|
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.
|
|
|
|