‘We were struck’: Recent infection doubles odds of later Kawasaki disease diagnosis
Key takeaways:
- Previous infections or antibiotic prescriptions more than doubled the odds of Kawasaki disease.
- Researchers were “struck by the high frequency of infections and antibiotic prescriptions” just before Kawasaki disease diagnosis.
Patients with a history of recent respiratory, skin, urogenital and gastrointestinal tract infections demonstrate a two-fold increased risk for subsequent Kawasaki disease, according to data published in RMD Open.
“A connection between infections and the development of inflammatory conditions, including Kawasaki disease, has been frequently suggested,” Johannes Mofors, MD, PhD, resident rheumatologist at Karolinska University Hospital, in Stockholm, told Healio. “We wanted to explore this link using large-scale epidemiological data.”
To accomplish this, Mofors and colleagues conducted a case-control study using Swedish national registries. The study included all cases of Kawasaki disease diagnosed in Sweden from 1987 to 2018 (n = 1,774; median age at diagnosis, 2.6 years) in the National Patient Register, each of whom were matched with 10 control patients from the Total Population Register. For each case, control patients were randomly selected from those of the same sex, birth year and month, and county of residence at the time of Kawasaki disease diagnosis.
Using univariate conditional logistic regression, the researchers assessed the risk for Kawasaki disease following either a diagnosis of infection or prescription of antibiotics. The infections were analyzed based on the anatomical site predominantly affected, as well as in time periods evaluating the time between infection and Kawasaki disease diagnosis.
According to the researchers, patients with previous infections or antibiotic prescriptions demonstrated more than double the odds of Kawasaki disease (OR = 2.3; 95% CI, 2-2.5). Infections associated with Kawasaki disease were those that impacted the respiratory system, skin, the urogenital system and the gastrointestinal tract, they added. This relationship remained even after infections were separated by impacted organ systems and patients’ sex, as well as in an analysis limited to inpatient records with infection as the main diagnosis.
“I think the findings warrant vigilance regarding signs of perpetuation of inflammation linked to infections, as it may indicate the onset of inflammatory disorders,” Mofors said.
The timing of infection or antibiotic prescription seemed to affect the odds of Kawasaki disease diagnosis, the researchers added. For example, Kawasaki disease was most likely among patients with infections diagnosed 1 to 7 days (OR = 91.5; 95% CI, 66.1-126.8) or 8 to 14 days (OR = 11.6; 95% CI, 8.1-16.6) prior.
“We were struck by the high frequency of infections and antibiotic prescriptions in the weeks before Kawasaki disease diagnosis,” Mofors said. “This suggests that early symptoms of Kawasaki might be mistaken for common infections.”
For more information:
Johannes Mofors, MD, PhD, can be reached at johannes.mofors@ki.se.
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