Characteristics and Indications of Kawasaki Disease Among Infants Under 6 Months

Abstract

Objectives: To explore the characteristics of Kawasaki disease (KD) under 6 months and to investigate the possible indications of incomplete KD (iKD). Methods: The medical records of KD patients hospitalized in Children's Hospital of Soochow University from January 2007 to December 2017 were retrospectively reviewed and analyzed. A total of 50 cases of urinary tract infection (UTI) and 50 cases of adenovirus (ADV)-infected patients under 6 months that were age and gender-matched with the main complaint of high fever were selected as controls. Results: A total of 1,872 KD patients were enrolled. Among them, 194 (10.4%) were infantile patients under 6 months. There were 72 (37.1%) and 494 (29.4%) iKD in patients younger and older than 6 months, respectively (P < 0.05). Although patients under 6 months had a shorter fever duration before immunoglobulin (IVIG) treatment, a larger proportion of these patients had IVIG resistance and coronary artery lesions. They also tended to have higher platelet (PLT) counts and C-reactive protein (CRP) and lower hemoglobin (Hb), percentage of neutrophils (N%), albumin and serum sodium. When we compared iKD under 6 months with UTI and ADV-infected patients, significant differences were found in white blood cells (WBC), Hb, PLT, CRP, N% and serum albumin (P < 0.05). After adjusting the confounders, Hb < 105.5 g/L, CRP > 22.7 mg/L, N% > 47.4 and PLT > 496 × 10 9 /L were indications of iKD when compared with ADV infection (area under the curve [AUC]: 0.872, 0.939, 0.707, and 0.684, respectively). N% > 51.8 and albumin < 39.0 g/L were indications of iKD when compared with UTI (AUC: 0.627 and 0.832, respectively). Conclusions: Infantile KD patients under 6 months had their own particularity. Laboratory variables could be good indications of iKD when compared with UTI and ADV infection.

Potential Diagnostic and Prognostic Biomarkers for Adenovirus Respiratory Infection in Children and Young Adults

“…However, not all the HAdV species have been shown to cause elevation in WBC count [ 69 ]. What has been proven to characterize HAdV immune response is the neutrophilic prevalence [ 69 , 76 , 77 , 78 ] with neutrophil percentage over 40% in most studies, during the acute phase [ 79 , 80 , 81 ]. These findings may actually be confusing for at least two reasons.…”

“…C3b and C4b (a product of C4 cleavage) bind to the surface of the virion impeding infection progression; extracellular, opsonized HAdV virions can be recognized and internalized by receptors on cells (such as neutrophils and macrophage [ 87 ]). Intracellular HAdV bound to C4b are unable to unfold the capsid and escape endosomes, C3b-bound HAdV is degraded in the proteasome independent from TRIM-21 and activates the proinflammatory pathway [ 81 , 88 , 89 ].…”

“…In an experimental model by Jie Tian et al, HAdV showed the ability to activate both pathways: in vitro, antibodies are needed to activate the classical pathway, but when injected in mice, antibodies played no significant role. The rise in plasma C3a, suggests the activation of complement is driven by an alternative pathway and other factors, including tissue damage [ 81 ]. A comprehensive description of the role of the cytokine and cell types involved in the HAdV immune response is provided in Figure 1 .…”

Combination of Hemoglobin-for-Age Z-Score and Plasma Hepcidin Identified as a Novel Predictor for Kawasaki Disease

“…However, cases of incomplete KD, in which patients do not fulfill the KD definition, have been increasing [ 4 ]. Such cases have recently accounted for more than 20% of new-onset KD [ 4 ], especially in patients under six months of age [ 6 ].…”