title: Diagnosis and management of kawasaki disease.
abstract: Kawasaki disease is an acute, systemic vasculitis that predominantly affects patients younger than five years. It represents the most prominent cause of acquired coronary artery disease in childhood. In the United States, 19 per 100,000 children younger than five years are hospitalized with Kawasaki disease annually. According to U.S. and Japanese guidelines, Kawasaki disease is a clinical diagnosis. Classic (typical) Kawasaki disease is diagnosed based on the presence of a fever lasting five or more days, accompanied by four out of five findings: bilateral conjunctival injection, oral changes such as cracked and erythematous lips and strawberry tongue, cervical lymphadenopathy, extremity changes such as erythema or palm and sole desquamation, and polymorphous rash. Incomplete (atypical) Kawasaki disease occurs in persons with fever lasting five or more days and with two or three of these findings. Transthoracic echocardiography is the diagnostic imaging modality of choice to screen for coronary aneurysms, although other techniques are being evaluated for diagnosis and management. Treatment for acute disease is intravenous immunoglobulin and aspirin. If there is no response to treatment, patients are given a second dose of intravenous immunoglobulin with or without corticosteroids or other adjunctive treatments. The presence and severity of coronary aneurysms and obstruction at diagnosis determine treatment options and the need, periodicity, and intensity of long-term cardiovascular monitoring for potential atherosclerosis.
authors.affiliation: Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine, Bethesda, MD, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Saguil
authors.affiliation: Dwight D. Eisenhower Army Medical Center Family Medicine Residency Program, Fort Gordon, GA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fargo
authors.affiliation: Dwight D. Eisenhower Army Medical Center Family Medicine Residency Program, Fort Gordon, GA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Grogan
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology; D001241:Aspirin / Q000494:pharmacology*; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D019468:Disease Management; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000494:pharmacology*; D007155:Immunologic Factors / Q000494:pharmacology; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D010808:Physical Examination / Q000379:methods; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D001241:Aspirin