Respiratory virus positivity should not exclude Kawasaki disease

1. Results of this retrospective study revealed that children diagnosed with Kawasaki disease often have a concurrent respiratory viral infection detectable by polymerase chain reaction (PCR).

2. Concurrent detection of a respiratory virus by PCR does not appear to be linked to the clinical presentation or outcomes of children with Kawasaki disease.

Evidence Rating Level: 2 (Good)                       

Study Rundown: Kawasaki disease (KD) is a common entity and the leading cause of acquired heart disease among children in the developed world. Despite its prevalence, the etiology of KD remains unknown and diagnosis continues to be challenging, especially in children with concurrent respiratory symptoms.

This study retrospectively examined a cohort of children diagnosed with KD who also had a viral polymerase chain reaction (PCR) test performed at presentation. A significant proportion of those children tested with KD had a positive PCR. There was no significant difference in the clinical characteristics or laboratory data between children with a positive PCR and those without. In addition, there was no difference in outcomes for patients with a positive PCR.

The study is limited by the examination of a fairly small, homogenous cohort at a single center. In addition, approximately 14% children with a diagnosis of KD did not have a viral PCR performed at presentation. However, the study does underscore that the presence of a positive viral PCR does not exclude the possibility of KD.

Click to read the study, published today in Pediatrics

Relevant Reading: Concomitant respiratory viral infections in children with Kawasaki disease

In-Depth [retrospective cohort]: This study examined 222 children who were given the diagnosis of KD at Children’s Hospital of Colorado. Of these, 192 (86%) had viral PCR performed, of which 41.9% had positive results. The types of virus detected in patients with KD were not significantly different when compared to all viral PCR samples at the institution, with the exception of respiratory syncytial virus, which was higher in the general hospital population. When comparing major clinical manifestations (respiratory symptoms, gastrointestinal symptoms) and laboratory values (white blood cell count, platelet count, C-reactive protein, erythrocyte sedimentation rate, albumin), there was no significant difference between virus-positive and virus-negative KD. In addition, there was no significant difference in clinical outcomes (intensive care admissions, resistance to immune globulin and coronary artery lesions) between the 2 groups.

Image: PD

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