Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  

   
correspondence

Indian Pediatr 2012;49: 160-161

Kawasaki Disease in Association with Urinary Tract Infection


We have few comments on the report by Husain, et al. [1]. Apart from two case reports of the association, a retrospective cohort study by Jan, et al. [2] on 285 patient with Kawasaki disease(KD), reported the incidence of bacterial pyuria as 10.7%.

As urine microscopy and culture forms the basis of diagnosis in infant <3 months, complete urine microscopic examination is not mentioned. How urine was collected for culture is not mentioned? Latter has to be either by suprapubic aspiration/transurethral catheterization. Urine nitrite test could have been followed with urine leucocyte esterase test. Urine culture still forms the gold standard for diagnosis of UTI as urine nitrite test can have false positives with positive predictive value of 50-83%. Why was blood culture not included as a part of septicemic work-up?

As per latest guidelines on management of UTI, infant should have DMSA study done apart from USG and MCU [3]. A prospective study by Jieh, et al. [4] on 50 KD patients reports that to assess the renal inflammation and its sequelae (incidence 46% in KD patients) DMSA should be included in diagnostic work up. They have concluded that the potential longterm clinical impact of KD is not limited to coronary artery lesion sequelae but also includes renal scar formation [4]. Lastly, last sentence which says KD should be one of the differential diagnoses in patients who are suspected of having UTI and do not respond to antibiotic therapy. This cannot be generalized as whole picture has to be taken, even the reported patient had rash and conjunctival inflammation to start with.

Vivek Kumar and Kiran Sodhi
12 Air Force Hospital, Akash Vihar Kunraghat,
Gorakhpur 273 002, UP, India.
Email: [email protected]

References

1. Husain EH, Al-Rashid. Kawasaki disease in association with urinary tract infection. Indian Pediatr. 2011;48:808-9.

2. Jan SL, Wu MC, Lin MC, Fu YC, Chan SC, Lin SJ. Pyuria is not always sterile in children with Kawasaki disease. Pediatr Int.  2010;52:113-7.

3. Indian Society of Pediatric Nephrology. Revised Statement on Management of Urinary Tract Infections. 2011;48:709-17.

4. Jieh-Neng Wang, Yuan-Yow Chiou, Nan-Tsing Chiu, Mei-Ju Chen, Bi-Fang Lee,  Jing-Ming Wu. Renal scarring sequelae in childhood Kawasaki disease.Pediatric Nephrol. 2007;22:684-9.

Reply


We would like to thank the authors for providing an important opinion regarding our case report [1]. We agree that 10.7% of children with Kawasaki disease (KD) have bacterial pyuria, as was reported by Jan, et al. [2]. The authors in this study concluded that there is an associated urinary tract infection (UTI) in children with diagnosed KD. This is contrary to the point we were trying to make in this case report, where the initial clinical and laboratory presentation was consistent with UTI and the patient was diagnosed later with KD, as the fever was not responding to antibiotics and the patient was developing criteria of KD during hospitalization.

As it is internationally accepted in infants and children who are not toilet trained; urine should be collected in a sterile way, which was the case here. The urine was collected through a transurethral catheter. We have mentioned the positive significant findings in the urine analysis. Blood culture was done as part of the septic workup and it was negative.

The infant in the case report [1] was treated acutely and long term for both KD and UTI; so had DMSA which was negative. This was not mentioned as it was not serving the purpose of the case report.

Finally, we agree with the authors that we cannot generalize that KD should be in the differential diagnosis in patients with UTI not responding to antibiotic therapy. In addition, we can add this statement "if they have showed some criteria suggestive of KD like rash, conjunctivitis or mouth changes".

Entesar H Husain and Maryam Al-Rashid
Email: [email protected]
 

References

1. Husain EH, Al-Rashid M. Kawasaki disease in association with urinary tract infection. Indian Pediatr. 2011;48:808-9.

2. Jan SL, Wu MC, Lin MC, Fu YC, Chan SC, Lin SJ. Pyuria is not always sterile in children with Kawasaki disease. Pediatr Int. 2010;52:113-7.

 

 

Copyright © 1999-2012 Indian Pediatrics