HOW IS KAWASAKI DISEASE DIAGNOSED ?
- Fever persisting at least 5 days
- PRESENCE OF AT LEAST 4 PRINCIPAL FEATURES:
- Changes in extremities
- Acute: Erythema of palms, soles; edema of hands, feet
- Subacute: Periungual peeling of fingers, toes in weeks 2 and 3
- Polymorphous exanthem
- Bilateral bulbar conjunctival injection without exudate
- Changes in lips and oral cavity: Erythema, lips cracking, strawberry tongue, diffuse injection of oral and pharyngeal mucosae
- Cervical lymphadenopathy (1.5-cm diameter), usually unilateral
Exclusion of other diseases with similar findings-
- 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
- Mercury hypersensitivity reaction (acrodynia)
- 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
- 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.