Kawasaki disease, multisystem inflammatory syndrome in children, and adenoviral infection: a scoring system to guide differential diagnosis

Abstract

Children with Kawasaki disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C), and Adenovirus infections (AI) of the upper respiratory tract show overlapping features. This study aims to develop a scoring system based on clinical or laboratory parameters to differentiate KD or MIS-C from AI patients. Ninety pediatric patients diagnosed with KD (n = 30), MIS-C (n = 26), and AI (n = 34) admitted to the Pediatric Emergency Unit of S.Orsola University Hospital in Bologna, Italy, from April 2018 to December 2021 were enrolled. Demographic, clinical, and laboratory data were recorded. A multivariable logistic regression analysis was performed, and a scoring system was subsequently developed. A simple model (clinical score), including five clinical parameters, and a complex model (clinic-lab score), resulting from the addition of one laboratory parameter, were developed and yielded 100% sensitivity and 80% specificity with a score ≥2 and 98.3% sensitivity and 83.3% specificity with a score ≥3, respectively, for MIS-C and KD diagnosis, as compared to AI. Conclusion: This scoring system, intended for both outpatients and inpatients, might limit overtesting, contribute to a more effective use of resources, and help the clinician not underestimate the true risk of KD or MIS-C among patients with an incidental Adenovirus detection. What is Known:• Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C) and adenoviral infections share overlapping clinical presentation in persistently febrile children, making differential diagnosis challenging.• Scoring systems have been developed to identify high-risk KD patients and discriminate KD from MIS-C patients. What is New:• This is the first scoring model based on clinical criteria to distinguish adenoviral infection from KD and MIS-C.• The score might be used by general pediatricians before referring febrile children to the emergency department.

Epidemiology of Adenovirus Infection in Hospitalized Children in the United States From 1997 to 2019

“…Children with HAdV infection and Kawasaki disease show overlapping clinical features. 43 We report that 1.2% of children with HAdV infection had a concomitant diagnosis of Kawasaki disease. In a study from a children's hospital, 5 of 143 children who were positive for HAdV were suspected of having Kawasaki disease.…”

Risk factors and scores for prediction of coronary artery aneurysms in Kawasaki disease: a European monocentric study

“…We did not include MIS-C patients according to the World Health Organization and Centers for Disease Control and Prevention Guidelines who did not meet KD diagnostic criteria [23,24]. Differential diagnosis between KD and MIS-C could be difficult because they share overlapping clinical presentations [25,26]. All the patients included in the present study were discharged with a diagnosis of KD, moreover, four expert clinicians, two paediatric immunologists and two paediatric cardiologists, analysed the cases to include to better discriminate between the two diagnoses.…”

A High Copy Number from a Pharyngeal Swab Is Not Associated with Different Presenting Features in 100 Children with Acute Adenovirus Infection from a Cluster in Italy

“…By using a multivariable logistic regression analysis, they reported accuracy in recognizing Kawasaki disease from the other overlapping conditions, including 30 cases of HAdV infection. Neutrophilia appears to be the laboratory parameter, which contributes to differentiate HAdV infection from potentially mis-recognized MIS-C [21].…”