A Severe Form of Kawasaki Disease Presenting with Only Fever and Cervical Lymphadenopathy at Admission

Nomura, Yoshio; Arata, Michiko; Koriyama, Chihaya; Masuda, Kiminori; Morita, Yasuko; Hazeki, Daisuke; Ueno, Koichi; Eguchi, Takashi; Kawano, Yoshifumi

doi:10.1016/j.jpeds.2009.11.042

Cited by 41 publications

(51 citation statements)

References 17 publications

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“…1, 9, 10 A Japanese comparison of 14 patients with NFKD and 24 patients with BCL 12 revealed that patients with NFKD, as in our study, were older and had higher CRP levels. In contrast, their patients with NFKD had higher WBC, ANC, and aspartate aminotransferase levels and lacked the relative anemia and thrombocytopenia which we observed.…”

Section: Discussionsupporting

confidence: 62%

“…Compared with those with typical KD, previously reported patients with NFKD 9, 10 and patients with KD with cervical adenopathy 3, 4 were older and ill longer prior to diagnosis and had higher CRP 9, 10 and ESR values. 3 In the largest previous series (16 patients with NFKD and 171 with typical KD), patients with NFKD more often required repeated administration of IVIG and had an increased risk of coronary artery lesions.…”

Section: Discussionmentioning

confidence: 76%

“…Previous reports have compared NFKD with typical KD. 9, 10 Others have described radiologic features 11 and laboratory values 12 that could distinguish NFKD from BCL. Our KD Research Center’s extensive database afforded the unique opportunity to describe and compare NFKD, typical KD, and BCL from a single center.…”

mentioning

confidence: 99%

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Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Kanegaye

Cott

Tremoulet

et al. 2013

The Journal of Pediatrics

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Objective To identify characteristics differentiating the node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). Study design From our prospectively collected database, we compared clinical, laboratory, and imaging characteristics of NFKD and BCL cohorts and performed multivariable logistic regression to identify variables that distinguish NFKD from BCL. We then compared outcomes of NFKD and patients with typical KD treated during the same period. Results Over 7 years, 57 patients were hospitalized for NFKD, 78 for BCL, and 287 for typical KD. Patients with NFKD were older and had more medical encounters and longer duration of illness prior to correct diagnosis than patients with BCL. Of patients with NFKD, 33% had an admission diagnosis of bacterial adenitis or abscess. Compared with patients with BCL, patients with NFKD had lower leukocyte (WBC), hemoglobin, and platelet counts and higher absolute band counts (ABC), C-reactive protein (CRP), alanine transaminase and γ-glutamyl transpeptidase levels, and erythrocyte sedimentation rates. In the multivariable analysis, smaller nodes, lower WBC, and higher ABC and CRP were independently associated with NFKD. Patients with NFKD had multiple enlarged solid nodes and comparable rates of retropharyngeal edema. Compared with patients with typical KD, patients with NFKD were older, had more severe inflammation, and had similar rates of coronary artery abnormalities and resistance to intravenous immune globulin. Conclusions High ABC and CRP values and multiple enlarged solid nodes in febrile patients with cervical adenopathy should prompt consideration of NFKD to prevent delayed diagnosis of KD. Retropharyngeal edema on radiography should not dissuade from the diagnosis of NFKD.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 76%

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Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Kanegaye

Cott

Tremoulet

et al. 2013

The Journal of Pediatrics

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“…Patients with Kd with cervical lymphadenopathy as their dominant initial presentation were shown to be older and diagnosed later than other patients. 13,14 two other case series also reported that, in these patients, diagnosis was made on an average of 8.2 days of illness. 20,21 Comparatively delayed diagnosis in such patients highlights difficulty in timely diagnosis.…”

Section: Discussionmentioning

confidence: 85%

“…Patients with Kd presenting with only fever and cervical lymphadenopathy are reported to be older than patients with other presentations. 13,14 incomplete Kd, by contrast, is more common in infants. 2,15 understanding these differences in clinical manifestation is particularly helpful to provide timely identification of patients with Kd.…”

mentioning

confidence: 95%

Age-related Differences in the Course of the Acute Phase Symptoms of Kawasaki Disease

Shiozawa

Inuzuka

Harita³

et al. 2013

Pediatric Infectious Disease Journal

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A high index of suspicion for KD is required in febrile patients ≤24 months presenting with rash and in those >24 months with cervical lymphadenopathy. Younger patients need close observation because their acute phase symptoms progress rapidly. On the contrary, in older patients, cervical lymphadenopathy often remains the only manifestation for more than a few days and complicates the diagnosis. Recognizing age-specific patterns is useful for accurate and timely diagnosis of KD.

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Use of Machine Learning to Differentiate Children With Kawasaki Disease From Other Febrile Children in a Pediatric Emergency Department

et al. 2023

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ImportanceEarly awareness of Kawasaki disease (KD) helps physicians administer appropriate therapy to prevent acquired heart disease in children. However, diagnosing KD is challenging and relies largely on subjective diagnosis criteria.ObjectiveTo develop a prediction model using machine learning with objective parameters to differentiate children with KD from other febrile children.Design, Setting, and ParticipantsThis diagnostic study included 74 641 febrile children younger than 5 years who were recruited from 4 hospitals, including 2 medical centers and 2 regional hospitals, between January 1, 2010, and December 31, 2019. Statistical analysis was performed from October 2021 to February 2023.Main Outcomes and MeasuresDemographic data and laboratory values from electronic medical records, including complete blood cell count with differential, urinalysis, and biochemistry, were collected as possible parameters. The primary outcome was whether the febrile children fulfilled the diagnostic criteria of KD. The supervised eXtreme Gradient Boosting (XGBoost) machine learning method was applied to establish a prediction model. The confusion matrix and likelihood ratio were used to evaluate the performance of the prediction model.ResultsThis study included a total of 1142 patients with KD (mean [SD] age, 1.1 [0.8] years; 687 male patients [60.2%]) and 73 499 febrile children (mean [SD] age, 1.6 [1.4] years; 41 465 male patients [56.4%]) comprising the control group. The KD group was predominantly male (odds ratio, 1.79; 95% CI, 1.55-2.06) with younger age (mean difference, −0.6 years [95% CI, −0.6 to −0.5 years]) compared with the control group. The prediction model’s best performance in the testing set was able to achieve 92.5% sensitivity, 97.3% specificity, 34.5% positive predictive value, 99.9% negative predictive value, and a positive likelihood ratio of 34.0, which indicates outstanding performance. The area under the receiver operating characteristic curve of the prediction model was 0.980 (95% CI, 0.974-0.987).Conclusions and RelevanceThis diagnostic study suggests that results of objective laboratory tests had the potential to be predictors of KD. Furthermore, these findings suggested that machine learning with XGBoost can help physicians differentiate children with KD from other febrile children in pediatric emergency departments with excellent sensitivity, specificity, and accuracy.

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A Severe Form of Kawasaki Disease Presenting with Only Fever and Cervical Lymphadenopathy at Admission

Cited by 41 publications

References 17 publications

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Age-related Differences in the Course of the Acute Phase Symptoms of Kawasaki Disease

Use of Machine Learning to Differentiate Children With Kawasaki Disease From Other Febrile Children in a Pediatric Emergency Department

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