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

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.

Keywords: Adenovirus; Infection; Kawasaki disease.

Fig. 1. Respiratory virus distribution in Kawasaki disease. Rhinovirus was most commonly detected. Adenovirus was detected in 11 patients. RSV B, respiratory syncytial virus type B.

Fig. 2. Receiver-operating characteristic curves for C-reactive protein (CRP). The cutoff CRP level for differentiating adenovirus-positive Kawasaki disease from isolated adenoviral infection was determined to be 56 mg/L with 81.8% sensitivity and 75.9 % specificity. AUC, area under the receiver-operating characteristic curve; CI, confidence interval.