Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy

Yanagi, Sadamitsu; Nomura, Yoshio; Masuda, Kiminori; Koriyama, Chihaya; Sameshima, Koji; Eguchi, Takashi; Imamura, Mari; Arata, Michiko; Kawano, Yoshifumi

doi:10.1111/j.1442-200x.2008.02547.x

Cited by 32 publications

(40 citation statements)

References 10 publications

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“…1, 9, 10 A Japanese comparison of 14 patients with NFKD and 24 patients with BCL 12 revealed that patients with NFKD, as in our study, were older and had higher CRP levels. In contrast, their patients with NFKD had higher WBC, ANC, and aspartate aminotransferase levels and lacked the relative anemia and thrombocytopenia which we observed.…”

Section: Discussionsupporting

confidence: 60%

“…1 Others report a high frequency of multiple enlarged nodes in both patients with NFKD and patients with BCL. 12 Patients with KD with the CT finding of retropharyngeal edema have greater extension of inflammation into deep neck spaces and more adjacent soft tissue involvement than patients with retropharyngeal edema of infectious etiology. 11 Nonetheless, patients with NFKD with retropharyngeal edema commonly experience delayed diagnosis due to the erroneous diagnosis of bacterial infection.…”

Section: Discussionmentioning

confidence: 91%

“…In contrast, their patients with NFKD had higher WBC, ANC, and aspartate aminotransferase levels and lacked the relative anemia and thrombocytopenia which we observed. The authors proposed a 4-item scoring system to discriminate NFKD from BCL (age >5.0 years, ANC >10×10 9 cells/L, CRP >7.0 mg/dL, aspartate aminotransferase level >30 IU/L), 12 which we could not assess due to the lack of aspartate transaminase levels in our database.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have compared NFKD with typical KD. 9, 10 Others have described radiologic features 11 and laboratory values 12 that could distinguish NFKD from BCL. Our KD Research Center’s extensive database afforded the unique opportunity to describe and compare NFKD, typical KD, and BCL from a single center.…”

mentioning

confidence: 99%

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Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Kanegaye

Cott

Tremoulet

et al. 2013

The Journal of Pediatrics

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Objective To identify characteristics differentiating the node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). Study design From our prospectively collected database, we compared clinical, laboratory, and imaging characteristics of NFKD and BCL cohorts and performed multivariable logistic regression to identify variables that distinguish NFKD from BCL. We then compared outcomes of NFKD and patients with typical KD treated during the same period. Results Over 7 years, 57 patients were hospitalized for NFKD, 78 for BCL, and 287 for typical KD. Patients with NFKD were older and had more medical encounters and longer duration of illness prior to correct diagnosis than patients with BCL. Of patients with NFKD, 33% had an admission diagnosis of bacterial adenitis or abscess. Compared with patients with BCL, patients with NFKD had lower leukocyte (WBC), hemoglobin, and platelet counts and higher absolute band counts (ABC), C-reactive protein (CRP), alanine transaminase and γ-glutamyl transpeptidase levels, and erythrocyte sedimentation rates. In the multivariable analysis, smaller nodes, lower WBC, and higher ABC and CRP were independently associated with NFKD. Patients with NFKD had multiple enlarged solid nodes and comparable rates of retropharyngeal edema. Compared with patients with typical KD, patients with NFKD were older, had more severe inflammation, and had similar rates of coronary artery abnormalities and resistance to intravenous immune globulin. Conclusions High ABC and CRP values and multiple enlarged solid nodes in febrile patients with cervical adenopathy should prompt consideration of NFKD to prevent delayed diagnosis of KD. Retropharyngeal edema on radiography should not dissuade from the diagnosis of NFKD.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Kanegaye

Cott

Tremoulet

et al. 2013

The Journal of Pediatrics

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“…One observational study found that among patients with only fever and cervical lymphadenopathy at admission, age ≥5.0 years, neutrophil count ≥10 × 10 9 /l, C-reactive protein ≥7.0 mg/dl and aspartate aminotransferase ≥30 iu/l were predictive of Kd rather than bacterial infection. 22 Patients with these findings need special attention.…”

Section: Discussionmentioning

confidence: 96%

Age-related Differences in the Course of the Acute Phase Symptoms of Kawasaki Disease

Shiozawa

Inuzuka

Harita³

et al. 2013

Pediatric Infectious Disease Journal

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A high index of suspicion for KD is required in febrile patients ≤24 months presenting with rash and in those >24 months with cervical lymphadenopathy. Younger patients need close observation because their acute phase symptoms progress rapidly. On the contrary, in older patients, cervical lymphadenopathy often remains the only manifestation for more than a few days and complicates the diagnosis. Recognizing age-specific patterns is useful for accurate and timely diagnosis of KD.

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Evaluating Lymph Node Stiffness to Differentiate Bacterial Cervical Lymphadenitis and Lymph Node–First Presentation of Kawasaki Disease by Shear Wave Elastography

Qin

Wang

et al. 2020

J of Ultrasound Medicine

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Objectives The purpose of our study was to evaluate the potential of cervical lymph node shear wave elastography (SWE) to quantify the lymph node stiffness (kilopascals) noninvasively among patients with lymph node–first presentation of Kawasaki disease (NFKD), patients with bacterial cervical lymphadenitis (BCL), and healthy children (HC). We further aimed to investigate the correlation of laboratory data and lymph node stiffness to provide a reference basis for the early diagnosis of NFKD. Methods Lymph node stiffness measurements were prospectively performed in 47 patients with NFKD, 56 patients with BCL, and 56 HC using SWE. Cervical SWE was compared in the groups. Factors associated with increased cervical lymph node stiffness were studied. Results The mean elasticity of the largest cervical lymph nodes was significantly higher in the BCL group than the NFKD and HC groups (mean elasticity ± SD, 16.37 ± 2.45, 12.22 ± 2.64, and 7.81 ± 1.67 kPa, respectively; P < .01), with a cutoff of 14.55 kPa (area under the curve, 0.885; sensitivity, 89%; and specificity, 76%). In patients with NFKD, interleukin 6 (standardized β = 0.363; P = .01), alanine aminotransferase (standardized β = 0.253; P = .03), aspartate aminotransaminase (standardized β = 0.536; P = .047), and total bilirubin (standardized β = 0.486; P < .01) values were correlated with increased largest cervical lymph node stiffness. Conclusions Cervical lymph node stiffness was different between NFKD and BCL. Shear wave elastography is a potential method to identify clinically distinguishable early NFKD.

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Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy

Abstract: KDL indices may be helpful in discriminating KDL from lymphadenitis at admission. It is important to monitor the symptoms of KD in a patient with three or four KDL indices at admission.

Cited by 32 publications

References 10 publications

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Age-related Differences in the Course of the Acute Phase Symptoms of Kawasaki Disease

Evaluating Lymph Node Stiffness to Differentiate Bacterial Cervical Lymphadenitis and Lymph Node–First Presentation of Kawasaki Disease by Shear Wave Elastography

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