Diagnosis of Kawasaki disease

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Abstract

Kawasaki disease ( KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association ( AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.

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Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Jane W Newburger, Masato Takahashi, Michael Gerber … (2004)

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.

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Kawasaki Disease.

Jane W Newburger, Masato Takahashi, Jane C. Burns (2016)

Kawasaki disease is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and children. If not treated early with high-dose intravenous immunoglobulin, 1 in 5 children develop coronary artery aneurysms; this risk is reduced 5-fold if intravenous immunoglobulin is administered within 10 days of fever onset. Coronary artery aneurysms evolve dynamically over time, usually reaching a peak dimension by 6 weeks after illness onset. Almost all the morbidity and mortality occur in patients with giant aneurysms. Risk of myocardial infarction from coronary artery thrombosis is greatest in the first 2 years after illness onset. However, stenosis and occlusion progress over years. Indeed, Kawasaki disease is no longer a rare cause of acute coronary syndrome presenting in young adults. Both coronary artery bypass surgery and percutaneous intervention have been used to treat Kawasaki disease patients who develop myocardial ischemia as a consequence of coronary artery aneurysms and stenosis.

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The epidemiology of Kawasaki disease: a global update.

Surjit Singh, Pandiarajan Vignesh, David Burgner (2015)

Kawasaki disease (KD) is a childhood vasculitis and the most frequent cause of paediatric acquired heart disease in North America, Europe and Japan. It is increasingly recognised in rapidly industrialising countries such as China and India where it may replace rheumatic heart disease as the most common cause of acquired heart disease in children. We review the current global epidemiology of KD and discuss some public health implications.

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Author and article information

Contributors

Surjit Singh:

ORCID: http://orcid.org/0000-0002-6716-1883

surjitsinghpgi@rediffmail.com

Journal

Journal ID (nlm-ta): Int J Rheum Dis

Journal ID (iso-abbrev): Int J Rheum Dis

Journal ID (doi): 10.1111/(ISSN)1756-185X

Journal ID (publisher-id): APL

Title: International Journal of Rheumatic Diseases

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 1756-1841

ISSN (Electronic): 1756-185X

Publication date (Electronic): 13 November 2017

Publication date (Print): January 2018

Volume: 21

Issue: 1 , Special Issue ‐ Kawasaki Disease ( doiID: 10.1111/apl.2018.21.issue-1 )

Pages: 36-44

Affiliations

[ ¹ ] Allergy Immunology Unit Department of Pediatrics Advanced Pediatrics Centre Post‐Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India

Author notes

[*] [* ] Correspondence: Dr Surjit Singh, Department of Pediatrics, and Chief, Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh, India, 160012. Email: surjitsinghpgi@ 123456rediffmail.com

Author information

Surjit Singh http://orcid.org/0000-0002-6716-1883

Ankur Kumar Jindal http://orcid.org/0000-0002-7954-0661

Article

Publisher ID: APL13224

DOI: 10.1111/1756-185X.13224

PMC ID: 7159575

PubMed ID: 29131549

SO-VID: 2470797a-8007-4f16-9ba1-f2e76c253695

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

History

Page count

Figures: 0, Tables: 5, Pages: 9, Words: 6289

Custom metadata

source-schema-version-number 2.0

cover-date January 2018

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

ScienceOpen disciplines: Rheumatology

Keywords: aha,diagnosis,echocardiography,kawasaki disease

Data availability:

ScienceOpen disciplines: Rheumatology

Keywords: aha, diagnosis, echocardiography, kawasaki disease

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