Laboratory Biomarkers to Facilitate Differential Diagnosis Between Measles and Kawasaki Disease in a Pediatric Emergency Room: A Retrospective Study

Buonsenso, Danilo; Macchiarulo, Giulia; Supino, Maria Chiara; Penna, Francesco La; Scateni, Simona; Marchesi, Alessandra; Reale, Antonino; Boccuzzi, Elena

doi:10.4084/mjhid.2018.033

Cited by 10 publications

(10 citation statements)

References 6 publications

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“…Consistent with previous studies of clinical laboratory data in KD progression ( 45 – 48 ), in our study, the levels of ESR, CRP, WBC, and ANC peaked in the acute phase, the platelet levels were highest in the sub-acute phase, and RBC, Hct, Hgb, and leukocyte levels were highest in the convalescent phase. Correlations between individual KD patient's clinical laboratory data and the PTX-3 levels throughout KD progression showed PTX-3 levels with positive correlations to ESR, CRP, WBC, and ANC levels and negative correlations with Hct, ALC, and PLT.…”

Section: Discussionsupporting

confidence: 92%

“…Consistent with previous studies of clinical laboratory data in KD progression (45)(46)(47)(48), in our study, the levels of ESR, CRP, WBC, and ANC peaked in the acute phase, the platelet levels were highest in the sub-acute phase, and RBC, Hct, Hgb, and leukocyte levels were highest in the convalescent phase.…”

Section: Ptx-3 In Kd Is Correlated To Clinical Assessment Of Inflammationsupporting

confidence: 92%

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Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

et al. 2020

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Kawasaki disease (KD) is the leading cause of acquired pediatric heart disease in the developed world as 25–30% of untreated patients and at least 5% of treated patients will develop irreversible coronary artery lesions (CAL). Pentraxin-3 (PTX-3) has been well-studied in inflammatory diseases, particularly in cardiovascular diseases associated with vascular endothelial dysfunction. We hypothesized that PTX-3 plays an important role in the development of KD-associated CAL and investigated the circulating levels of PTX-3 in the serum of KD patients. Children with acute KD were followed from diagnosis through normalization of the clinical parameters of inflammation (convalescent phase). Serum samples were obtained and echocardiograms were conducted at several phases of the illness: acute [prior to intravenous immunoglobulin (IVIG) treatment], sub-acute (5–10 days after IVIG treatment), and convalescent (1–4 months after KD diagnosis). Seventy children were included in the final cohort of the study, of whom 26 (37%) presented with CAL and 18 (26%) developed IVIG resistance. The patients included in this study came from diverse ethnic backgrounds, mostly with mixed ancestry/ ethnicity. Significantly increased PTX-3 levels were observed during the acute phase of KD compared to the sub-acute and the convalescent phases. The PTX-3 levels during acute KD were significantly higher among KD patients with CAL compared to patients with normal coronary arteries (NCA). Also, the PTX-3 levels were significantly higher in patients with IVIG resistance. Furthermore, the PTX-3 levels were significantly higher in IVIG-resistant KD patients with CAL as compared to the NCA group. Moreover, the PTX-3 levels were significantly correlated to coronary artery z-score during acute KD and to neutrophil counts throughout KD progression regardless of coronary artery z-score. Elevated PTX-3 levels correlated to elevated neutrophil counts, a known source of PTX-3 in acute inflammation and an important player in the development of KD vasculitis. We, therefore, suggest PTX-3 as a novel factor in the development of KD-associated CAL and propose neutrophil-derived PTX-3 as contributing to KD vascular dysfunction.

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Section: Discussionsupporting

confidence: 92%

Section: Ptx-3 In Kd Is Correlated To Clinical Assessment Of Inflammationsupporting

confidence: 92%

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

et al. 2020

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“…Differential diagnosis includes other viruses causing exanthema such as rubella virus, human herpes virus 6, cytomegalovirus, parvovirus B19, Epstein–Barr virus, varicella virus and arboviral diseases (dengue, zika and chikungunya) as well as conditions such as Kawasaki disease especially in children. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population

Torner

Mercader

Domı́nguez

et al. 2023

Pediatrics International

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Background Measles can lead to serious complications and remains an important cause of morbidity and mortality worldwide. In this study we aimed to assess the etiological diagnosis of discarded measles cases in the context of an outbreak among a highly immunized population. Methods We conducted a retrospective observational study of discarded measles cases from an outbreak that occurred from October 2006 to July 2007 in Catalonia. A confirmed case was defined as having a positive measles serum IgM result and/or a positive result by RT‐PCR in urine and/or nasopharyngeal swab; or an epidemiological link to a confirmed case. Serum specimens were tested by a commercially available indirect‐format and by an in‐house capture‐format measles IgM enzyme immunoassays. Results Testing of 89 samples discarded for measles determined the etiologies for 10 (11.2%), including one rubella, three human herpes virus 6, and six measles infections. Of 381 confirmed cases in the outbreak, 10% had received at least one dose of the measles‐mumps‐rubella vaccine versus 54% of the discarded for measles (OR: 0.09; 95% CI: 0.06, 0.14; p < 0.001). Conclusions Highly sensitive surveillance systems are critical to identifying cases, responding to outbreaks and verifying progress towards measles elimination. Molecular tools for measles detection and differential diagnosis, and collection of appropriate specimens for molecular and serological testing are essential to correctly diagnose suspected measles infection.

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“…Some reports have suggested that hepatitis caused by measles elevated serum LDH, 11,13 whereas Ten Oever et al 12 and Sugaya et al 10 reported that the elevation of serum LDH level implicated lymphocyte destruction or activation in typical measles cases. The elevated LDH level has also been recognized as an auxiliary diagnostic marker for measles in hospital settings 14 . However, these reports focused mainly on typical measles cases in hospital settings and did not include measles cases with SVF.…”

Section: Introductionmentioning

confidence: 99%

“…The elevated LDH level has also been recognized as an auxiliary diagnostic marker for measles in hospital settings. 14 However, these reports focused mainly on typical measles cases in hospital settings and did not include measles cases with SVF. Additionally, the relationship between virus genome copy numbers and biochemical markers has not been investigated.…”

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confidence: 99%

Relationship between biochemical markers and measles viral load in patients with immunologically naive cases and secondary vaccine failure: LDH is one of the potential auxiliary indicators for secondary vaccine failure

Kurata

Kanbayashi

Komano

et al. 2021

Microbiology and Immunology

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This study investigated the correlation between biochemical markers and viral load among 38 measles cases, including 15 immunologically naive patients and 23 patients with secondary vaccine failure (SVF). We examined four biochemical markers, namely, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, and lactate dehydrogenase (LDH) and their relationship between virus genome copy numbers in peripheral blood mononuclear cells (PBMCs) and throat swabs as well as the concentration of measles-specific IgG. Although viral genome copies in both clinical specimens showed a significant correlation with specific IgG concentration, they had a higher correlation in PBMCs (Pearson's product-moment correlation coefficient, −0.662; p < .0001) than in throat swabs (Spearman's rank correlation coefficient, −0.443; p = .0078). The viral load in PBMCs also significantly correlated with LDH values (correlation coefficient, 0.360; p = .036). Thus, the serum LDH level might be a potential auxiliary indicator to distinguish immunologically naive patients with measles from those with SVF.Measles is a highly contagious viral disease characterized by a generalized rash and severe fever. Since 1968, when an effective live attenuated measles-containing vaccine (MCV) was developed, the incidence and mortality rate of measles has decreased globally. 1 After introducing routine two-dose schedules with the measles-rubella vaccine in 2006, 2 the number of reported measles cases was drastically reduced in Japan, 3 and in 2015, measles elimination in Japan was verified by the World Health Organization Western Pacific Regional Office. 4 After the elimination of measles, outbreaks related with patients who had previously received an MCV have become an issue. According to the National Institute of Infectious Diseases (NIID), approximately 35% of patients with measles reported in 2019 had been vaccinated. 3 These measles infections were induced by primary vaccine failure (PVF) or secondary vaccine failure (SVF). PVF is a failed response to vaccination and is observed in approximately 2%-5% of children who receive a single MCV dose. 1 Patients with PVF are more likely to present severe clinical signs similar to unvaccinated patients and an immunological reaction (i.e., low

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Laboratory Biomarkers to Facilitate Differential Diagnosis Between Measles and Kawasaki Disease in a Pediatric Emergency Room: A Retrospective Study

Cited by 10 publications

References 6 publications

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population

Relationship between biochemical markers and measles viral load in patients with immunologically naive cases and secondary vaccine failure: LDH is one of the potential auxiliary indicators for secondary vaccine failure

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