INDEX

    Kawasaki’s Disease

    Cardiovascular, Inflammatory, Pediatrics

    Last Updated Jun 01, 2020
    Read Disclaimer

    Context

    • Kawasaki’s Disease (KD) is one of the most common causes of vasculitis and a leading cause of acquired heart disease in children.
    • Boys are affected more commonly than girls.
    • 80-90% of cases occur in patients under the age of 5.
    • The underlying etiology is unknown.
    • Its incidence is highest in Japan at 265 cases per 100,000 children under the age of 5. In the USA, incidence is 20 cases per 100,000 children under the age of 5.
    • Usually a self-limiting condition characterized by a prolonged fever with other acute inflammatory manifestations lasting 12 days on average.
    • 20-25% of untreated cases develop coronary artery aneurysms, which could lead to myocardial ischemia, infarction, or sudden death. Early recognition and treatment with intravenous immunoglobulin (IVIG) will lower this rate of aneurysms to less than 5%.
    • Diagnosis = fever (typically above 38.5ºC) persisting > 5 days AND > 4 of:
      • Bilateral non-exudative conjunctival injection, usually limbic-sparing.
      • Oral mucous membrane changes (e.g. erythema and/or fissuring of lips, strawberry tongue, and/or erythema of oropharyngeal mucosa).
      • Peripheral extremity changes.
      • Acute phase: erythema of palms and/or soles and/or edema of hands and/or feet.
      • Subacute phase: periungual desquamation.
      • Polymorphous rash (maculopapular, diffuse erythroderma, or erythema multiforme-like).
      • Cervical lymphadenopathy (at least one lymph node ≥1.5 cm in diameter, usually unilateral).
    •  Algorithm of evaluating suspected KD below:

    CLICK TO ENLARGE

    Recommended Treatment

    • Immediate treatment includes:
      • IVIG 2 grams/kg x 1 dose over 8 to 12 hours.
      • High-dose acetylsalicylic acid 30 to 50 mg/kg/day in 4 divided doses up to 4 grams per day until fever resolves, then give low-dose acetylsalicylic acid (local guidelines may differ).
      • Consider glucocorticoids 2 mg/kg/day PO or IV in three divided doses for 10 days then 1 mg/kg/day for 5 days if history of IVIG resistance noted (local guidelines may differ).
    • Further investigations and treatments listed in algorithm below:

    CLICK TO ENLARGE

    Criteria For Hospital Admission

    All patients diagnosed with KD need referral and admission.

    Criteria For Transfer To Another Facility

    Dependent on local guidelines.

    Criteria For Close Observation And/or Consult

    Suspicion of KD in a patient warrants consult to pediatrics/internal medicine and cardiology.

    Criteria For Safe Discharge Home

    Dependent on patient’s clinical response to treatment and echocardiogram results.

    Quality Of Evidence?

    Justification

    A single dose of intravenous immunoglobulin 2 grams/kg administered over 8 to 12 hours IVIG is most effective if administered within the first 10 days of illness, before aneurysms typically develop.

    High
    • Acetylsalicylic acid 30 to 50 mg/kg day provides some anti-inflammatory and anti-platelet effects.
    • Glucocorticoids can decrease the rate of coronary aneurysm abnormalities in patients, especially those of Japanese heritage, at high risk for IVIG resistance.
    • Postpone administration of live-virus vaccines for at least 11 months in children who have been treated with IVIG because IVIG can interfere with vaccine immunogenicity.
    Low

    Related Information

    Reference List

    Relevant Resources

    RELEVANT CLINICAL RESOURCES

    View all Resources

    RESOURCE AUTHOR(S)

    COMMENTS (0)

    Add public comment…