小结
定义
病史和体格检查
关键诊断因素
- polymorphous rash
- conjunctival injection
- mucositis
- skin changes in the peripheral extremities
- enlarged cervical lymph nodes
- coronary artery aneurysms
- fever and extreme irritability
其他诊断因素
- pericarditis with effusion
- congestive heart failure
- joint pain or edema
- neurologic manifestations
- gastrointestinal manifestations
- urologic manifestations
- other dermatologic manifestations
危险因素
- Asian ancestry
- age 3 months to 4 years
- male sex
诊断性检查
首要检查
- CBC
- erythrocyte sedimentation rate (ESR)
- CRP
- echocardiogram
需考虑的检查
- serum LFTs
- urinalysis
- chest x-ray
- electrocardiogram
- ultrasonography of the gallbladder
- ultrasonography of the testes
- lumbar puncture
- magnetic resonance angiography
- cardiac catheterization and angiography
- natriuretic peptide tests
治疗流程
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
presentation >10 days from onset without evidence of ongoing inflammation
after initial episode: Z score always <2; no involvement at any time
after initial episode: Z score ≥2.0 to <2.5; dilation only
after initial episode: Z score ≥2.5 to <5.0; small aneurysm
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
撰稿人
作者
Paul Brogan, BSc(Hon), MBChB(Hon), FRCPCH, MSc, PhD
Professor of vasculitis
University College London
London
UK
利益声明
PB is co-chief investigator of the KDCAAP trial, and is an author of several references cited in this topic.
Kirsty McLellan, BMedSci, MBChB, MRCPCH
Specialist Registrar in Paediatric Rheumatology
Great Ormond Street Hospital
London
UK
利益声明
KM declares she has no competing interests.
鸣谢
Dr Paul Brogan and Dr Kirsty McLellan would like to gratefully acknowledge Professor Abraham Gedalia and Dr James Krulisky, previous contributors to this topic.
利益声明
AG declares that he has no competing interests. JK declares that he is a paid consultant for Axia Medical Solutions, a small skincare company from Carlsbad, CA.
同行评议者
Michael Levin, null
Professor of International Child Health
Imperial College London
London
利益声明
ML declares that he has no competing interests
Russell W. Steele, MD
Editor in Chief
Journal of Clinical Pediatrics
Department of Pediatrics
Division of Infectious Diseases
Ochsner Children's Health Center
New Orleans
LA
利益声明
RWS declares that he has no competing interests.
John L. Ey, MD
Clinical Professor of Pediatrics
Department of Pediatrics
Oregon Health Science University
Portland
OR
利益声明
JLE declares that he has no competing interests.
David Burgner, BSc(Hons), MBChB, MRCP, MRCPCH, FRACP, DTMH, PhD
Principal Research Fellow
Murdoch Childrens Research Institute
The Royal Children’s Hospital
Victoria
Australia
利益声明
DB has received competitive research funding from the National Heart Foundation Australia and from the Agency for Science, Technology and Research of the Singapore Government. He is co-inventor on a patent related to diagnostics submitted through the Genome Institute of Singapore.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
McCrindle BW, Rowley AH, Newburger JW, et al; American Heart Association. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017 Apr 25;135(17):e927-99.全文 摘要
Kawasaki T, Kosaki T, Okawa S, et al. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics. 1974 Sep;54(3):271-6. 摘要
de Graeff N, Groot N, Ozen S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative. Rheumatology (Oxford). 2019 Apr 1;58(4):672-82.全文 摘要
Gorelik M, Chung SA, Ardalan K, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of Kawasaki disease. Arthritis Care Res (Hoboken). 2022 Apr;74(4):538-48. 摘要
Newburger JW, Takahashi M, Beiser AS, et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med. 1991 Jun 6;324(23):1633-9. 摘要
Lei WT, Chang LS, Zeng BY, et al. Pharmacologic interventions for Kawasaki disease in children: A network meta-analysis of 56 randomized controlled trials. EBioMedicine. 2022 Apr;78:103946.全文 摘要
McCrindle BW, Rowley AH, Newburger JW, et al; American Heart Association. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017 Apr 25;135(17):e927-99.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Staphylococcal or streptococcal infection
- Systemic juvenile idiopathic arthritis (systemic JIA)
- Scarlet fever
更多 鉴别诊断指南
- Guideline for the management of Kawasaki disease
- European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative
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