Kawasaki disease diagnosis pathway evidence based outcome. Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a disease in which blood vessels throughout the body become inflamed. Pathogenesis of kawasaki disease pubmed central pmc. A rare disease without pathognomonic findings or a diagnostic test, kawasaki disease should be considered in the differential diagnosis of a child with prolonged fever. Kawasaki disease symptoms, diagnosis and treatment bmj.
Kawasaki disease kd see the image below is an acute febrile vasculitic syndrome of early childhood that, although it has a good prognosis. Streptococcal infection including scarlet fever, toxic shocklike syndrome staphylococcal infection such as toxic shock syndrome or scalded skin syndrome measles, rubella, roseola infantum, epstein barr virus, influenza a and b, adenovirus. Disease name and synonyms kawasaki disease kd, kawasaki syndrome, mucocutaneous lymph node syndrome excluded diseases infantile polyarteritis nodosa diagnostic criteriadefinition diagnostic guidelines for kd were established by the japanese kawasaki disease research committee 1. Table 3 summarizes guidance for the diagnosis of kawasaki disease. Kawasaki disease clinical guideline dell childrens. In an immunogenetically predisposed host, one or more infectious agents may play a role in triggering the clinical manifestations of the disease.
The patient demonstrated marked improvement with treatment and had a normal echocardiogram. The diagnosis of kawasaki disease is made based on the clinical findings. Various infections can mimic kawasaki disease including. Recognize the clinical findings associated with kawasaki disease kd. Kawasaki disease kd most frequently affects infants and young children under 5 years of age. Classic typical kawasaki disease is diagnosed based on the presence of a fever lasting five or more days. Over the last 5 decades multiple papers have been published to further understand this disease. Kawasaki disease kd, previously called mucocutaneous lymph node. Incomplete atypical kawasaki disease occurs in persons with fever lasting. Guidelines for diagnosis and management of cardiovascular. The kawasaki disease diagnostic criteria diagnoses kawasaki disease.
Describe the laboratory values typically seen in kawasaki disease. Prolonged febrile illness 5 days andpresentation of four or more of the following symptoms meets classic criteria, if the patient presents with two or three symptom consider incomplete kawasaki disease. Kawasaki disease kd is a medium vessel vasculitis with predilection for coronary arteries. Kawasaki disease diagnosis pathway evidence based outcome center. Discuss the role of echocardiography in the management of patients who have kawasaki disease and describe the cardiac complications of the disease. Thus, kd is the most common acquired heart disease in developed countries. The diagnosis of classic or complete kawasaki disease is based on the presence of. Diagnosis involves ruling out other diseases that cause similar signs and symptoms, including. It also affects your lymph nodes and causes symptoms in. Scarlet fever, which is caused by streptococcal bacteria and results in fever, rash, chills and sore throat. Delayed diagnosis and treatment results in coronary artery aneurysms in up to 25% of all affected individuals. Consider incomplete kawasaki disease in any child with unexplained fever for at least 7 days or fever for at least 5 days combined with 2 or 3 of the principal clinical features. There are no diagnostic tests for kawasaki disease and the diagnosis relies on clinical criteria, supported by evidence of inflammation, whilst ruling out other differential diagnoses.
In some cases, kawasaki disease may be diagnosed even if a child doesnt have 4 or more of the key symptoms listed above, or even if the fever has only lasted 4 days. Jul 24, 2017 newburger jw, takahashi m, gerber ma, et al. The diagnosis is rare and may be delayed in older children and adults. Kawasaki disease is an acute systemic vasculitis that was first reported in 1961. Thrombocytosis is common in the second week of illness. It makes the walls of the blood vessels in the body become inflamed. Diagnosis and management of kawasaki disease cardiology. The exact cause has not yet been established but there is considerable support for it is to be due to an infectious agent causing disease among genetically vulnerable individuals. Due to lack of a reliable confirmatory laboratory test, the diagnosis of kd is based on a constellation.
Diagnostic guidelines for kawasaki disease circulation. Early treatment with intravenous immunoglobulin ivig has been shown to reduce morbidity and mortality. The differential diagnoses of kawasaki disease include. Disclosure statement the authors have no conflicts of interest to disclose. Patients with a suspected diagnosis of kawasaki disease.
Intravenous immunoglobulin febrile child sepsis assessment and management. It can affect any type of blood vessel, including the arteries, veins, and capillaries. The most common symptoms include a fever that lasts for more than five days not affected by usual medications, large lymph nodes in the neck, a rash in the genital area, and red eyes, lips, palms or soles of the feet. Kawasaki disease kd is an acute, febrile, selflimiting, systemic vasculitis of unknown origin that almost exclusively affects young children. Kd occurs more often among boys and is more commonly seen in the winter and spring months. Kawasaki disease kd is a clinical diagnosis that requires prompt recognition and management. Common abnormalities include elevation of esr, crp and wcc. Diagnosis and management of kawasaki disease american. Kawasaki disease kd see the image below is an acute febrile vasculitic syndrome of early childhood that, although it has a good prognosis with treatment, can lead to death from coronary artery aneurysm caa in a very small percentage of patients.
The multiple differential diagnosis to rule out kd includes drug hypersensitivity, stevensjohnson syndrome, staphylococcal scalded skin. It accounts for the compulsory and optional criteria in the national institute for health and care excellence nice and the diagnosis rule for positivity. Oct 31, 2019 a number of theories link the disease to bacteria, viruses or other environmental factors, but none has been proved. Although nonspecific, laboratory tests provide support for diagnosis, assessment of severity and monitoring of disease and treatment. Newburger, md, mph,a,b masato takahashi, md,c jane c. Some laboratory findings that assist in the diagnosis of kawasaki disease include the presence of raised white blood cell counts, white blood cells in urine microscopy, and raised transaminase or. A scientific statement for health professionals from the american heart association. Atypical kawasaki disease includes patients who do not meet all the criteria for diagnosis.
Recognition of kawasaki disease pubmed central pmc. Diagnosis, treatment, and management of kawasaki disease e929 ciica tatmt ad idi circulation. Your child may need to have tests to rule out other conditions that could be causing their symptoms. Rationale the diagnosis of kawasaki disease kd is difficult and is often delayed for children whose age falls outside the typical age range of 6 months to 5 years, especially for those with. Here are six 6 nursing care plans ncp for kawasaki disease. Oct 21, 2016 kawasaki disease kd, or mucocutaneous lymph node syndrome, is an illness that causes inflammation in arteries, veins, and capillaries. It is the leading cause of acquired heart disease in children in the us. Diagnosis of kawasaki disease surjit singh, ankur kumar jindal and rakesh kumar pilania allergy immunology unit, department of pediatrics, advanced pediatrics centre, postgraduate institute of medical education and research pgimer, chandigarh, india abstract kawasaki disease kd is a medium vessel vasculitis with predilection for coronary. Hemophagocytic lymphohistiocytosis and kawasaki disease. After completing this article, readers should be able to. Nursing goals for a child with kawasaki disease may include increased understanding of the parents and child about the disease condition, medical treatment and planned followup care, relief of pain, improved physical mobility, adequate coping, and absence of complications.
Kawasaki disease kd is a systemic vasculitis that affects mediumsized arteries with a predilection for involvement of the coronary arteries. What are the differential diagnoses for kawasaki disease. Kawasaki disease is one of the most common vasculidities of childhood. Classic typical kawasaki disease is diagnosed based on the presence of a fever lasting five or more days, accompanied by four out. The differential diagnosis of kawasaki disease is potentially wide, but it is most often confused with streptococcal and staphylococcal infections including scarlet fever and toxic shock syndrome, viral infections such as measles. Kawasaki disease and the pediatric gastroenterologist. Incomplete kawasaki disease should be considered if a child has fever and inflammation without all the symptoms above. Globally, it is the most common form of childhood primary vasculitis. Japanese guidelines, kawasaki disease is a clinical diagnosis. Kawasaki disease is an acute inflammatory vasculitis of medium sized arteries, also known as mucocutaneous lymph node syndrome. Diagnosis, treatment, and longterm management of kawasaki. Early treatment with intravenous immunoglobulin ivig has.
Kawasaki disease is most common in children younger than 5 years old. Theres no specific test available to diagnose kawasaki disease. Jul 29, 2018 kawasaki disease kd see the image below is an acute febrile vasculitic syndrome of early childhood that, although it has a good prognosis with treatment, can lead to death from coronary artery aneurysm caa in a very small percentage of patients. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Kawasaki syndrome ks is an acute, vasculitic illness of young children that typically presents with fever, bilateral nonexudative conjunctivitis, mucousmembrane changes, swollen extremities, andor palm and sole erythema, rash, and adenopathy. Kawasaki disease is potentially wide, but it is most often confused with streptococcal and staphylococ cal infections including scarlet.
Diagnosis is based on clinical criteria that include fever, exanthema, conjunctivitis, changes in the extremities, erythema of oral mucosa and lips and cervical lymphadenopathy. The diagnosis of complete kd relies on fever for at least 5 days in the presence of 4 of 5 other clinical criteria changes in extremities, polymorphous exanthema, bilateral bulbar conjunctival injection without exudates, changes in lips and oral. Kawasaki disease kd, or mucocutaneous lymph node syndrome, is an illness that causes inflammation in arteries, veins, and capillaries. There are some characteristic laboratory findings in kawasaki disease which may help in atypical cases.
Kawasaki disease kd is an acuteonset systemic vasculitis of mediumsized vessels that mostly affects infants and toddlers. If the fever isnt treated, it can last up to 11 days. Certain genes may make your child more likely to get kawasaki disease. Classic typical kawasaki disease is diagnosed based on the presence of a fever lasting five or. Formulate a differential diagnosis for patients with suspected kawasaki disease. This disease is considered a kind of systemic vasculitis syndrome, and primarily invades the mediumsized muscular arteries, including coronary arteries. Kawasaki disease is the most common cause of acquired heart disease in children in the developed world. Jul 10, 2018 kawasaki disease kd is an acuteonset systemic vasculitis of mediumsized vessels that mostly affects infants and toddlers. Fever for 5 days or more plus four of the following symptoms 1. Thus, diagnosis of kawasaki disease is based on characteristic clinical signs and symptoms, which are classified as principal clinical findings and other clinical and laboratory findings. The disease was first described in japan by tomisaku kawasaki in 1967, and the first. It is the dedication of healthcare workers that will lead us through this crisis.
Apr 10, 2019 nursing goals for a child with kawasaki disease may include increased understanding of the parents and child about the disease condition, medical treatment and planned followup care, relief of pain, improved physical mobility, adequate coping, and absence of complications. The kawasaki disease criteria calculator aids diagnosis of the syndrome in infants and children based on one major criterion fever characteristics and six minor criteria. Kawasaki disease should be included in the differential diagnosis for any child with a prolonged unexplained fever, and the appropriate medical history questions should be asked. Kawasaki disease differential diagnoses medscape reference. Diagnosis, treatment, and longterm management of kawasaki disease. Diagnosis of kawasaki disease wiley online library. Burns, mdd abstract kawasaki disease is an acute, selflimited vasculitis of unknown etiology that occurs predominantly in infants and children.
Feb 01, 2018 a rare disease without pathognomonic findings or a diagnostic test, kawasaki disease should be considered in the differential diagnosis of a child with prolonged fever. If these factors are present, the diagnosis is narrowed substantially, usually to ten in adults and staphylococcal scalded skin syndrome sss in infants and young children. The fever is accompanied by at least four of the following five symptoms. About onethird develop temporary arthritis with pain and swelling of knee, hip and ankle joints. Kawasaki disease is a selflimited vasculitis of mediumsized arteries, the diagnosis of which is made in patients with fever in addition to the presence of the following clinical criteria. Kawasaki disease should be considered in the differential diagnosis of a young child with unexplained fever for.
Diagnosis and classification of kawasaki disease request pdf. The differential diagnosis of kawasaki disease is potentially wide, but it is most often confused with streptococcal and staphylococcal infections including scarlet fever and toxic shock syndrome, viral infections such. Differential diagnosis the differential diagnoses of kawasaki disease include. Kawasaki disease is an acute systemic vasculitis of unknown etiology. If not treated early with highdose intravenous immunoglobulin, 1 in 5 children develop coronary artery. Diagnosis, treatment, and management of kawasaki disease e929. The hallmark of the disease is the rosered blanching macular rash that appears first on the extremities, but subsequently spreads to involve the entire body, including palms and soles. Kawasaki disease red book 2018 red book online aap. Photo courtesy of kawasaki disease foundation what causes it and how can it be prevented.
The patient was admitted with a diagnosis of kawasaki disease and was treated with ivig and highdose aspirin. Diagnosis and classification of kawasaki disease sciencedirect. The maletofemale ratio among patients with kawasaki disease is 1. Kawasaki disease diagnosis and treatment mayo clinic. Kawasaki disease kd, also known as kawasaki syndrome, is an acute febrile illness of unknown cause that primarily affects children younger than 5 years of age. Mucous membrane changes erythema, peeling, cracking of lips, strawberry tongue, or diffuse oropharyngeal mucosae 3. Csw kawasaki disease pathway return to diagnosis phase return to management phase differential diagnosis the differential diagnosis includes other infectious and noninfectious conditions, including the following. The disease is transmitted by a tick bite and characterised by fever, headaches, abdominal pain, vomiting, and diarrhoea, followed by severe myalgias.