Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. e760-e766 (doi:10.1542/10.1542/peds.2005-0559)
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ELECTRONIC ARTICLE

Infections and Kawasaki Disease: Implications for Coronary Artery Outcome

Susanne M. Benseler, MD*,{ddagger}, Brian W. McCrindle, MD, MPH, FRCPC*,{ddagger},§, Earl D. Silverman, MD, FRCPC*,{ddagger}, Pascal N. Tyrrell, Msc*,{ddagger}, Joseph Wong*,{ddagger} and Rae S.M. Yeung, MD, PhD, FRCPC*,{ddagger}

* Department of Pediatrics, Divisions of
{ddagger} Rheumatology
§ Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Objective. We sought to determine the effect of coincident infection, at time of diagnosis of Kawasaki disease (KD), on treatment response and coronary artery outcome.

Methods. A single-center, retrospective study of 129 consecutive patients diagnosed with typical KD between January 1997 and December 1998 was performed. Standardized clinical assessments, laboratory, microbiology, and imaging test results plus treatment regimens were reviewed. Coronary arteries were visualized by using echocardiography, and coronary artery lesions (CALs) were reported as body surface area–adjusted z scores. Infection-positive and -negative groups were identified, and clinical, laboratory, and treatment data were analyzed. The effect of infections and other outcome variables on CAL development was determined by multivariate regression analysis.

Results. (1) Concurrent infections: 33% of children with typical KD had ≥1 confirmed infection at KD diagnosis. (2) Treatment response: the presence of infection did not alter the response to treatment with intravenous immunoglobulin, with resolution of fever in 83% of children after 1 dose of intravenous immunoglobulin together with aspirin administration regardless of presence or absence of infection. (3) Coronary outcome: in total, 31% of the patients developed CALs. Both the proven-infection and no-proven-infection groups had a similar CAL frequency. (4) Multivariate regression analysis: proven infection did not increase the risk of coronary artery involvement even after adjusting for other factors impacting on coronary artery outcomes.

Conclusions. Infections are common at diagnosis of KD. A broad spectrum of infectious agents was found. Infections at diagnosis of KD did not affect the patients' response to treatment and coronary artery outcome when compared with those patients without infections.

Key Words: Kawasaki disease • aneurysm • infection • risk factors • inflammation

Abbreviations: KD, Kawasaki disease • CAL, coronary artery lesion • IV, intravenous • Ig, immunoglobulin • BSA, body surface area • ESR, erythrocyte sedimentation rate • WBC, white blood cell • OR, odds ratio • CI, confidence interval

Accepted Jun 20, 2005.


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