Click here for an explanation of these scores
Answer Rating key
|
search
|
|
strong
|
|
appraisal
|
|
weak
|
|
confidence
|
|
moderate
|
Question answered:21/03/02 Warning! this question is over two years old.
GP notebook has a section on Kawasaki disease (1). They state that a diagnosis of Kawasaki disease can be made if five out of six major features are present. If only four of the major features are found then the demonstration of coronary aneurysms confirms the diagnosis. The major presenting features of the disease are listed as:
- fever more than 5 days
- bilateral non-purulent conjunctival congestion
- dry, fissured mouth and lips and a strawberry red tongue
- acute, non-purulent cervical lymphadenopathy in more than 60%
- polymorphous exanthema for days 1 to 5 of the fever; typically there are no vesicles or crusts
- changes in the extremeties:
- reddening and oedema of the hands and feet occurs on days 2 to 5 of the fever
- desquamation of affected skin from days 10 to 15
GP notebook adds that other features include:
"Cardiovascular:
- pancarditis and coronary arteritis
- auscultation reveals gallop rhythm and distant heart sounds
- the ECG shows variable PQ, long QT, changes in the ST and T waves, arrhythmias
- coronary artery aneurysms - these are sufficient to confirm the diagnosis if only four major criteria are present
Gastrointestinal tract:
- diarrhoea in 35%
- abdominal pain with gallbladder involvement
- jaundice in 5%
Blood:
- leukocytosis
- increased ESR, CRP and platelet count
- decreased albumin and red cell count
Urinary tract:
Joints:
- arthralgia in 25% of casesac
Nervous system:
- aseptic meningitis in 25 to 50% of cases"
In terms of treatment they highlight the need to consult expert advice and add:
"If the diagnosis is made within 10 days of onset:
- intravenous immunoglobulin
- aspirin: e.g. 30 mg/kg/day in divided doses for 2 weeks
Thereafter:
- aspirin, e.g. 3-5 mg/kg/day until the 6-8 week check echocardiograph
- if coronary aneurysms are detected then aspirin should be continued indefinitely
Intravenous immunoglobulin may be given to patients diagnosed more than 10 days after onset if there is evidence of ongoing inflammation. A second course of immunoglobulin may be given for resistant or recurrent disease.
Immunoglobulin has been shown to:
- reduce the incidence and severity of coronary aneurysms
- resolve inflammation
- relieve symptoms"
eMedicine, and American online textbook, also has a section on Kawasaki disease which may be accessed in full at
http://www.emedicine.com/emerg/topic811.htm. This document also describes presenting features, stages of disease, investigations and treatment. In terms of emergency department care they say,
"Any young child presenting to the ED with symptoms of early or acute stage Kawasaki disease should be evaluated to rule out sepsis or meningitis. Although the diagnosis of Kawasaki disease may seem obvious, other life-threatening diseases must be ruled out."
1. http://www.gpnotebook.co.uk
DISCLAIMER: TRIPanswers is a collection of clinical questions and answers. Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review. If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document. Also, ensure you have read the terms and conditions for using the site.