Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- erupción polimorfa
- inyección conjuntival
- mucositis
- cambios cutáneos en las extremidades periféricas
- linfadenopatía cervical
- aneurismas en la arteria coronaria
- fiebre e irritabilidad extrema
Other diagnostic factors
- pericarditis con derrame
- insuficiencia cardíaca congestiva
- edema o dolor en las articulaciones
- manifestaciones neurológicas
- manifestaciones gastrointestinales
- manifestaciones urológicas
- otras manifestaciones dermatológicas
Risk factors
- linaje asiático
- edad: de 3 meses a 4 años
- sexo masculino
Diagnostic investigations
1st investigations to order
- hemograma completo (HC)
- velocidad de sedimentación globular (VSG)
- proteína C-reactiva sérica
- ecocardiograma
Investigations to consider
- pruebas de función hepática (PFH) séricas
- análisis de orina
- radiografía de tórax
- electrocardiograma
- ultrasonografía de la vesícula biliar
- ultrasonografía de testicular
- punción lumbar
- angiografía por resonancia magnética
- angiografía y cateterismo cardíaco
- pruebas de péptidos natriuréticos
Treatment algorithm
presentación ≤10 días desde el inicio; o presentación >10 días desde el inicio con evidencia de inflamación en curso
presentación >10 días desde el inicio sin evidencia de inflamación en curso
después del episodio inicial: el puntaje Z siempre <2; sin afectación en ningún momento
desde el episodio inicial: puntaje Z ≥2.0 a <2.5; solo dilación
desde el episodio inicial: puntuación Z ≥2.5 a <5.0; aneurisma de pequeño tamaño
desde el episodio inicial: el puntaje Z ≥5 a <10 (con dimensión luminal absoluta <8 mm); aneurisma de tamaño medio
después del episodio inicial: puntaje Z ≥10 o diámetro luminal absoluto ≥8 mm; aneurisma de gran tamaño o gigante
Contributors
Authors
Paul Brogan, BSc(Hon), MBChB(Hon), FRCPCH, MSc, PhD
Professor of vasculitis
University College London
London
UK
Disclosures
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
Disclosures
KM declares she has no competing interests.
Acknowledgements
Dr Paul Brogan and Dr Kirsty McLellan would like to gratefully acknowledge Professor Abraham Gedalia and Dr James Krulisky, previous contributors to this topic.
Disclosures
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.
Peer reviewers
Michael Levin, null
Professor of International Child Health
Imperial College London
London
Disclosures
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
Disclosures
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
Disclosures
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
Disclosures
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.
References
Key articles
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.Full text Abstract
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. Abstract
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.Full text Abstract
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. Abstract
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. Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- infecciones estafilocócicas o estreptocócicas
- Artritis idiopática juvenil sistémica (AIJ sistémica)
- Escarlatina
More DifferentialsGuidelines
- Guideline for the management of Kawasaki disease
- European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative
More Guidelines
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