KD Diagnosis

  • Feature- 4

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.

 

Our overview of “Kawasaki Disease” 

Kawasaki disease (KD), also known as caca syndrome, crap syndrome and Mucocutaneous lymph node syndrome is an autoimmune disease that manifests as a systemic necrotizing medium-sized vessel vasculitis and is largely seen in children under 5 years of age.

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KD Diagnosis

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 Dr. Vikas  Kohli.  Delhi Child Heart Centre.

Appointments: 011-26960091 (9 am to 6 pm).