1173. Distinguishing Adenoviral Disease from Kawasaki Disease: The Role of PCR
Session: Poster Abstract Session: Kawasaki Disease
Saturday, October 22, 2011
Room: Poster Hall B1
Background: AdV disease is commonly included in the differential diagnosis for acute KD, but can also be found as a concomitant infection in KD disease, leading to patient misclassification. We use a semiquantitative AdV real-time PCR targeting a conserved region of the hexon gene. We sought to determine whether there are differences in the semiquantitative Cts (reflecting viral loads) between children hospitalized with adenoviral infection in whom KD was considered versus those treated for complete KD in whom adenovirus was identified.

Methods: We prospectively recorded clinical data from all hospitalized KD patients (pts) and retrospectively reviewed all hospitalized cases of adenoviral throat or nasopharyngeal infection detected by PCR from 8/09-4/11.  Patients were classified into 3 groups: I-complete KD or incomplete KD as defined by the American Heart Association (AHA) guidelines, II-treated for KD but not fulfilling strict AHA criteria, and III-AdV infection without KD in whom KD was mentioned in the differential diagnosis.  AdV pts in the intensive care unit and those with underlying chronic conditions were excluded; 2 KD pts were admitted to the intensive care unit and were included.  Unpaired t-test was used to compare means with a two-tailed p-value.

Results: 77 pts (61%male) < 18 yrs of age were treated for KD. Among KD pts, 57 were Group I, and 20 were group II. Of the 77 KD pts, 10 pts (13%) had identifiable nasopharyngeal adenovirus by PCR (5 Group I and 5 Group II).  Among Group II, 2 of 5 patients were also adenovirus positive by direct fluorescence antibody (DFA).  5 of 57 (8.8%) of highly likely KD patients had identifiable AdV infection. There were 26 patients who had features of KD (fulfilled Group III criteria). Group I Cts were significantly higher (i.e, lower positivity) (mean 34.4 ±5) versus Group III (27.3 ±6.7) (p=0.036). One Group I patient with adenovirus co-infection who presented in shock developed coronary artery ectasia.

Conclusion: PCR based AdV infection in acute KD is not uncommon and should be interpreted with caution in patients suspected to have KD.  Quantitative PCR may be an underutilized tool to help distinguish KD with adenoviral infection from those with adenoviral disease, but future prospective studies are needed to clarify.


Subject Category: P. Pediatric and perinatal infections

Preeti Jaggi, MD1, Leber Amy, PhD2, Octavio Ramilo, MD3 and Asuncion Mejias, MD, PhD1, (1)Pediatrics, Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, (2)Nationwide Children's Hospital, Columbus, OH, (3)Department of Pediatrics, Section of Infectious Diseases, Nationwide Children's Hospital (NCH) and The Ohio State University College of Medicine, Columbus, OH

Disclosures:

P. Jaggi, None

L. Amy, None

O. Ramilo, Abbott Labs: Consultant and Scientific Advisor, Consulting fee and Speaker honorarium
Medimmune: Investigator and Scientific Advisor, Research support
Merck : Consultant and Scientific Advisor, Consulting fee
Abbott Molecular: Grant Investigator, Research grant
Quidel: Scientific Advisor, Consulting fee

A. Mejias, Abbott: Investigator and Speaker's Bureau, Research grant
Mead-Johnson: Investigator, Research grant

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