Distinguishing Kawasaki Disease from Other Febrile Illnesses in Infants

INTRODUCTION: Kawasaki disease (KD) is difficult to diagnose in infants, since the disease course is subtle. We aimed to identify whether infants with KD demonstrate significant alterations in laboratory parameters that can be used to distinguish them from other febrile infants.
METHODS: In this retrospective case-control study, infants diagnosed with KD between January 2010 and December 2019 were evaluated and compared to a cohort of febrile infants admitted with prolonged fever during the same period. Demographic, clinical, and laboratory features were recorded and compared between those two groups.
RESULTS: A total of 42 infants (27 male) with KD (32 incomplete KD) and age-matched 84 febrile infants (57 male) were evaluated. Coronary artery involvement was identified in 20 (47.6%) infants of whom 5 (25%) had coronary aneurysms. All infants with KD were treated with IVIG and high dose acetylsalicylic acid, and 38 (90.5%) responded to treatment. Duration of fever and hospitalization was longer in infants with KD compared to controls (p˂0.001). White blood cell (WBC), eosinophil, platelet counts, platelet distribution width (PDW), acute phase reactants, alanine aminotransferase, and gamma glutamyl transferase were significantly higher; whereas, mean platelet volume (MPV), hemoglobin, and albumin levels were lower in the KD group compared to controls. Lower MPV and albumin values were found to be independently associated with higher likelihood of having KD diagnosis.
DISCUSSION AND CONCLUSION: It may be difficult to diagnose KD in infants. Our data shows that MPV and albumin may be used as supportive parameters to discriminate KD from other febrile conditions in infants.