Differential Diagnosis of Bacterial Cervical Lymphadenitis and Kawasaki Disease in Patients with Fever and Cervical Lymphadenopathy

Homin Jang; Eun Gyo Ha; Hee Jin Kim; Taek-jin Lee

doi:10.14776/piv.2016.23.3.188

Journal List > Pediatr Infect Vaccine > v.23(3) > 1095928

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Jang, Ha, Kim, and Lee: Differential Diagnosis of Bacterial Cervical Lymphadenitis and Kawasaki Disease in Patients with Fever and Cervical Lymphadenopathy

Original Article

Pediatric Infection & Vaccine 2016; 23(3): 188-193.

Published online: 20 December 2016

DOI: https://doi.org/10.14776/piv.2016.23.3.188

Differential Diagnosis of Bacterial Cervical Lymphadenitis and Kawasaki Disease in Patients with Fever and Cervical Lymphadenopathy

Homin Jang, Eun Gyo Ha, Hee Jin Kim, Taek-jin Lee

Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Corresponding author (bjloveu@chamc.co.kr)

Received 9 June 2016 Revised 22 July 2016 Accepted 21 September 2016

Abstract

Purpose

This study identified the characteristics differentiating node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD).

Methods

From July 2007 to June 2015, the medical records of patients with BCL, NFKD, and typical KD were retrospectively reviewed. We analyzed and compared the demographic, clinical, laboratory, and imaging characteristics of the cohorts.

Results

Twenty-two patients with BCL, 37 with NFKD, and 132 with typical KD were included in this study. Patients with BCL had longer durations of hospitalization than patients with NFKD. Bilateral and multiple enlarged cervical lymph nodes were associated more with NFKD than BCL. Compared with BCL patients, NFKD patients had lower platelet counts, higher percentages of neutrophils, and higher C-reactive protein (CRP) levels. NFKD patients were older and presented with higher white blood cell counts, percentages of neutrophils, absolute neutrophil counts, and CRP levels as well as lower platelet counts and alanine aminotransferase levels than typical KD patients.

Conclusions

In febrile patients with cervical lymphadenopathy, the combination of bilateral and multiple enlarged nodes, low platelet count, high percentage of neutrophils, and high CRP levels should prompt consideration of NFKD for prevention of delayed diagnosis of KD.

Keywords: Fever, Lymphadenitis, Mucocutaneous lymph node syndrome

Figures and Tables

Table 1

Comparison of Clinical and Demographic Characteristics of Patients with BCL and NFKD

Values are presented as number (%) or median (interquartile range). Chi-square test and Mann-Whitney U test.

^*Illness day 1, first calendar day of fever.

Abbreviations: BCL, bacterial cervical lymphadenitis; NFKD, node-first presented Kawasaki disease.

Table 2

Initial Laboratory Values in Patients with BCL and NFKD

Values are presented as median (interquartile range). It was measured on the day of admission. Mann-Whitney U test.

Abbreviations: BCL, bacterial cervical lymphadenitis; NFKD, node-first presented Kawasaki disease; WBC, white blood cell; ANC, absolute neutrophil count; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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