KAWASAKI DISEASE

Question 1

What is kawasaki disease?

Answer 1

A vasculitis of medium sized vessels

Question 2

What is the peak age of incidence of Kawasaki disease?

Answer 2

1 year (6 months to 4 years)

Question 3

What is the UK incidence of Kawasaki disease?

Answer 3

8 per 100,000 cases

Question 4

What are the clinical features of Kawasaki disease?

Answer 4

High grade fever which lasts for more than 5 days

Very irritable

Conjunctival injection

Bright red, cracked lips

Strawberry tongue

Cervical lymphadenopathy

Red palms of the hands and the soles of the feet which later peel

Question 5

What is the diagnostic test that confirms Kawasaki disease?

Answer 5

There isn’t one. It is a clinical diagnosis and the differential diagnoses should be excluded. These include measles, scarlet fever, rubella, roseola and fifth disease.

Patients will have raised inflammatory markers (CRP, ESR, WCC) and platelet count may rise in the second week of illness.

Question 6

What are the major complications of Kawasaki disease in untreated individuals?

Answer 6

Coronary artery aneurysm

Thrombosis

Question 7

How do we manage a child with Kawasaki disease?

Answer 7

IV immunoglobulin (2g/kg)

High dose aspirin (one of the few indications for aspirin in children)

Must do an echocardiogram to check for coronary artery aneurysm

Question 8

What is the major complication of IV immunoglobulin therapy?

Answer 8

Anaphylaxis

Question 9

How do we manage a child with suspected Kawasaki disease who does not respond to IVIG or in whom the fever returns?

Answer 9

Consider alternative cause

Second dose of IVIG

Persistent inflammation and fever may require treatment with infliximab, steroids or ciclosporin.