Kawasaki Disease
Kawasaki disease(KD) is an acute self limited vasculitis in children that leads to coronary artery aneurisms or ectasia in 15-25% of untreated children. It is now the leading cause of acquired heart disease in children in the United States.
Classic clinical criteria for KD include five days of fever along with at least four of the five principal features:
- Conjunctivitis (bilateral bulbar without exudate)
- Rash (polymorphous exanthem)
- Adenopathy (cervical lymph node > 1.5 CM typically unilateral)
- Strawberry tongue (changes in lips and oral cavity including cracked lips, strawberry tongue, oral and pharyngeal mucosal injection)
- Hand and foot changes (erythema, edema, peeling weeks later)
Along with exclusion of other diagnosis.
These classic criteria are taught as the CRASH and Burn mnemonic. Criteria for evaluation for suspected incomplete KD can be found in the reference below.
Treatment with intravenous immunoglobulin and aspirin should be initiated as soon as the diagnosis and prior to day 10 of illness. The dose of IVIG used in this condition requires 11 month pass before administration of the MMR and VZV vaccines.
References:
McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017 Apr 25;135(17):e927-e999. doi: 10.1161/CIR.0000000000000484. Epub 2017 Mar 29. Review. PubMed PMID: 28356445