Human adenoviruses (HAdV) can cause prolonged fever, elevated inflammatory markers, and clinical features that mimic Kawasaki disease (KD), but can also be incidentally detected in the pediatric nasopharynx (NP), most commonly with HAdV-C species. We previously reported that 8.8% of KD patients were HAdV+ by NP PCR. We sought to identify discriminative clinical and virologic characteristics between children with acute HAdV disease and KD patients with presumed incidental HAdV detection.
Immunocompetent HAdV+ pediatric patients were identified from 8/11-12/12 using microbiology records; chart review was performed to identify patients treated for KD (KD Group), or those diagnosed clinically with acute HAdV disease (AD Group) who had some KD-like features. Clinical and virologic characteristics (e.g. HAdV culture, semi-quantitative viral loads (Ct) and species identification by molecular assays) were evaluated in both groups. Mann-Whitney or chi square was used for comparisons.
We identified 25 patients in the AD Group and 6 patients in the KD Group; 24/25 (96%) patients of the AD group had <4 clinical features of KD, and none had >3 supplemental laboratory criteria for incomplete KD as defined by the American Heart Association (AHA). HAdV species B or E (n=17, 68%) were predominant and HAdV was isolated in culture in 22 specimens (88.8%), HAdV Ct was lower in AD group vs. KD group (median NP Ct 24.3 (IQR 21.2-28.7) vs. 36.5 (23.6-38.5), p=0.02). Culture negative, HAdV-C was found in 4 of 6 patients (66%) with KD.
Identification of HAdV-C with low viral load in children with >4 clinical features of KD suggests incidental HAdV detection. Most patients with AD had < 4 clinical features of KD, had relatively higher viral loads, and lacked the AHA supplemental lab criteria to support a diagnosis of incomplete KD.
D. Salamon, None
A. Leber, Biofire: Scientific Advisor , Research support
O. Ramilo, None
P. Jaggi, None