I read with interest the article by Barone et al,1 which demonstrates the difficulties of differentiating acute adenoviral infection from Kawasaki disease and the value of a rapid antigen detection assay for adenovirus. The author did not detect a significant difference in age between the 2 patient groups. Children with Kawasaki disease had a mean ± SD age of 39 ± 22 months vs a mean ± SD age of 64 ± 33 months in children with adenovirus infection. None of the 36 patients with Kawasaki disease, in contrast with 2 of the 7 patients with adenoviral infection, were older than 61 months. Five of 7 patients with adenoviral infection were older than 4 years. Of previously reported patients with Kawasaki disease, 80% have been younger than 4 years and 90% younger than 5 years. A more appropriate measurement in this instance might have been the median or mode for age in months. Incidentally, the small number of children with adenoviral infection (7) also makes tests of statistical significance susceptible to a type II error. One final question remains: Was cobblestoning of the palpebral conjunctiva, known to be associated with adenovirus disease, noted in study patients with this infection? This could provide another valuable clinical clue to disease differentiation. Despite these relatively small quibbles, the study and its results once again underscore the importance of ascertaining the etiology of Kawasaki disease to facilitate rational therapy. Until then, Kawasaki disease may well be characterized as a syndrome.
Barton LL. Differentiation of Adenoviral Infection and Kawasaki Disease. Arch Pediatr Adolesc Med. 2001;155(1):96–97. doi:10.1001/archpedi.155.1.95
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