The Differentiation of Classic Kawasaki Disease, Atypical Kawasaki Disease, and Acute Adenoviral Infection

Abstract

Kawasaki disease and acute adenoviral infection can present with many of the same clinical characteristics. A rapid direct fluorescent antigen assay for adenovirus may be a helpful adjunctive test for distinguishing acute adenoviral infection from Kawasaki disease.

Human Adenovirus Infection in Kawasaki Disease: A Confounding Bystander?

“…This is particularly relevant when using PCR, which is highly sensitive and can detect low-level virus. The other clinical or laboratory data that were helpful in distinguishing KD from HAdV disease in our cohort included neck swelling, distal extremity changes, and presence of pyuria and/or hepatitis (Table 1), which is similar to previous reports [15]. Among the HAdVs capable of infecting the respiratory tract, HAdV-C (types 1, 2, 5, and 6) species are also capable of establishing low-level persistence or shedding.…”

Kidney and Urinary Tract Involvement in Kawasaki Disease

“…Of these, pyuria is the most common abnormal finding [ 12 , 14 , 15 ], with some patients with KD and pyuria being misdiagnosed as having acute pyelonephritis [ 16 , 17 ]. In a previous study, we showed 43.5% of patients with KD had sterile pyuria, a proportion similar to that reported by Melish et al [ 13 ], Wirojanan et al [ 18 ], Barone et al [ 19 ], and Shike et al [ 20 ] of 62.5%, 33%, 50%, and 74%, respectively. On the other hand, Turner and Coulthard [ 21 ] reported that 43% of febrile children without urinary tract infection had moderate pyuria (10–100 cells/high-power field) with only 9% of febrile children having obvious pyuria (>100 cells/high-power field).…”

Adenovirus Infection in Hospitalized Immunocompetent Children

“…However, their sample included only 7 patients with adenovirus infection. 13 Our data confirm the lack of extremity changes and perianal peeling in adenovirus infection, but liver enzyme elevation was not exceptional, and therefore, it cannot serve as a factor in the differential diagnosis.…”