Challenges in early diagnosis of Kawasaki disease in the pediatric emergency department: differentiation from adenoviral and invasive pneumococcal disease
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作者:
Maric, Lorna Stemberger
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Univ Hosp Infect Dis, Clin Dept Pediat Infect Dis, Mirogojska 8, Zagreb 10000, Croatia
Univ Zagreb, Sch Dent Med, Zagreb, CroatiaUniv Hosp Infect Dis, Clin Dept Pediat Infect Dis, Mirogojska 8, Zagreb 10000, Croatia
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 x 10(9)/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 x 10(9) and Plt > 400 x 10(9)/L compared to AdV and conjuctivitis, rash and Plt > 400 x 10(9)/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.
机构:
Univ Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, IndonesiaUniv Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, Indonesia
Arguni, Eggi
Wijaya, Conroy Surya
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Univ Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, IndonesiaUniv Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, Indonesia
Wijaya, Conroy Surya
Indrawanti, Ratni
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Univ Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, IndonesiaUniv Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, Indonesia
Indrawanti, Ratni
Safitri Laksono, Ida
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Univ Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, IndonesiaUniv Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, Indonesia
Safitri Laksono, Ida
Ishiwada, Naruhiko
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Chiba Univ, Dept Infect Dis, Med Mycol Res Ctr, Chiba, JapanUniv Gadjah Mada, Dr Sardjito Gen Hosp, Dept Child Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, Indonesia
机构:
Univ Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Colorado Sch Publ Hlth, Ctr Global Hlth, Mail Stop A090,13199 East Montview Blvd,Suite 310, Aurora, CO 80045 USA
Denver Hlth Hosp Author, Dept Pediat, Denver, CO USAUniv Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Gaensbauer, James T.
Asturias, Edwin J.
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Univ Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Colorado Sch Publ Hlth, Ctr Global Hlth, Mail Stop A090,13199 East Montview Blvd,Suite 310, Aurora, CO 80045 USA
Colorado Sch Publ Hlth, Dept Epidemiol, Aurora, CO USAUniv Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Asturias, Edwin J.
Soto, Monica
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Univ Francisco Marroquin, Dept Pediat, Guatemala City, GuatemalaUniv Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Soto, Monica
Holt, Elizabeth
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Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USAUniv Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Holt, Elizabeth
Olson, Daniel
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Univ Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Colorado Sch Publ Hlth, Ctr Global Hlth, Mail Stop A090,13199 East Montview Blvd,Suite 310, Aurora, CO 80045 USAUniv Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
Olson, Daniel
Halsey, Neal A.
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Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USAUniv Colorado, Sch Med, Dept Pediat, Div Infect Dis, Aurora, CO USA
机构:
Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Pediat, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, JapanOkayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Pediat, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, Japan
Tsuge, Mitsuru
Miyamoto, Machiko
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Matsuyama Red Cross Hosp, Dept Pediat, 1 Bunkyo Cho, Matsuyama, Ehime 7908524, JapanOkayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Pediat, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, Japan
Miyamoto, Machiko
Miyawaki, Reiji
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Ehime Univ, Dept Pediat, Grad Sch Med, Toon, Ehime 7910295, JapanOkayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Pediat, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, Japan
Miyawaki, Reiji
Kondo, Yoichi
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Matsuyama Red Cross Hosp, Dept Pediat, 1 Bunkyo Cho, Matsuyama, Ehime 7908524, JapanOkayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Pediat, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, Japan
Kondo, Yoichi
Tsukahara, Hirokazu
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Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Pediat, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, JapanOkayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Pediat, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, Japan