Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized
by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa,
changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms
or ectasia develop in approximately 15% to 25% of untreated children and may lead
to ischemic heart disease or sudden death.
A multidisciplinary committee of experts was convened to revise the American Heart
Association recommendations for diagnosis, treatment, and long-term management of
Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in
deciding which children with fever for > or =5 days and < or =4 classic criteria should
undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or
both for Kawasaki disease. The writing group reviews the available data regarding
the initial treatment for children with acute Kawasaki disease, as well for those
who have persistent or recrudescent fever despite initial therapy with IVIG, including
IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-alpha antagonists,
and abciximab. Long-term management of patients with Kawasaki disease is tailored
to the degree of coronary involvement; recommendations regarding antiplatelet and
anticoagulant therapy, physical activity, follow-up assessment, and the appropriate
diagnostic procedures to evaluate cardiac disease are classified according to risk
strata.
Recommendations for the initial evaluation, treatment in the acute phase, and long-term
management of patients with Kawasaki disease are intended to assist physicians in
understanding the range of acceptable approaches for caring for patients with Kawasaki
disease. The ultimate decisions for case management must be made by physicians in
light of the particular conditions presented by individual patients.