Kawasaki's Disease
Kawasaki’s 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 and often in practice children are treated with antibiotics for 24-48 hours. The criteria may present sequentially such that an ‘incomplete’ case can evolve with time to become ‘complete’. This makes the definite exclusion of Kawasaki’s difficult and the disease should be considered in any irritable child with a fever for 5 or more days.
Diagnostic Criteria
- Fever more than five days plus 4 of the following:
- Conjunctivitis
- Lymphadenopathy
- Rash
- Changes to lips or oral mucosal
- Changes of extremities
Differential Diagnosis
- Toxic Shock Syndrome
- Scalded skin syndrome
- Scarlet fever
- EBV, CMV, Mycoplasma
- Polyarteritis nodosa
- Juvenile idiopathic arthritis
- Malignancy eg lymphoma
Initial investigations
KD is associated with many non-specific laboratory findings.
- Acute phase proteins raised
- Neutrophilia, ESR rainsed
- 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, antiDNaseSerology (mycoplasma, enterovirus, adenovirus, measles, parvovirus, EBV, CMV
- Blood Cultures
- Urine MC&S
- ECG and echocardiogram
- Consider CXR
Treatment
- Aspirin. Given during the acute phase of the illness at high dose (30mg/kg/day) and then reduced to 5mg/kg/day when the inflammatory markers have returned to normal.
- 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 diagnosed 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.
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
