Pediatric Rheumatology Online Journal → July 2003 → Vasculitides → Kawasaki Disease → Abstract #130

INFECTIONS AND KAWASAKI DISEASE (KD): IMPLICATIONS FOR CORONARY ARTERY OUTCOME

S. M. Benseler,¹ B. W. McCrindle,² E. D. Silverman,¹ P. N. Tyrrell,¹ J. Wong,¹ R. SM. Yeung.¹

Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada; ²Cardiology, The Hospital for Sick Children, Toronto, ON, Canada

Background: The role of infections in Kawasaki disease is highly controversial and needs to be further analyzed.
Objective: a) To determine the prevalence of infections in children with KD and b) To correlate the presence of infection with coronary outcome.
Methods: A cohort study of 129 consecutive patients with complete KD seen at HSC between 01/1997 and 02/1999 was performed. Data was collected for preceding infection plus treatment, KD criteria, lab data, microbiology, imaging, and echocardiography (ECHO) (N=528 studies). Patients were stratified for presence or absence of confirmed infection. Age-adjusted multivariant regression analyses were performed to idenitify predictive factors for the development of coronary artery lesions (CAL) defined as 2 SD above the expected mean adjusted for BSA.
Results: 129 patients (88M:41F) were identified; mean age: 4.0yrs (0.19-15.7yrs). No statistically significant differences were seen between the groups for the percentage of patients with: each of the KD criteria, duration of fever, sex, or retreatment. 83 patients (64%) received antibiotic treatment for suspected infection (tonsillitis, otitis media, cervical lymphadenitis). 49 patients (38%) had 1 confirmed infection (otitis 23%, strep throat 21%, viral infections 18%, pneumonia 8%, other 9%). 80 patients had no confirmed infection. CAL were seen in 18/49 (37%) with and in 32/80 (40%) without infection. Consistent with published data, regression analysis confirmed known CAL risk factors (male sex, young age, days of fever) for both groups. In contrast, there was no statistically significant correlation of infection with CAL development after adjustment for the known risk factors (p=0.33).
Conclusion: Infections are common at onset of KD as in our cohort 64% had suspected, 38% had confirmed infections (otitis, strep throat, viral infections, pneumonia). Children with or without infection presented with the identical clinical picture of Kawasaki disease and had a similar coronary outcome.