HOW IS KAWASAKI DISEASE DIAGNOSED ?

• Fever persisting at least 5 days
• PRESENCE OF AT LEAST 4 PRINCIPAL FEATURES:

1. Changes in extremities
   • Acute: Erythema of palms, soles; edema of hands, feet
   • Subacute: Periungual peeling of fingers, toes in weeks 2 and 3
2. Polymorphous exanthem
3. Bilateral bulbar conjunctival injection without exudate
4. Changes in lips and oral cavity: Erythema, lips cracking, strawberry tongue, diffuse injection of oral and pharyngeal mucosae
5. Cervical lymphadenopathy (1.5-cm diameter), usually unilateral

Exclusion of other diseases with similar findings-

BDIFFERENTIAL DIAGNOSIS

• Viral infections (eg, measles, adenovirus, enterovirus, Epstein-Barr virus)
• Scarlet fever/TSS
• Staphylococcal scalded skin syndrome
• Bacterial cervical lymphadenitis
• Drug hypersensitivity reactions
• Stevens-Johnson syndrome
• Juvenile rheumatoid arthritis
• Rocky Mountain spotted fever
• Leptospirosis
• Mercury hypersensitivity reaction (acrodynia)

DIAGNOSIS

• The classic diagnosis of Kawasaki disease has been based on the presence of 5 days of fever and 4 of the 5 principal clinical features
• All of the clinical features are not present at a single point in time, and watchful waiting is sometimes necessary before a diagnosis can be made

OTHER PRESENTATIONS

• Rarely,Kawasaki disease can present as an acute surgical abdomen
• Hepatic enlargement and jaundice can occur.

• Acute acalculous distention of the gallbladder (hydrops) occurs in 15% of patients during the first 2 weeks of the illness and can be identified by abdominal ultrasound.

DIAGNOSIS OF KD

Patients with fever at least 5 days and< 4 principal criteria can be diagnosed with Kawasaki disease when coronary artery abnormalities are detected by 2DE or angiography.

In the presence of 4 principal criteria, Kawasaki disease diagnosis can be made on day 4 of illness.

Experienced clinicians who have treated many Kawasaki disease patients may establish diagnosis before day 4.

DIAGNOSIS IN < 6 M OLD INFANTS

• Infants <6 months old on day 7 of fever without other explanation should undergo laboratory testing and, if
• Evidence of systemic inflammation is found, an echocardiogram, even if the infants have no clinical criteria.

WHEN NOT TO SUSPECT KAWASAKI DISEASE

Characteristics suggesting disease

other than Kawasaki disease include

• exudative conjunctivitis
• exudative pharyngitis
• discrete intraoral lesionsE
• bullous or vesicular rash
• generalized adenopathy.