Clinical characteristics of children with influenza A and Kawasaki disease

doi:10.3877/cma.j.issn.1674-1358.2020.03.014

Abstract

Abstract:

Objective

To analyze the clinical features of influenza A complicated with Kawasaki disease (KD) in children and enhance its early identification.

Methods

The medical records of 682 cases with laboratory-confirmed influenza A in Beijing Ditan Hospital, Capital Medical University from January 1st, 2018 to December 31st, 2019 were analyzed, retrospectively. Among whom, 14 children with influenza A virus infection complicated with KD were collected as KD+influenza A group. While 28 cases with KD meeting the inclusion criteria and exclusion criteria were selected as KD group, and 28 cases with influenza A alone as influenza A group, respectively. The clinical manifestations, duration of fever and incidence of coronary artery disease were compared between KD+influenza A group and KD group. The levels of white blood cell (WBC), neutrophil percentage, lymphocyte percentage, platelet, rapid C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), serum amyloid protease A (SSA), albumin, aminotransferase and myocardial enzyme were compared among KD+influenza A group, KD group and influenza A group, respectively.

Results

The duration of fever in children of KD+influenza A group [(11.21 ± 3.36) d] was significantly longer than that of KD group [(6.29 ± 2.21) d], with significant difference (t = 5.81, P < 0.001). The levels of WBC [(13.18 ± 4.39) × 10⁹/L], ESR [(60.5 ± 15.82) mm/h], CPR [55.5 (17.56, 61.0) g/L], SSA [76.5 (23.0, 311.6) mg/L] and alanine aminotransferase (ALT) [49.5 (23.1, 78.0) U/L] of cases in KD group were significantly higher than those of KD group and influenza A group, with significant differences (F = 27.92, P < 0.001; F = 47.97, P < 0.001; Z = 3.15, P = 0.007; Z = 4.36, P < 0.001; Z = 2.68, P = 0.027). The probability of coronary artery dilation of cases in KD+influenza A group was higher than that of KD group (57.0% vs. 25.0%), with significant difference (χ² = 4.2, P = 0.041). The incidence rate of non-response to intravenous immunoglobulin (IVIG) of cases in KD+influenza A group was significantly higher than that of KD group (42.9% vs. 14.3%), with significant difference (χ² = 4.1, P = 0.041).

Conclusions

The duration of fever and period of definite diagnosis were longer, the incidence rate of non-response to IVIG was higher, and the levels of serum SSA and ALT increased significantly in children with influenza A and KD.

Key words: Children, Kawasaki disease, Influenza A

Yang Zhao, Caiying Wang, Gang Wan, Xinxin Zhang, Shuxin He, Yiwei Hao, Lin Pang. Clinical characteristics of children with influenza A and Kawasaki disease[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(03): 258-263.

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References 23

[1]	Kim JO, Kim YH, Hyun MC. Comparison between Kawasaki disease with lymph-node-first presentation and Kawasaki disease without cervical lymphadenopathy[J]. Korean J Pediatr,2016,59(2):54-58.
[2]	Bayers S, Shulman ST, Paller AS. Kawasaki disease: Part Ⅱ. complications and treatment[J]. J Am Acad Dermatol,2013,69(4):513. e1-8.
[3]	闫辉, 杜军保. 川崎病的临床诊治探索任重道远[J]. 中国实用儿科杂志,2017,32(8):561-564.
[4]	Kim GB, Han JW, Park YW, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011[J]. Pediatr Infect Dis J,2014,33(1):24-27.
[5]	Du ZD, Zhao D, Du J, et al. Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004[J]. Pediatr Infect Dis J,2007,26(5):449-451.
[6]	Jaggi P, Kajon AE, Mejias A, et al. Human adenovirus infection in Kawasaki disease: a confounding bystander?[J]. Clin Infect Dis,2013,56(1):58-64.
[7]	Jalel C, Saida H, Soumaya K, et al. Kawasaki disease, Mycoplasma pneumoniae infection and anaplastic large cell lymphoma: An uncommon association[J]. Open J Pediatrics,2012,2(3):250-252.
[8]	Matsubara K, Fukaya T. The role of superantigens of group A Streptococcus and Staphylococcus aureus in Kawasaki disease[J]. Curr Opin Infect Dis,2007,20(3):298-303.
[9]	Nigro G, Midulla M. Retrovirus and Kawasaki disease[J]. Lancet (London, England),1986,2(8514):1045.
[10]	Kikuta H, Mizuno F, Osato T, et al. Development of Kawasaki disease and the initial infection by EB virus[J]. Nihon Rinsho,1983,41(9):2069-2074.
[11]	Moreira A, Leite I, Baptista A, et al. Kawasaki disease associated with parainfluenza type 3 virus infection[J]. Acta Dermatovenerol Croat,2010,18(2):120-123.
[12]	JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2013)[J]. Circ J,2014,78(10):2521-2562.
[13]	McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association[J]. Circulation,2017,135(17):e927-e999.
[14]	江载芳, 申昆玲, 沈颖. 诸福棠实用儿科学[M]. 8版. 北京人民卫生出版社,2015:778-788.
[15]	中华人民共和国国家卫生健康委员会, 国家中医药局. 流行性感冒诊疗方案(2019年版)[J] .中华临床感染病杂志,2019,12(6):451-455.
[16]	赵春娜, 杜忠东. 感染因素对川崎病及其冠状动脉病变的影响[J]. 中国循证儿科杂志,2015,10(6):454-457.
[17]	Jun W, Fang S, Hui LD, et al. Influenza A (H1N1) pdm09 virus infection in a patient with incomplete Kawasaki disease: A case report[J]. Medicine,2019,98(15):e15009.
[18]	杜军保, 陈咏冰. 川崎病丙种球蛋白无反应型的预测及治疗[J]. 北京大学学报(医学版),2017,49(5):749-752.
[19]	Schmitz N, Kurrer M, Bachmann MF, et al. Interleukin-1 is responsible for acute lung immunopathology but increases survival of respiratory influenza virus infection[J]. J Virol,2005,79(10):6441-6448. .
[20]	张艳兰, 杜忠东, 杨海明, 等. 川崎病小鼠肿瘤坏死因子α/核因子κB/基质金属蛋白酶-9通路研究[J]. 中国循证儿科杂志,2014,9(1):59-63.
[21]	Gakuji O, Fukumi F, Hisayoshi F, et al. Hepatomegaly and splenomegaly in Kawasaki disease[J]. Pediatr Pathol,2009,4(3-4):257-264.
[22]	雷小雨, 贺美玲, 孙玉婵. 川崎病并发肝功能损害患儿临床特点分析[J]. 中国中西医结合儿科学,2019,11(2):167-169.
[23]	Hongo T, Momoki N, Mae S, et al. A rare case of Reye’s syndrome induced by influenza A virus with use of ibuprofen in an adult[J]. Acut Med Surg,2020,7(1):e457.

症状	KD+甲型流感组（14例）	KD组（28例）	统计量	P值
双侧结膜充血[例（%）]	12（85.7）	21（75.0）	χ² = 0.63	0.425
口唇黏膜改变[例（%）]	11（78.6）	24（85.7）	χ² = 0.34	0.558
多形性皮疹[例（%）]	11（78.6）	25（89.3）	χ² = 0.87	0.351
四肢变化[例（%）]	11（78.6）	18（64.3）	χ² = 0.89	0.345
淋巴结肿大[例（%）]	14（100.0）	27（96.4）	χ² = 0.51	0.474
肛门皮肤脱皮[例（%）]	7（50.0）	5（17.9）	χ² = 4.73	0.031
卡疤（+） [例（%）]	7（50.0）	5（17.9）	χ² = 4.70	0.031
冠脉损害[例（%）]	8（57.0）	7（25.0）	χ² = 4.20	0.041
发热持续时间（ ± s，d）	11.21 ± 3.36	6.29 ± 2.21	t = 5.81	< 0.001
IVIG无反应型^a	6（42.9）	4（14.3）	χ² = 4.10	0.041

症状	KD+甲型流感组（14例）	KD组（28例）	统计量	P值
双侧结膜充血[例（%）]	12（85.7）	21（75.0）	χ² = 0.63	0.425
口唇黏膜改变[例（%）]	11（78.6）	24（85.7）	χ² = 0.34	0.558
多形性皮疹[例（%）]	11（78.6）	25（89.3）	χ² = 0.87	0.351
四肢变化[例（%）]	11（78.6）	18（64.3）	χ² = 0.89	0.345
淋巴结肿大[例（%）]	14（100.0）	27（96.4）	χ² = 0.51	0.474
肛门皮肤脱皮[例（%）]	7（50.0）	5（17.9）	χ² = 4.73	0.031
卡疤（+） [例（%）]	7（50.0）	5（17.9）	χ² = 4.70	0.031
冠脉损害[例（%）]	8（57.0）	7（25.0）	χ² = 4.20	0.041
发热持续时间（ ± s，d）	11.21 ± 3.36	6.29 ± 2.21	t = 5.81	< 0.001
IVIG无反应型^a	6（42.9）	4（14.3）	χ² = 4.10	0.041

实验室指标	KD+甲型流感组（14例）	KD（28例）	甲型流感组（28例）	统计量	P值
WBC（ ± s，× 10⁹/L）	13.18 ± 4.39	14.00 ± 5.00	6.58 ± 2.02	F = 27.92	< 0.001
N%（ ± s）	62.54 ± 11.07	63.00 ± 18.41	51.84 ± 22.70	F = 2.76	0.070
L%（ ± s）	26.73 ± 11.18	28.61 ± 15.91	35.84 ± 21.39	F = 1.72	0.186
PLT（× 10⁹/L）	319.72 ± 101.27	328.43 ± 119.56	300.13 ± 154.19	F = 0.33	0.718
CRP[M（Q1，Q3），mg/L]	5.5（17.56，61.0）	17.2（6.4，59.6）	7.6（2.4，15.5）	Z = 3.15	0.007
ESR（ ± s，mm/h）	60.50 ± 15.82	53.68 ± 21.11a	19.75 ± 3.83	F = 47.97	< 0.001
PCT[M（Q1，Q3），ng/ml]	0.3（0.1，1.3）	0.7（0.3，1.9）	0.2（0.2，0.2）	Z = 4.98	< 0.001
SAA[M（Q1，Q3），mg/L]	76.5（23.0，311.6）	11.5（3.0，23.0）	29.5（23.0，42.5）	Z = 4.36	< 0.001
ALB（ ± s，g/L）	38.21 ± 4.06	36.15 ± 3.81	37.99 ± 4.35	F = 1.86	0.164
ALT[M（Q1，Q3），U/L]	49.5（23.1，78.0）	24.9（11.9，42.9）	31.8（14.5，46.0）	Z = 2.68	0.027
AST[M（Q1，Q3），U/L]	44.7（14.0，62.0）	29.4（27.0，48.4）	34.0（22.0，41.2）	Z = 0.83	0.709
CK-MB[M（Q1，Q3），U/L]	21.0（17.6，31.4）	25.0（14.9，27.7）	23.2（18.1，31.9）	Z = 0.57	0.852

实验室指标	KD+甲型流感组（14例）	KD（28例）	甲型流感组（28例）	统计量	P值
WBC（ ± s，× 10⁹/L）	13.18 ± 4.39	14.00 ± 5.00	6.58 ± 2.02	F = 27.92	< 0.001
N%（ ± s）	62.54 ± 11.07	63.00 ± 18.41	51.84 ± 22.70	F = 2.76	0.070
L%（ ± s）	26.73 ± 11.18	28.61 ± 15.91	35.84 ± 21.39	F = 1.72	0.186
PLT（× 10⁹/L）	319.72 ± 101.27	328.43 ± 119.56	300.13 ± 154.19	F = 0.33	0.718
CRP[M（Q1，Q3），mg/L]	5.5（17.56，61.0）	17.2（6.4，59.6）	7.6（2.4，15.5）	Z = 3.15	0.007
ESR（ ± s，mm/h）	60.50 ± 15.82	53.68 ± 21.11a	19.75 ± 3.83	F = 47.97	< 0.001
PCT[M（Q1，Q3），ng/ml]	0.3（0.1，1.3）	0.7（0.3，1.9）	0.2（0.2，0.2）	Z = 4.98	< 0.001
SAA[M（Q1，Q3），mg/L]	76.5（23.0，311.6）	11.5（3.0，23.0）	29.5（23.0，42.5）	Z = 4.36	< 0.001
ALB（ ± s，g/L）	38.21 ± 4.06	36.15 ± 3.81	37.99 ± 4.35	F = 1.86	0.164
ALT[M（Q1，Q3），U/L]	49.5（23.1，78.0）	24.9（11.9，42.9）	31.8（14.5，46.0）	Z = 2.68	0.027
AST[M（Q1，Q3），U/L]	44.7（14.0，62.0）	29.4（27.0，48.4）	34.0（22.0，41.2）	Z = 0.83	0.709
CK-MB[M（Q1，Q3），U/L]	21.0（17.6，31.4）	25.0（14.9，27.7）	23.2（18.1，31.9）	Z = 0.57	0.852

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