SAQ 444 – Paediatrics – Kawasaki disease criteria and investigations
Model Answer
Paediatrics – Kawasaki disease criteria and investigations.
a. Diagnostic criteria
- Fever for 5 days or more, plus four of the five principal clinical features.
- Polymorphous rash.
- Bilateral non-purulent conjunctival injection.
- Mucous membrane changes such as cracked red lips, strawberry tongue, or diffuse oral/pharyngeal erythema.
- Peripheral extremity changes such as erythema or oedema of hands/feet, with desquamation usually in convalescence.
- Cervical lymphadenopathy, usually unilateral, single, painful, non-purulent and greater than 15 mm.
- Exclusion of diseases with a similar presentation.
b. Differential diagnoses
- Staphylococcal infection such as scalded skin syndrome or toxic shock syndrome.
- Streptococcal infection such as scarlet fever or toxic shock-like syndrome.
- Measles.
- Stevens-Johnson syndrome.
- Drug reaction.
- Juvenile idiopathic/rheumatoid arthritis.
c. Supportive investigations
- Platelet count/FBE, noting thrombocytosis may develop and thrombocytopaenia suggests severity or alternative disease.
- Echocardiography to assess coronary artery involvement and cardiac complications.
- ASOT/anti-DNase B or related streptococcal testing when considering scarlet fever/toxic shock-like differential.
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