Background
Kawasaki disease (KD) is a disease of exclusion and the diagnosis and treatment of possible cases must be discussed with senior medical staff
Diagnosis
There is no diagnostic test and diagnosis is based on clinical criteria and the exclusion of other diseases. Infection must be considered. The criteria may present sequentially such that an ‘incomplete’ case can evolve with time to become ‘complete’. This makes the definite exclusion of Kawasaki disease (KD) difficult and the disease should be considered in any irritable child with a fever for 5 or more days.
Diagnostic Criteria
Fever >five days plus 4 of the following:
- Conjunctivitis: non-exudative
- Cervical lymphadenopathy - > one >1.5cm node
- Rash
- Changes to lips or oral mucosal - erythema or cracking or swelling of lips, strawberry tongue
- Changes of extremities - erythema and/or painful oedema and /or desquamation from the 2nd week
Atypical KD has a similar morbidity, thus senior advice should be sought in cases with 2 or more features of KD.
Differential Diagnosis
- Toxic Shock Syndrome
- Scalded skin syndrome
- Scarlet fever
- EBV, CMV, Mycoplasma
- Adenovirus, SARS-CoV-2, measles
- Stephen-Johnson syndrome
- Drug reaction
- Polyarteritis nodosa
- Juvenile idiopathic arthritis
- Malignancy e.g. lymphoma
Initial investigations
KD is associated with many non-specific laboratory findings.
- Acute phase proteins raised
- Neutrophilia, ESR raised
- Thrombocytosis towards the end of the second week and therefore is not useful diagnostically
- LFTs may be deranged
- Pyuria, CSF pleocytosis
Other investigations
- FBC and Film
- ESR,CRP
- Renal profile
- LFT
- Coagulation
- Autoimmune profile
Other investigations
- ASOT, anti DNA serology (mycoplasma, enterovirus, adenovirus, measles, parvovirus, EBV, CMV)
- Blood Cultures
- Urine MC&S
- ECG and echocardiogram
- Consider CXR
Consider
Treatment
Aspirin
- Given during the acute phase of the illness at 30-50 mg/kg/day until afebrile
Immunoglobulin
- Early recognition and treatment with IVIG has been shown to reduce the occurrence of coronary artery aneurysms
- For maximum benefit it should be given before day 10 of the illness but should not be withheld if Dx after this time
- If you suspect KD then it should be treated regardless of what the echo shows
- Recommended dose is 2g/Kg over 12 hours except where there is cardiac compromise when a smaller volume in divided doses may be preferable
Steroids
- No steroids unless x2 fail of IVIG
Mx algorithm
References
Brogan PA, Bose A, Burgner D et al Kawasaki disease:an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 2002; 86:286-290