Department of Cardiology, CHU Ste-Justine, Montreal, Canada.
Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America.
PLoS One. 2018 Oct 17;13(10):e0206001. doi: 10.1371/journal.pone.0206001. eCollection 2018.
Kawasaki disease (KD) can be associated with concomitant viral or bacterial infections. Children with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications. Although concomitant infection does not affect coronary outcome, it is unknown how it influences the response to IVIG treatment.
Retrospective cohort study between 2008 and 2016 in a tertiary pediatric university hospital, including 154 children, of which 59 (38%) had concomitant infection.
Children with concomitant infection were more likely to have fever 48 hours after initial IVIG treatment (36% vs 20%, p = 0.05) and to be treated with a second dose (33% vs 18%, p = 0.04). Children with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p = 0.04), and 48 hours after IVIG administration (111 vs 59 mg/L, p = 0.003). Nevertheless, there was no statistically significant difference in the prevalence of coronary complications (Z-score > 2.5) between children with and without concomitant infection (36% vs 39%, p = 0.68).
Children with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment. This association increases the likelihood of receiving a second dose of IVIG but not the risk of coronary complication. Accordingly, prospective studies to distinguish true IVIG resistance from infection induced persistent fever is warranted.
川崎病（KD）可伴有并发的病毒或细菌感染。静脉注射免疫球蛋白（IVIG）治疗结束后持续或反复发热 36 小时的患儿被认为对治疗有抵抗作用，且发生冠状动脉并发症的风险增加。虽然并发感染不会影响冠状动脉结局，但尚不清楚其如何影响 IVIG 治疗的反应。
这是一项 2008 年至 2016 年在一家三级儿科大学医院进行的回顾性队列研究，共纳入 154 名患儿，其中 59 名（38%）有并发感染。
并发感染的患儿初始 IVIG 治疗后 48 小时发热的可能性更高（36%比 20%，p = 0.05），需要接受第二剂治疗的可能性也更高（33%比 18%，p = 0.04）。感染患儿在诊断时（148 比 112 mg/L，p = 0.04）和 IVIG 给药后 48 小时（111 比 59 mg/L，p = 0.003）的 C 反应蛋白更高。然而，并发感染患儿的冠状动脉并发症（Z 评分>2.5）发生率与无并发感染患儿之间无统计学差异（36%比 39%，p = 0.68）。
并发感染的 KD 患儿在治疗后更有可能持续发热和炎症标志物升高。这种相关性增加了接受第二剂 IVIG 的可能性，但不会增加冠状动脉并发症的风险。因此，需要进行前瞻性研究来区分真正的 IVIG 抵抗与感染引起的持续发热。
