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

 Seo Hee Yoon  ;  Dong Soo Kim  ;  Jong Gyun Ahn 
 BMC Pediatrics, Vol.18(1) : 389, 2018 
Journal Title
 BMC Pediatrics 
Issue Date
Differential diagnosis ; Fever ; Infant ; Kawasaki disease ; Urinary tract infection
BACKGROUND: Children 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. METHODS: We 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. RESULTS: During 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. CONCLUSION: Persistent 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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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
Yonsei Authors
김동수(Kim, Dong Soo)
안종균(Ahn, Jong Gyun) ORCID logo https://orcid.org/0000-0001-5748-0015
윤서희(Yoon, Seo Hee) ORCID logo https://orcid.org/0000-0002-8361-9815
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