Concurrent respiratory viruses common in children with Kawasaki disease

Last Updated: 2015-08-27

By Will Boggs MD

NEW YORK (Reuters Health) - More than 40% of children with Kawasaki disease (KD) admitted to the hospital also tested positive for respiratory viruses during a four-year period at a Colorado hospital.

"Our clinical sense was that a number of children with KD presented with respiratory and gastrointestinal symptoms," Dr. Samuel R. Dominguez, from Children's Hospital Colorado, Aurora, told Reuters Health by email. "We were surprised by how high the numbers actually were."

The already challenging diagnosis of KD is confounded when children present with symptoms consistent with respiratory viruses and/or KD symptoms that could be attributed to a respiratory virus.

Dr. Dominguez's team evaluated the frequency of respiratory viral co-infections in 192 KD patients and 16,415 controls and sought to determine if viral co-infections were associated with differences in the clinical features of the disease or cardiac outcomes.

Ninety-three KD patients (41.9%) had a positive respiratory viral polymerase chain reaction (PCR) result. Rhinovirus/enteroviruses were most common (in 28.1% of KD patients), followed by adenovirus, human metapneumovirus, and respiratory syncytial virus (RSV).

With the exception of RSV, which was more prevalent in the control population, the overall distribution of types of viruses detected in the KD patient group was similar to those detected in controls.

Major clinical manifestations of KD, laboratory parameters, and frequency of coronary artery lesions in KD patients did not differ between those who were virus-positive and those who were virus-negative, according to the August 24 Pediatrics online report.

"If KD is on your differential diagnosis, the presence of respiratory symptoms should not be used as evidence for or against the diagnosis," Dr. Dominguez said. "Similarly, finding a respiratory virus by diagnostic testing should not be used to rule out the diagnosis and offers no prognostic information."

"Viral diagnostics are not useful when trying to diagnose KD," he concluded. "The one area where viral diagnostics is useful in children with KD is in identifying influenza, which would be a contraindication for treatment with aspirin."

"KD is a very difficult diagnostic dilemma," Dr. Dominguez added. "This study highlights this. In order to more accurately identify and treat patients with KD, we are in great need of a diagnostic test for KD. Finding the etiology and/or a diagnostic test for KD should be a research priority and more funding and attention to this important disease/problem are needed."

Dr. Anne H. Rowley, from Northwestern University Feinberg School of Medicine, Chicago, who has published widely about KD, told Reuters Health by email, "The presence of a respiratory viral infection does not exclude the diagnosis of Kawasaki disease. In fact, because Kawasaki disease is most prevalent during the winter-spring in most non-temperate climates, when many respiratory viruses are circulating, it is quite common to identify a concurrent respiratory virus in children with Kawasaki disease."

"In children with clinical and laboratory findings consistent with Kawasaki disease, respiratory viral testing is not useful in excluding the diagnosis," she explained. "Failure to accurately diagnose, treat, and monitor children with Kawasaki Disease can lead to severe adverse cardiac consequences in infants and young children."

"Children who have the clinical and laboratory findings of Kawasaki disease should be managed as recommended by the American Heart Association guidelines (http://bit.ly/1KQdT84), whether they have a concurrent respiratory virus infection or not," Dr. Rowley concluded.

Dr. Pierre Lebon, from Paris Descartes University, France, recently found bocavirus infection in association with Kawasaki disease. He told Reuters Health by email that tests other than PCR might be more useful when seeking to determine whether particular viruses play a causal role in KD, but "to determine what infections may be a cofactor in the onset of KD is difficult to prove."

The authors reported no external funding or disclosures.

SOURCE: http://bit.ly/1EkSarZ

Pediatrics 2015.