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Viral Coinfections in Kawasaki Disease: A Meta-analysis
Hannah C Neubauer1, Michelle A Lopez2,3, Heather A Haq2,3
1Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado.
Insights
Viral infections are common in children with Kawasaki disease (KD), but no single virus is predominant. Viral presence did not correlate with coronary artery aneurysms or treatment resistance.
Area of Science:
- Pediatric infectious diseases
- Rheumatology
- Epidemiology
Background:
- Kawasaki disease (KD) is a critical pediatric illness with suspected viral triggers.
- Identifying specific viral etiologies is crucial for understanding KD pathogenesis and improving treatment.
- Current evidence lacks a definitive link between specific viruses and KD development or severity.
Conclusions:
- Viral infections are frequently detected in children with Kawasaki disease, but no single virus appears to be the primary trigger.
- The presence of viral infections in KD patients was not linked to an increased risk of coronary artery aneurysms or resistance to IVIG therapy.
- Further research is needed to elucidate the complex interplay between viral infections and Kawasaki disease, given the low to very low quality of existing evidence.
Context:
Viral infections are suspected triggers in Kawasaki disease (KD); however, a specific viral trigger has not been identified.
Objectives:
In children with KD, to identify (1) overall prevalence of viral infections; (2) prevalence of specific viruses; and (3) whether viral positivity was associated with coronary artery aneurysms (CAAs) or refractoriness to intravenous immunoglobin (IVIG).
Data Sources:
We searched Embase, Medline, and Cochrane databases and gray literature.
Study Selection:
Eligible studies were conducted between 1999 and 2019, and included children diagnosed with KD who underwent viral testing.
Data Extraction:
Two investigators independently reviewed full-text articles to confirm eligibility, extract data, appraise for bias, and assess evidence quality for outcomes using the Grading of Recommendations Assessment Development and Evaluation criteria. We defined viral positivity as number of children with a positive viral test divided by total tested. Secondary outcomes were CAA (z score ≥2.5) and IVIG refractoriness (fever ≥36 hours after IVIG).
Results:
Of 3189 unique articles identified, 54 full-text articles were reviewed, and 18 observational studies were included. Viral positivity weighted mean prevalence was 30% (95% confidence interval [CI], 14-51) and varied from 5% to 66%, with significant between-study heterogeneity. Individual virus positivity was highest for rhinovirus (19%), adenovirus (10%), and coronavirus (7%). Odds of CAA (odds ratio, 1.08; 95% CI, 0.75-1.56) or IVIG refractoriness (odds ratio, 0.88; 95% CI, 0.58-1.35) did not differ on the basis of viral status.
Limitations:
Low or very low evidence quality.
Conclusions:
Viral infection was common with KD but without a predominant virus. Viral positivity was not associated with CAAs or IVIG refractoriness.
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