The Clinical Diagnosis and Management of Kawasaki Disease: a Review and Update.
Kawasaki disease is an acute, self-limited vasculitis of childhood and has become the leading cause of acquired pediatric heart disease in the USA. Prompt treatment is essential in reducing cardiac-related morbidity and mortality. The underlying etiology remains unknown. The disease itself may be the characteristic manifestation of a common pathway of immune-mediated vascular inflammation in susceptible hosts. The characteristic clinical features of fever for at least 5 days with bilateral nonpurulent conjunctivitis, rash, changes in lips and oral cavity, changes in peripheral extremities, and cervical lymphadenopathy remain the mainstay of diagnosis. Supplementary laboratory criteria can aid in the diagnosis, particularly in cases of incomplete clinical presentation. Diagnosis of Kawasaki disease can be challenging as the clinical presentation can be mistaken for a variety of other pediatric illnesses. Standard of care consists of intravenous immune globulin and aspirin. Corticosteroids, infliximab, and cyclosporine A have been used as adjunct therapy for Kawasaki disease refractory to initial treatment. There is ongoing research into the use of these agents in the initial therapy of Kawasaki disease.
Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.|Department of Pediatrics, Wayne State University, School of Medicine, Detroit, MI, 48201, USA.
Frank H
FH
Zhu
Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA. jang@med.wayne.edu.|Department of Pediatrics, Wayne State University, School of Medicine, Detroit, MI, 48201, USA. jang@med.wayne.edu.
Jocelyn Y
JY
Ang
Etiology; Kawasaki disease; Pathogenesis; Treatment; Update
Lancet. 2014 May 17;383(9930):1731-8
24572997
Circulation. 1998 Sep 1;98(9):839-44
9738637
Autoimmunity. 2015 May;48(3):177-80
25822883
Pediatrics. 2004 Dec;114(6):1708-33
15574639
Contemp Clin Trials. 2016 May;48:70-5
27080929
N Engl J Med. 2001 Dec 20;345(25):1809-17
11752357
J Pediatr. 1993 Apr;122(4):538-42
8463897
Pediatr Rheumatol Online J. 2014 Jul 11;12:26
25045337
N Engl J Med. 1986 Aug 7;315(6):341-7
2426590
Circulation. 1987 Feb;75(2):387-94
3802442
Lancet. 1984 Nov 10;2(8411):1055-8
6209513
Annu Rev Med. 2011;62:69-77
20690826
Clin Rheumatol. 2017 Jan;36(1):223-228
27230223
Rheumatol Int. 2013 Apr;33(4):1065-9
21132551
Pediatrics. 1995 Dec;96(6):1057-61
7491221
Circulation. 1996 Sep 15;94(6):1379-85
8822996
Rheum Dis Clin North Am. 2015;41(1):63-73, viii
25399940
J Infect. 2016 Jul 5;72 Suppl:S1-5
27241708
Circulation. 2006 Jun 6;113(22):2606-12
16735679
Cytokine. 2012 Dec;60(3):681-5
22944461
Circulation. 2000 Jun 27;101(25):2935-41
10869266
Eur J Pediatr. 2013 Mar;172(3):337-42
23152158
Pediatrics. 2009 May;123(5):e783-9
19403470
Circulation. 1999 Jul 20;100(3):230-5
10411845
Hawaii Med J. 2010 Aug;69(8):194-7
20845285
Pediatrics. 1974 Sep;54(3):271-6
4153258
Am J Cardiol. 1988 Feb 1;61(4):386-90
3341217
Arch Dis Child. 2015 Nov;100(11):1084-8
26111818
J Pediatr. 1991 Aug;119(2):279-82
1861216
J Paediatr Child Health. 2013 Sep;49(9):704-8
23560706
Pediatrics. 1985 Sep;76(3):420-4
2993992
J Pediatr. 2004 Apr;144(4):496-9
15069399
Proc Natl Acad Sci U S A. 2014 Jun 3;111(22):7952-7
24843117
Pediatr Infect Dis J. 2015 Nov;34(11):1163-7
26222065
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1992 Jan-Feb;33(1):67-71
1626454
Pediatr Infect Dis J. 1998 Dec;17(12):1144-8
9877364
Indian J Pediatr. 2013 Sep;80(9):783-5
23054859
Circulation. 2012 Mar 27;125(12):1542-50
22361326
Pediatr Int. 2001 Jun;43(3):211-7
11380911
Lancet. 2012 Apr 28;379(9826):1613-20
22405251
J Clin Virol. 2010 Sep;49(1):16-20
20650679
Eur J Pediatr. 2014 Mar;173(3):381-6
24146166
PLoS One. 2012;7(6):e38998
22723916
J Pediatr. 2013 Jun;162(6):1259-63, 1263.e1-2
23305955
Korean Circ J. 2010 Jul;40(7):334-8
20664742
J Epidemiol. 2012;22(2):79-85
22307434
Int J Cardiol. 2007 Feb 7;115(2):e94-6
17126927
J Pediatr. 2016 Mar;170:325-30
26707621
Curr Opin Rheumatol. 2014 Jan;26(1):31-6
24247115
Clin Immunol Immunopathol. 1990 Jul;56(1):29-36
2113446
N Engl J Med. 2007 Feb 15;356(7):663-75
17301297
J Pediatr. 1982 Feb;100(2):225-31
7057330
BMJ Open. 2015 Dec 01;5(12):e009562
26628527
Int J Cardiol. 2015 Jan 20;179:61-2
25464413
Yonsei Med J. 2010 Sep;51(5):784-6
20635457
Pediatr Infect Dis J. 2016 Apr;35(4):457-9
26673981
J Pediatr. 2005 May;146(5):662-7
15870671