Kawasaki Disease

Question 1

Discuss the incidence of Kawasaki disease in paediatric populations and what the age of the child at the time of illness determines.

Answer 1

Most common <5 years (85%), peak age 18-24 months.

KD in <6 months or >5 years is less common but these kids are more likely to develop aneurysms

Question 2

What are the classic Kawasaki disease diagnostic criteria?

Answer 2

Fever for 5/7 plus 4 out of 5 of the following:

1) Eyes = bilateral non-exudative conjunctivitis
2) Mucous membranes = red lips, strawberry tongue
3) Extremities = oedema, desquamation
4) Rash = polymorphous red rash
5) Nodes = cervical node > 1.5 cm

Question 3

Discuss incomplete Kawasaki disease.

Answer 3

Fever for 5 days and 2-3 criteria (conjunctivitis, red lips/strawberry tongue, oedema, rash, nodes)
AND
Inflammation CRP >8 or ESR 20
Albumin <30, anaemia, raised ALT, platelets >450, WCC >12 or sterile pyuria

Question 4

Discuss the rash in KD.

Answer 4

Polymorphous without vesicles, bullae or crusts. Occurring in the first few days, involving the trunk/extremities. Variable presentations possible.

Question 5

Discuss the mucous membranes in KD.

Answer 5

Intense hyperaemia of lips leading to redness and cracking and/or diffuse erythema of oropharynx. Strawberry tongue.

Question 6

Discuss the extremity changes in KD.

Answer 6

Hyperaemia, painful oedema of the hands/feet that progresses to desquamation in the convalescent stage. Perineal desquamation can occur too.

Question 7

In a child with aseptic meningitis and prolonged fever what should always be considered?

Answer 7

KD

Question 8

A child presents with suspected KD. What is your ddx?

Answer 8

Group A Strep (tonsillitis, Scarlet fever, acute rheumatic fever), EBV, adenovirus, JIA, sepsis/TSSS, SJS, drug reaction

Question 9

When are echos done with KD?

Answer 9

At baseline and at 6 weeks

Question 10

What is the treatment for KD?

Answer 10

IV immunoglobulin and steroids. Sometimes aspirin.