Clinical Management
RAYAN RAHMAN, n/a
Research Student
The Hospital for Sick Children, Toronto, United States
Background: The differential diagnosis for acute KD includes adenovirus infection. Nonetheless, concomitant infections may be present, and adenovirus may be one of them. We sought to contrast KD patients with concomitant adenovirus infection vs. those with no evidence of any infection.
Methods: Patients assessed at the Hospital for Sick Children, Toronto, with acute KD from 1995 to 2023 were included if information about concomitant infections were available. Patients were excluded if they had evidence for a concomitant infection other than adenovirus. We then determined associations of adenovirus infection with demographics, clinical and laboratory features, treatment and CA outcomes.
Results: Of 2697 patients, 407 patients who lacked sufficient information to verify concomitant infections and 811 who were documented to have concomitant infections other than adenovirus were excluded. This left 1440 patients without concomitant infection to compare to 39 patients with adenovirus. Patients with adenovirus did not differ by demographics, and had a similar number of KD clinical criteria, although they were less likely to have rash (69% vs. 88%; p< 0.001) and somewhat more likely to have cervical adenopathy (72% vs. 56%; p=0.06). They were more likely to have both respiratory (61% vs. 20%; p< 0.001) and abdominal symptoms (47% vs. 27%; p=0.008). No patient with adenovirus presented with shock, or had ICU admission or inotropes. At presentation, adenovirus patients had lower WBC (median 9.6 vs. 12.7 x109/L; p=0.008), neutrophils (5.5 vs. 7.3 x109/L; p< 0.04), eosinophils (0.03 vs. 0.25 x109/L; p< 0.001) and platelets (277 vs. 355 x109/L; p=0.004). They also had lower alanine transaminase (18 vs. 30 U/L; p< 0.001) with no differences regarding inflammatory markers. Results were similar for most extreme values during the admission. Adenovirus patients did not differ regarding IVIG received, but no patient received either IV or oral steroids. There was no CA involvement of any category for the adenovirus patients, with overall lower maximum Z-score in any branch (+0.31 vs. +0.41; p< 0.04).
Conclusions: KD patients with concomitant adenovirus infection have similar demographics to patients without any concomitant infection, and have similar patterns of KD clinical criteria. They are more likely to have other symptoms, and less remarkable clinical presentation and laboratory features. They are less likely to require additional immunomodulatory therapy, and have overall better CA outcomes. Whether some of these adenovirus patients truly had KD or just a KD-like presentation cannot be definitively determined. Nonetheless, outcomes are optimal for these patients.