Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.
BACKGROUND
Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.


RESULTS
A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for > or =5 days and < or =4 classic criteria should undergo echocardiography [correction], receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-alpha antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata.


CONCLUSIONS
Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.
Newburger
Jane W
JW
Takahashi
Masato
M
Gerber
Michael A
MA
Gewitz
Michael H
MH
Tani
Lloyd Y
LY
Burns
Jane C
JC
Shulman
Stanford T
ST
Bolger
Ann F
AF
Ferrieri
Patricia
P
Baltimore
Robert S
RS
Wilson
Walter R
WR
Baddour
Larry M
LM
Levison
Matthew E
ME
Pallasch
Thomas J
TJ
Falace
Donald A
DA
Taubert
Kathryn A
KA
D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002648:Child; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D004452:Echocardiography; D005334:Fever / Q000209:etiology; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D018570:Risk Assessment; D013256:Steroids / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016756:Immunoglobulins, Intravenous; D013256:Steroids; D001241:Aspirin