Malady Wise

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Kawasaki

Reference:

Background

  • Second commonest vasculitis in kids behind HSP

  • Medium vessel vasculopathy, any organ can be affected

  • Lack of treatment leads to coronary artery aneurysm in 25%

  • 75% of cases occur < 5 years

  • Can present without ALL diagnostic criteria

Assessment

KD Criteria = fever for 5 days plus 4/5 of

  • Eyes - Bilateral, non-exudative, painless conjunctival injection, with limbic sparing

  • Rash - Red, polymorphous, trunks and limbs, variable but commonly maculopapular similar to EM or Scarlet Fever

  • Mouth - Red, dry, cracked lips with diffuse red oropharynx including strawberry tongue

  • Limbs - Red, painful swelling hands and feet that desquamates in week 2

  • Lymph nodes - Cx lymphadenopathy, unilateral, tender, >1.5cm

Common additional findings

  • Neuro - Irritability, aseptic meningitis

  • GIT - Abdo pain, vomit, diarrhoea

  • Joint - Arthralgias and arthritis

  • Dysuria

Incomplete KD

  • Sick kid with history suspicious for KD but doesn’t fulfil criteria

  • Bloods tests for CRP and ECR

    • If low, serial bloods and echo

    • If high, and 3 or more abnormal other bloods or echo then treat

Ddx

  • Group A Strep

  • Virus including EBV, CMV, Adenovirus, HHV-6, SARS-CoV2

  • JIA

  • Sepsis

  • Toxic shock syndrome

  • Steven John Syndrome

  • Drug reaction

  • Malignancy

Treatment

  • Echo at presentation, then 2 weeks and 6 weeks

  • All patients FBC, CRP, ESR, UEC, LFT, Blood culture, ASOT, Serum stored, Urine MCS, COVID-19 swab, ECG

  • IVIg as a single dose

  • Aspirin 3-5mg/kg orally daily until normal echo, minimum 6 weeks

  • Corticosteroids (limited evidence)