Concurrent viral infections and Kawasaki disease

Song E, et al. Clinical and virologic characteristics may aid distinction of acute adenovirus disease from Kawasaki disease with incidental adenovirus detection. J Pediatr. 2016 Mar;170:325-30.

Incidental adenovirus detection in Kawasaki disease (KD) is important to differentiate from acute adenovirus disease. Twenty-four of 25 children with adenovirus disease and mimicking features of KD had <4 KD-like features, predominance of species B or E, and higher viral burden compared with those with KD and incidental adenovirus detection.

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Turnier JL, et al. Concurrent respiratory viruses and Kawasaki disease. Pediatrics. 2015 Sep;136(3):e609-14.

“Overall, our study supports earlier evidence that a large number of patients with KD have respiratory symptoms and evidence of viral nucleic acid in the nasopharynx. This study showed that a large percentage of patients with KD have a concurrent or recent history of respiratory viral infections and suggests that clinicians should not dismiss the diagnosis of KD based on the presence of respiratory or gastrointestinal symptoms or solely on the results of a positive respiratory viral PCR test. Furthermore, our data support the recommendation that a positive respiratory virus test result, regardless of the virus detected, should not be used to exclude the diagnosis of KD.4,16 Continued research is needed to elucidate the etiology and/or discover a more sensitive and specific diagnostic test for this important pediatric disease.”

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Chang LY, et al. Viral infections associated with Kawasaki disease. J Formos Med Assoc. 2014 Mar;113(3):148-54.

“This was a prospective study to investigate the association of common viruses with Kawasaki disease. We found that cases of KD frequently had a cough (69%), rhinorrhea (58%), and diarrhea (51%) in addition to the typical symptoms of KD; several common respiratory viruses were also more frequently detected in cases of KD than in the control children. We propose that heterogeneous infectious agents, such as common viruses found in our study, may trigger Kawasaki disease in young children with certain genetic backgrounds or susceptibility.”

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Jaggi P, et al. Human adenovirus infection in Kawasaki disease: a confounding bystander? Clin Infect Dis. 2013 Jan;56(1):58-64.

In conclusion, our results indicate that (1) HAdV detection using PCR is not uncommon even in children with complete KD; (2) using semiquantitative real-time PCR, HAdV Ct values were higher (ie, lower viral burden) among patients with complete KD vs those thought to have true HAdV disease; and (3) even though HAdV-C causes acute disease in children <5 years of age, HAdV-C DNA shedding may occur in patients with KD. Further prospective studies with systematic measurement of viral load, molecular typing, and close clinical observation are needed to clarify the diagnostic challenge of HAdV disease vs KD with incidental HAdV detection.

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Jordan-Villegas A, et al. Concomitant respiratory viral infections in children with Kawasaki disease. Pediatr Infect Dis J. 2010 Aug;29(8):770-2.

The role of respiratory viruses in the pathogenesis of Kawasaki disease (KD) remains controversial. In this study, we showed that 8.8% of patients with KD had documented respiratory viral infections. Patients with concomitant viral infections had a higher frequency of coronary artery dilatations and were significantly more often diagnosed with incomplete KD. The presence of a concomitant viral infection should not exclude the diagnosis of KD.

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