Clinical and Virologic Characteristics May Aid Distinction of Acute Adenovirus Disease from Kawasaki Disease with Incidental Adenovirus Detection

Song, Eun-Kyung; Kajon, Adriana E.; Wang, Huanyu; Salamon, Doug; Texter, Karen; Ramilo, Octavio; Leber, Amy; Jaggi, Preeti

doi:10.1016/j.jpeds.2015.11.021

Cited by 37 publications

(24 citation statements)

References 23 publications

(20 reference statements)

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“…89 Adenoviruses (particularly species C) can persist in tonsil or adenoid tissue, potentially confusing diagnosis of a subsequent febrile illness. 90 In a patient with fever, exudative pharyngitis, exudative conjunctivitis, and a nasopharyngeal sample positive for adenovirus by respiratory polymerase chain reaction assay, KD is extremely unlikely; however, the diagnosis of KD should still be considered if adenovirus is detected in a patient with nonexudative pharyngitis. Other diagnostic features of KD not commonly observed in adenovirus infection include erythema and swelling of the hands and feet, strawberry tongue, and a desquamating groin rash.…”

Section: Conjunctivitismentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,576

3,735

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Conjunctivitismentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,576

3,735

View full text Add to dashboard Cite

show abstract

“…We recognize that among patients diagnosed with KD, respiratory viral detection is fairly common [12] and should not impact the decision to treat for KD, particularly for those with complete KD. However, viral characterization of adenovirus in children may be useful in distinguishing the 2 illnesses when coupled with the clinical presentation, especially for those being evaluated for incomplete KD [13,14]. In addition, viral testing is often obtained before an inpatient attending evaluation.…”

Section: Discussionmentioning

confidence: 99%

Using the Electronic Medical Record to Correlate Kawasaki Disease Phenotypes With Clinical Outcomes

Jaggi

Grcic

Kovalchin

et al. 2017

Journal of the Pediatric Infectious Diseases Society

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“…Gene microarray of the blood samples also showed the distinct pattern between KD and adenovirus-infected patients (21). Further study is needed to clarify the involvement of adenoviral infection in KD (22).…”

Section: Adenovirusmentioning

confidence: 92%

Aetiological Significance of Infectious Stimuli in Kawasaki Disease

2019

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Kawasaki disease (KD) is a pediatric vasculitis syndrome that is often involves coronary artery lesions (e. g., coronary artery aneurysms). Although its causal factors and entire pathogenesis remain elusive, the available evidence indicates that the pathogenesis of KD is closely associated with dysregulation of immune responses to various viruses or microbes. In this short review, we address several essential aspects of the etiology of KD with respect to the immune response to infectious stimuli: 1) the role of viral infections, 2) the role of bacterial infections and the superantigen hypothesis, 3) involvement of innate immune response including pathogens/microbe-associated molecular patterns and complement pathways, and 4) the influence of genetic background on the response to infectious stimuli. Based on the clinical and experimental evidence, we discuss the possibility that a wide range of microbes and viruses could cause KD through common and distinct immune processes.

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Clinical and Virologic Characteristics May Aid Distinction of Acute Adenovirus Disease from Kawasaki Disease with Incidental Adenovirus Detection

Cited by 37 publications

References 23 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Using the Electronic Medical Record to Correlate Kawasaki Disease Phenotypes With Clinical Outcomes

Aetiological Significance of Infectious Stimuli in Kawasaki Disease

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