Conjunctival changes in children with Kawasaki disease: cytopathologic characterization

Area of Science:

• Ophthalmology
• Pediatrics
• Pathology

Background:

• Kawasaki disease (KD) is a pediatric illness causing inflammation in blood vessels.
• Conjunctival changes in active KD are not well-characterized.
• Cytopathology offers a method to analyze cellular changes in ocular tissues.

Purpose of the Study:

• To investigate the cytopathological alterations in the conjunctiva of children with active Kawasaki disease.
• To compare conjunctival cell counts and differentials between acute KD, inactive KD, and healthy controls.

Main Methods:

• A prospective, case-control study involving 3 groups: acute KD (11), inactive KD (9), and age-matched controls (7).
• Bilateral conjunctival swabs were collected, processed using ThinPrep, and stained with Papanicolaou.
• Two cytopathologists blindly evaluated smears for cell count differentials and specific features like neutrophilic rosetting.

Main Results:

• Neutrophil counts were significantly higher in the acute KD group (average score 3.5) compared to controls (1.6) and inactive KD (1.3).
• Conjunctival samples from acute KD patients were more cellular, with statistically significant differences noted between acute and inactive KD groups.
• "Neutrophilic rosetting" (neutrophils around epithelial cells) was observed in 36% of active KD cases, but not in other groups.

Conclusions:

• "Neutrophilic conjunctivitis" is a characteristic cytopathological finding in active Kawasaki disease.
• These conjunctival changes may serve as a valuable indicator for the initial diagnosis and ongoing monitoring of KD patients.