Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Clinical Features of Kawasaki Disease with Pyuria

농뇨 동반 가와사키병의 임상적 특징

  • Kim, Hyo-Jin (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Joo-Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Choi, Ui-Yoon (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Soo-Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 김효진 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이주영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 최의윤 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이수영 (가톨릭대학교 의과대학 소아과학교실)
  • Received : 2017.05.09
  • Accepted : 2017.08.07
  • Published : 2017.12.25
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Abstract

Purpose: Clinical and laboratory features of two Kawasaki disease (KD) groups were evaluated; the patient with pyuria and those without pyuria. Methods: From January 2015 to December 2016, the medical records of 140 (86 males and 54 females) inpatients with KD were retro-spectively analyzed. Results: Forty-eight KD patients (34.3%) presented with pyuria. KD patients with pyuria showed a higher level of C-reactive protein (CRP) and a higher proportion of elevated liver enzymes than those without pyuria. There were no differences in the proportions of unresponsiveness to intravenous immunoglobulin and coronary artery lesions between the two groups. Six KD patients (12.5%) with pyuria underwent a renal imaging study to rule out the possibility of a urinary tract infections. Thirty-two KD patients (66.7%) with pyuria received treatment with antibiotics in addition to the standard treatment for KD. Conclusions: KD patients with pyuria showed a higher level of CRP and elevated levels of liver enzymes than those without pyuria. These findings suggest that KD patients with pyuria have more severe systemic inflammation than those without pyuria.

목적: 농뇨가 동반된 가와사키병(Kawasaki disease [KD]) 환아와 농뇨 동반이 없는 KD 환아의 임상 및 검사실 지표들을 비교하여 농뇨 동반 KD의 임상적 특징을 파악하고자 하였다. 방법: 2015년 1월부터 2016년 12월까지 KD로 입원한 140명(남아 86명, 여아 54명) 환아의 의무기록을 후향적으로 조사하였다. 결과: 48명의 KD 환아(34.3%)에서 농뇨가 관찰되었다. 농뇨 KD군은 비농뇨 KD군보다 높은 C-반응단백(C-reactive protein [CRP]) 값을 보였고 간 효소치가 증가한 환아의 비율이 높았다. 두 군 간의면역글로불린(intravenous immunoglobulin) 치료 저항성과 관상동맥병변(coronary artery lesion) 발생률에 대한 차이점은 없었다. 농뇨 KD군 중 6명(12.5%)은 요로감염(urinary tract infection)을 감별하기 위해 신장 영상검사를 받았고, 농뇨 KD군의 2/3(66.7%)는 KD 표준치료에 추가로 항생제 치료를 받았다. 결론: 농뇨가 동반된 KD 환아들은 농뇨 동반이 없는 KD 환아들보다 더 높은 CRP 값과 더 많은 경우의 간 효소치 증가를 보였다. 이는 농뇨가 동반된 KD 환아가 농뇨 동반이 없는 KD 환아보다 더 심한 전신염증반응을 보인다는 점을 시사한다.

Keywords

References

  1. Shulman ST. Kawasaki disease. In: Cherry JD, Demmler-Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, editors. Feigin and Cherry's textbook of pediatric infectious diseases. 7th ed. Philadelphia: Elsevier Saunders, 2014:1064-85.
  2. Lee KY, Han JW, Lee JS. Kawasaki disease may be a hyperimmune reaction of genetically susceptible children to variants of normal environmental flora. Med Hypotheses 2007;69:642-51. https://doi.org/10.1016/j.mehy.2006.12.051
  3. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017;135:e927-99. https://doi.org/10.1161/CIR.0000000000000484
  4. Lee KJ, Kim HJ, Kim MJ, Yoon JH, Lee EJ, Lee JY, et al. Usefulness of anterior uveitis as an additional tool for diagnosing incomplete Kawasaki disease. Korean J Pediatr 2016;59:174-7. https://doi.org/10.3345/kjp.2016.59.4.174
  5. Wu CY, Hsieh KS, Chiou YH, Wang RS, Huang IF, Lee WY, et al. Prolonged fever and pyuria: a urinary tract infection presentation of incomplete Kawasaki disease. Acta Paediatr 2005;94:375-7. https://doi.org/10.1111/j.1651-2227.2005.tb03084.x
  6. Husain EH, Al-Rashid M. Kawasaki disease in association with urinary tract infection. Indian Pediatr 2011;48:808-9.
  7. Shike H, Kanegaye JT, Best BM, Pancheri J, Burns JC. Pyuria associated with acute Kawasaki disease and fever from other causes. Pediatr Infect Dis J 2009;28:440-3. https://doi.org/10.1097/INF.0b013e318193ec8e
  8. Choi JY, Park SY, Choi KH, Park YH, Lee YH. Clinical characteristics of Kawasaki disease with sterile pyuria. Korean J Pediatr 2013;56:13-8. https://doi.org/10.3345/kjp.2013.56.1.13
  9. Ram Krishna M, Sundaram B, Dhanalakshmi K. Predictors of coronary artery aneurysms in Kawasaki disease. Clin Pediatr (Phila) 2014;53:561-5. https://doi.org/10.1177/0009922814530802
  10. Park HM, Lee DW, Hyun MC, Lee SB. Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease. Korean J Pediatr 2013;56:75-9. https://doi.org/10.3345/kjp.2013.56.2.75
  11. Pfafferott C, Wirtzfeld A, Permanetter B. Atypical Kawasaki syndrome: how many symptoms have to be present? Heart 1997;78:619-21. https://doi.org/10.1136/hrt.78.6.619
  12. Barone SR, Pontrelli LR, Krilov LR. The differentiation acute adenoviral infection: use of clinical features and a rapid direct fluorescent antigen test. Arch Pediatr Adolesc Med 2000;154:453-6. https://doi.org/10.1001/archpedi.154.5.453
  13. Watanabe T, Abe Y, Sato S, Uehara Y, Ikeno K, Abe T. Hyponatremia in Kawasaki disease. Pediatr Nephrol 2006; 21:778-81. https://doi.org/10.1007/s00467-006-0086-6
  14. McPherson RA, Riley RS. Basic examination of urine. In: McPherson RA, Pincus MR, editors. Henry's clinical diagnosis and management by laboratory methods. 23rd ed. Philadelphia: Elsevier Saunders, 2017:442-80.
  15. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128: 595-610. https://doi.org/10.1542/peds.2011-1330
  16. Han SB, Lee SY, Jeong DC. The presence of coronary artery lesions may indicate the severity of the inflammation rather than the cause. Semin Arthritis Rheum 2017;47:e6. https://doi.org/10.1016/j.semarthrit.2017.03.013
  17. Lee KY, Rhim JW, Kang JH. Kawasaki disease: laboratory findings and an immunopathogenesis on the premise of a "protein homeostasis system". Yonsei Med J 2012;53:262-75. https://doi.org/10.3349/ymj.2012.53.2.262
  18. Lee KY. A common immunopathogenesis mechanism for infectious diseases: the protein-homeostasis-system hypothesis. Infect Chemother 2015;47:12-26. https://doi.org/10.3947/ic.2015.47.1.12
  19. Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 1974;54:271-6.
  20. Jan SL, Wu MC, Lin MC, Fu YC, Chan SC, Lin SJ. Pyuria is not always sterile in children with Kawasaki disease. Pediatr Int 2010;52:113-7. https://doi.org/10.1111/j.1442-200X.2009.02884.x
  21. McIlroy MA, Fisher EJ, Saravolatz LD, Hardwicke MB, Wilson FM. Aseptic meningitis complicating adult Kawasaki disease: case report and review of the literature. Am J Med 1989;87:106-10. https://doi.org/10.1016/S0002-9343(89)80495-4
  22. Lee HS, Kim JY, Song BK, Kim YW, Park SE. Comparison of cervical lymphadenitis as first presentation of Kawasaki disease and acute unilateral cervical lymphadenitis. Pediatr Infect Vaccine 2016;23:217-22. https://doi.org/10.14776/piv.2016.23.3.217
  23. de Magalhaes CM, Alves NR, de Melo AV, Junior CA, Nomicronbrega YK, Gandolfi L, et al. Catastrophic Kawasaki disease unresponsive to IVIG in a 3-month-old infant: a diagnostic and therapeutic challenge. Pediatr Rheumatol Online J 2012;10:28. https://doi.org/10.1186/1546-0096-10-28
  24. Benseler SM, McCrindle BW, Silverman ED, Tyrrell PN, Wong J, Yeung RS. Infections and Kawasaki disease: implications for coronary artery outcome. Pediatrics 2005; 116:e760-6. https://doi.org/10.1542/peds.2005-0559