Differentiating Kawasaki disease from urinary tract infection in febrile children with pyuria and C-reactive protein elevation

Han, Seung Beom; Lee, Soo‐Young

doi:10.1186/s13052-018-0585-7

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Hence, mid-stream urine culture and sensitivity need to be performed and the most common organisms concurrently causing urinary tract infection in KD are Escherichia coli and Klebsiella oxytoca [53]. UTI can also be differentiated from KD pyuria by the positive nitrite test, as it is more specific for the diagnosis of UTI [119]. Additionally, hyponatremia was observed in 45% of KD patients and it was linked to a more serious inflammatory event such as a longer febrile period [120].…”

Section: Renal Function and Urinary Sample Assessmentmentioning

confidence: 99%

Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features

et al. 2022

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Kawasaki disease (KD) has shown a marked increase in trend over the globe, especially within the last two decades. Kawasaki disease is often seen in the paediatric population below five years old, while it is rare for those who are beyond that age. Up to this date, no exact causes has been identified although KD was found more than half a century ago. The underlying pathogenesis of the disease is still unelucidated, and researchers are trying to unlock the mystery of KD. To further complicate the diagnosis and the prompt management, a specific biomarker for the diagnosis of KD is yet to be discovered, making it hard to differentiate between KD and other diseases with a similar presentation. Nonetheless, since its discovery, clinicians and scientists alike had known more about the different clinical aspects of typical KD. Thus, this article intends to revisit and review the various clinical manifestations and laboratory characteristics of KD in order to guide the diagnosis of KD.

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Section: Renal Function and Urinary Sample Assessmentmentioning

confidence: 99%

Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features

et al. 2022

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“…Patients with refractory KD have more severe systemic inflammation and increased risk of developing complications, including CAAs, than patients with KD [ 4 , 5 , 6 ]. Therefore, early identification of patients who do not respond to initial IVIG treatment is important in the management of KD [ 2 , 7 ]. Risk factors for IVIG resistance in patients with KD have been identified as prolonged fever, young age, leukocytosis, thrombocytopenia, high CRP levels, and/or elevated liver transaminases [ 5 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology that predominantly affects children less than five years of age [ 1 , 2 ]. It is characterized by the presence of prolonged fever with principal clinical features of conjunctivitis, lip redness and strawberry tongue, skin rash, changes in the extremities, and cervical lymphadenopathy [ 2 ]. Coronary artery abnormalities (CAAs) develop in about 25% of untreated children and can lead to long-term cardiovascular complications [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Under-Recognized Macrophage Activation Syndrome in Refractory Kawasaki Disease: A Wolf in Sheep’s Clothing

et al. 2022

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Recognition of macrophage activation syndrome (MAS) in patients with refractory Kawasaki disease (KD) can be challenging. This study aimed to investigate the incidence of MAS in patients with refractory KD and to compare the characteristics of refractory KD and MAS. Medical records of 468 patients diagnosed with KD from January 2010 to December 2019 were retrospectively reviewed. Of the 468 KD patients, 63 were enrolled in the study as a refractory KD group (n = 59) and an MAS group (n = 4). The incidence of MAS was 0.8% (4/468) in patients with KD and 6.3% (4/63) in patients with refractory KD. Compared to the refractory KD group, the MAS group had higher frequencies of incomplete KD, hepatosplenomegaly, third-line treatment, and MAS screening, and showed lower levels of albumin. No significant differences were found in other clinical and laboratory findings. In addition to four patients with MAS, five patients with refractory KD who received third-line treatment showed severe systemic inflammation and organ dysfunction, but only one in five patients underwent MAS screening, including ferritin levels. In conclusion, given the relatively high incidence of MAS in children with refractory KD and the similar phenotype between refractory KD and MAS, we propose that MAS screening should be included in routine laboratory tests for refractory KD.

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“…Therefore, this is a non-specific marker. CRP was initially used to differentiate infectious diseases (viral versus bacterial etiology of disease), but over time it has been noticed that this protein is useful in estimating the prognosis of inflammatory process (not necessarily infectious diseases), including KD [18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Can AI Help Pediatricians? Diagnosing Kawasaki Disease Using DRSA

et al. 2021

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The DRSA method (dominance-based rough set approach) was used to create decision-making rules based on the results of physical examination and additional laboratory tests in the differential diagnosis of Kawasaki disease (KD), infectious mononucleosis and S. pyogenes pharyngitis in children. The study was conducted retrospectively. The search was based on the ICD-10 (International Classification of Diseases) codes of final diagnosis. Demographic and laboratory data from one Polish hospital (Poznan) were collected. Traditional statistical methods and the DRSA method were applied in data analysis. The algorithm formed 45 decision rules recognizing KD. The rules with the highest sensitivity (number of false negatives equals zero) were based on the presence of conjunctivitis and CRP (C-reactive Protein) ≥ 40.1 mg/L, thrombocytosis and ESR (Erythrocyte Sedimentation Rate) ≥ 77 mm/h; fair general condition and fever ≥ 5 days and rash; fair general condition and fever ≥ 5 days and conjunctivitis; fever ≥ 5 days and rash and CRP ≥ 7.05 mg/L. The DRSA analysis may be helpful in diagnosing KD at an early stage of the disease. It can be used even with a small amount of clinical or laboratory data.

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Differentiating Kawasaki disease from urinary tract infection in febrile children with pyuria and C-reactive protein elevation

Cited by 4 publications

References 23 publications

Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features

Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features

Under-Recognized Macrophage Activation Syndrome in Refractory Kawasaki Disease: A Wolf in Sheep’s Clothing

Can AI Help Pediatricians? Diagnosing Kawasaki Disease Using DRSA

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