Pyuria is not always sterile in children with Kawasaki disease

Jan, Sheng-Ling; Wu, Meng‐Che; Lin, Ming-Chih; Fu, Yun‐Ching; Chan, Sheng-Ching; Lin, Shing‐Jong

doi:10.1111/j.1442-200x.2009.02884.x

Cited by 9 publications

(3 citation statements)

References 10 publications

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“…Jan et al reported that 10.7% of KD patients have bacterial pyuria. 6 In addition to our case, there are only 4 cases in the literature of children with UTI who subsequently developed KD (Table 2). [7][8][9] In our patient, UTI was suspected due to the presence of pyuria, and finally, ESBL-producing E coli was isolated from his urine.…”

Section: Discussionmentioning

confidence: 73%

Bacteriuria With CTX-M-8 Extended-Spectrum β-Lactamase–Producing Escherichia coli in a Patient With Incomplete Kawasaki Disease

Kamijo

Abe

Kagami

et al. 2019

Global Pediatric Health

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We report the case of a 2-month-old infant with incomplete Kawasaki disease that presented as an apparent urinary tract infection. The patient’s fever persisted despite antibiotic treatment. Intravenous immunoglobulin and aspirin therapy cured both the incomplete Kawasaki disease and bacterial pyuria. Renal sonography, voiding cystourethrography, and renal parenchyma radionuclide scanning did not detect any abnormalities. Temporary dilation of the coronary artery was noted. In a urine specimen obtained through transurethral catheterization, the growth of 105 colony-forming units/mL of extended-spectrum β-lactamase–producing Escherichia coli was detected. Polymerase chain reaction analysis revealed that the enzyme genotype was CTX-M-8, which is a rare type in Japan. In conclusion, attention should be paid to a misleading initial presentation of fever and pyuria, which might be interpreted as urinary tract infection in patients with Kawasaki disease. Furthermore, pediatricians should consider incomplete Kawasaki disease when patients present with fever and pyuria, which are consistent with urinary tract infection, but do not respond to antibiotic treatment.

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Section: Discussionmentioning

confidence: 73%

Bacteriuria With CTX-M-8 Extended-Spectrum β-Lactamase–Producing Escherichia coli in a Patient With Incomplete Kawasaki Disease

Kamijo

Abe

Kagami

et al. 2019

Global Pediatric Health

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“…Pyuria in most children with KD is sterile and accompanied by a negative nitrite test [ 13 , 21 ]. However, some children with KD can show bacterial pyuria and/or a positive nitrite test, indicating that there is a possibility of a coexisting UTI with KD in febrile children with pyuria and CRP elevation [ 17 , 22 ]. The clinical significance of pyuria observed in KD is controversial, but the presence of pyuria might be associated with the severity of systemic inflammation or coronary complications [ 8 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

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

Han

Lee

2018

Ital J Pediatr

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BackgroundKawasaki disease (KD) is sometimes confused with urinary tract infection (UTI) because both can present with pyuria and C-reactive protein (CRP) elevation. The present study investigated the clinical and laboratory findings that can differentiate KD from UTI in febrile children with pyuria and CRP elevation.MethodsMedical records were retrospectively reviewed for children with KD and those with UTI. The clinical and laboratory findings between the KD with pyuria group (n = 48) and the UTI group (n = 118) were compared.ResultsThe KD with pyuria group had older age (P < 0.001) and longer duration of fever (P < 0.001) than the UTI group. In blood tests, both groups showed increased CRP level, but the value of CRP was higher in the KD with pyuria group than in the UTI group (P < 0.001). The KD with pyuria group also showed higher values for liver enzymes than the UTI group (P < 0.001); > 70.0% of children in the KD with pyuria group, but < 20.0% of children in the UTI group possessed elevated liver enzymes (P < 0.001). On urinalysis, 40.7% of the UTI group had a positive nitrite test, but 0.0% of the KD with pyuria group had a positive nitrite test (P < 0.001).ConclusionsElevated liver enzymes are more specific to KD than to UTI, whereas a positive nitrite test is more specific to UTI than to KD. Our findings can be used as diagnostic clues to differentiate KD from UTI in febrile children with pyuria and CRP elevation.

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“…We also included incomplete KD, which showed prolonged unexplained fever, fewer than four of the major clinical manifestations, and compatible laboratory or echocardiographic findings [2]. The definition of pyuria was based on urinary white blood cell (WBC) count > 5 cells/high power field (HPF) and sterile pyuria is defined as pyuria with a negative urine culture [14, 15]. The diagnosis of UTI was based on the culture of a single organism from a catheterized urine culture with a colony count greater than 10,000 or from a clean-catch midstream urine culture with greater than 100,000 colonies [15, 16].…”

Section: Methodsmentioning

confidence: 99%

Early features of Kawasaki disease with pyuria in febrile infants younger than 6 months

2018

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BackgroundChildren with Kawasaki disease (KD) and pyuria have been misdiagnosed with urinary tract infection (UTI). We compared clinical and laboratory features at admission between two groups of infants under 6 months of age who showed initial pyuria, to identify the initial clues suggestive of KD.MethodsWe retrospectively reviewed the medical records of children with fever who were under 6 months of age with pyuria, over a 10-year period (2007–2017). We included infants with sterile pyuria who were finally diagnosed with KD and those with UTI.ResultsDuring the period investigated, 12 (9.9%) KD patients with sterile pyuria and 378 infants with UTI were included in this study. Older age (P < 0.01), a longer duration of fever; total and before admission (P < 0.01), more negative nitrite test (P < 0.01), higher platelet count (P = 0.04), increased C-reactive protein (CRP) (P < 0.01) and erythrocyte sedimentation rate (ESR) (P < 0.01), were identified as initial features of infants finally diagnosed with KD. In the receiver operating characteristic analysis, optimal cut-off values of 509 k/μL for platelet count, 60 mg/L for CRP, and 68 mm/H for ESR were selected. Patients with ESR > 68 mm/hr had a ninefold higher odds of KD compared to those with lower ESR levels (odds ratio: 8.963, 95% confidence intervals: 1.936–41.493, P = 0.005), whereas CRP and platelet count could not significantly increase in the odds of KD at a cut-off point.ConclusionPersistent fever, elevated ESR, and negative urine nitrite test can serve as early clues to suspect KD in febrile infants with pyuria.

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Pyuria is not always sterile in children with Kawasaki disease

Cited by 9 publications

References 10 publications

Bacteriuria With CTX-M-8 Extended-Spectrum β-Lactamase–Producing Escherichia coli in a Patient With Incomplete Kawasaki Disease

Bacteriuria With CTX-M-8 Extended-Spectrum β-Lactamase–Producing Escherichia coli in a Patient With Incomplete Kawasaki Disease

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

Early features of Kawasaki disease with pyuria in febrile infants younger than 6 months

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