1. Esper F, Shapiro ED, Weibel C, et al. Association between a novel human coronavirus and Kawasaki disease. J Infect Dis. 2005;191:499-502.
Kawasaki disease, a systemic vasculitis of childhood, is the most common cause of childhood acquired heart disease in developed countries and frequently a diagnosis made in the inpatient setting. Although the etiology of Kawasaki disease is not known, there is evidence to suggest the disease may be triggered by an infectious agent. This evidence includes wavelike spread in countries, seasonal epidemics, and the rarity of Kawasaki disease in adults and infants less than 3 months old. Even more compelling is the recent identification by Rowley et al. Of an antigen of unknown origin in respiratory epithelial cells and macrophages from children with Kawasaki disease (1).
Despite suggestion that retroviruses, Epstein–Barr virus, parvovirus B19, or chlamydia may be important in the pathogenesis of Kawasaki disease, no infectious etiology has been proven. In this brief report, Esper et al. document the interesting finding of a novel human coronavirus, “New Haven coronavirus” (HCoVNH), in the respiratory secretions of a 6-month old infant diagnosed with Kawasaki disease. Subsequently, the authors performed a retrospective, case-controlled study of 11 Kawasaki disease patients less than 5 years of age from whom respiratory secretions were archived but had tested negative for respiratory syncytial virus, influenza viruses A and B, parainfluenza viruses 1–3, and adenovirus by direct fluorescent antibody assay. These patients were matched with 2 control subjects. Eight (72.7%) of 11 case subjects and 1 (4.5%) of the 22 control subjects tested positive for HCoVNH by reverse transcriptase polymerase chain reaction (p=.0015). Further studies are needed to determine the precise role this, or other infectious pathogens, may have in the pathogenesis of the disease.
- Rowley AH, Baker SC, Shulman ST, et al. Detection of antigen in bronchial epithelium and macrophages in acute Kawasaki disease by use of synthetic antibody. J Infect Dis. 2004;190:856-65.
2. Eyaid WM, AlNouri DM, Rashed MS, et al. An inborn error of metabolism presenting as hypoxicischemic insult. Pediatr Neurol. 2005;32:134-6.
Inborn error of metabolism is frequently on the “bottom” of many differential diagnoses lists for common pediatric presenting complaints. Relative infrequency coupled with the occasional difficulty of making an accurate diagnosis presents unique challenges. Nonetheless, the importance of making this diagnosis is essential, given the frequent opportunity for pharmacologic and/ or dietary intervention to be therapeutic.
These authors present an interesting case of siblings presenting with seizures and central nervous system imaging consistent with hypoxicischemic insult who were subsequently diagnosed with isolated sulfite oxidase deficiency.