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Abstract
Objectives
Adenovirus infection, which has been known to mimic Kawasaki disease (KD), is one of the most frequent conditions observed during differential diagnosis when considering KD. Accordingly, it is essential to being able to differentiate between these two diseases. Therefore, we performed multiplex reverse transcriptase- polymerase chain reaction and tissue-Doppler echocardiography to distinguish between adenovirus patients and KD patients.
Methods
A total of 113 adenoviral infection patients (female 48, male 65) diagnosed from January 2010 to June 2016 were evaluated. We divided adenoviral infection patients into two groups: group 1, which consisted of individuals diagnosed with KD according to the KD American Heart Association criteria (n=62, KD with adenovirus infection); and group 2, which comprised individuals only diagnosed with adenovirus infection (n=51). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide. Echocardiographic measurements were compared between two groups. In addition, reverse transcriptase-polymerase chain reaction was performed using nasopharyngeal secretions to diagnose adenoviral infection.
Results
Conjunctival injection, cervical lymphadenopathy, polymorphous skin rash, abnormalities of the lip or oral mucosa and abnormalities of extremities were significantly higher in group 1 than group 2. Moreover, group 1 had significantly higher C-reactive protein and alanine aminotransferase levels, as well as lower platelet counts and albumin levels than group 2. Coronary artery diameter was significantly greater in group 1 than group 2.
References
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Fig. 1.
Myocardial velocity by tissue Doppler imaging in Kawasaki disease patient. E’, early diastolic myocardial velocity; A’, late diastolic myocardial velocity; S’, systolic myocardial velocity.
Fig. 2.
Tei index by tissue Doppler imaging in Kawasaki disease patient. Tei index=(a-b)/b=(IVCT+IVRT)/LVET. IVCT, isovolumetric contraction time; IVRT, isovolumetric relaxation time; LVET, left ventricle ejection time.
Table 1.
Comparison of clinical characteristics between group 1 and group 2
| Clinical characteristics | Group 1 (n=62) | Group 2 (n=51) | P-value |
|---|---|---|---|
| Boys | 37 (59.7) | 28 (54.9) | 0.609 |
| Girls | 25 (40.3) | 23 (45.1) | 0.703 |
| Age (year) | 4 (2–4) | 3 (1–4) | 0.045† |
| Fever duration (>5 days) | 38 (61.3) | 26 (51.0) | 0.271 |
| Conjunctival injection | 39 (62.9) | 16 (31.4) | 0.001 |
| Cervical lymphadenopathy | 20 (32.3) | 2 (3.9) | <0.001 |
| Polymorphous skin rash | 22 (35.5) | 1 (2.0) | <0.001 |
| Abnormalities of lip or oral mucosa | 19 (30.6) | 2 (3.9) | <0.001 |
| Abnormalities of extremities | 8 (12.9) | 1 (2.0) | 0.039‡ |
Table 2.
Comparison of laboratory data between two groups
Values are expressed as the mean (range).
Group 1, KD with adenoviral infection; Group 2, adenoviral infection.
Hb, hemoglobin; WBC, white blood cell count; ESR, erythrocyte sedimentation rate; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; NT-proBNP, N-terminal pro-brain natriuretic peptide; RCA, right coronary artery.
Table 3.
Comparison of echocardiographic finding between two groups
Values are expressed as the mean (range).
Group 1, KD with adenoviral infection; Group 2, adenoviral infection.
RCA, right coronary artery; LCA, left coronary artery; EF, ejection fraction; FS, fractional shortening; TDI, tissue Doppler imaging; E', early diastolic myocardial velocity; A', late diastolic myocardial velocity; S', systolic myocardial velocity; IVCT, isovolumetric contraction time; IVRT, isovolumetric relaxation time; LVET, left ventricle ejection time.
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