Early features of Kawasaki disease with pyuria in febrile infants younger than 6 months

Abstract

Abstract Background Children with Kawasaki disease (KD) and pyuria have been misdiagnosed with urinary tract infection (UTI). We compared clinical and laboratory features at admission between two groups of infants under 6 months of age who showed initial pyuria, to identify the initial clues suggestive of KD. Methods We retrospectively reviewed the medical records of children with fever who were under 6 months of age with pyuria, over a 10-year period (2007–2017). We included infants with sterile pyuria who were finally diagnosed with KD and those with UTI. Results During the period investigated, 12 (9.9%) KD patients with sterile pyuria and 378 infants with UTI were included in this study. Older age (P 68 mm/hr had a ninefold higher odds of KD compared to those with lower ESR levels (odds ratio: 8.963, 95% confidence intervals: 1.936–41.493, P = 0.005), whereas CRP and platelet count could not significantly increase in the odds of KD at a cut-off point. Conclusion Persistent fever, elevated ESR, and negative urine nitrite test can serve as early clues to suspect KD in febrile infants with pyuria.

Keywords

• Differential diagnosis
• Fever
• Infant
• Kawasaki disease
• Urinary tract infection