common Infections and Myocardial Profiling

Abstract

Abstract BACKGROUND: The diagnosis of Kawasaki disease (KD) is challenging due to similarities with infections, which often defers clinicians from diagnosing KD and administering intravenous immunoglobulins (IVIG). However, concurrent infection was reported in 1/3 patients with complete KD. No study has evaluated the prevalence of infection in patients with incomplete clinical criteria. OBJECTIVES: The aim of the study was to describe the prevalence and nature of concurrent infections in patients with KD. DESIGN/METHODS: A retrospective study including consecutive patients suspected for KD between 2008 and 2014 in a tertiary pediatric university hospital. RESULTS: From 134 patients (3.3±2.7 yo), infectious workup was performed for 129 (96%) patients, and positive in 32 (25%). A diagnosis of infection was maintained at discharge in 28/126 (22%) patients, of which 13 (46%) had a positive workup. Infections were diagnosed in a similar proportion of patients with complete and incomplete KD (25% vs 18%, p=0.29). During clinical course, 70 (54%) patients received antibiotics, with treatment failure in 42 (63%). Patients who received antibiotics were more likely to be resistant to IVIG (34% vs 10%, p=0.001), and need steroids (20% vs 3%, p=0.006). Patients with IVIG resistance had a higher rate of coronary artery aneurysm or dilatation (69% vs 45%, p=0.03). Patients with an infectious diagnosis at discharge were less likely to received IVIG (100% vs 89%, p=0.01). NT pro-BNP Z-score, indicating myocardial inflammation, was similar between patients with and without infection (2.3±2.2 vs 2.7±1.6, p=0.37). Coronary artery dilatations (Z-score>2.5) at diagnosis were present in 6/28 (21%) of patients with infection, and 30/98 (31%) of those without infection (p=0.34), which persisted at convalescence in 2/28 (7%) and 9/98 (9%), respectively (p=0.74). Finally, coronary aneurysms were present in 1/28 (4%) of patients with infections, and 17/98 (17%) of those without (p=0.07). CONCLUSION: KD and infection are not mutually exclusive, including cases with incomplete KD criteria. Recognizing that both can coexist will hopefully ensure timely IVIG treatment for patients.