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Appendices

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Section 3. Summaries of Infectious Diseases

Kawasaki Disease

(Mucocutaneous Lymph Node Syndrome)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Kawasaki disease is a febrile, exanthematous, multisystem vasculitis of importance, because approximately 20% of untreated children will develop coronary artery abnormalities. Most cases of Kawasaki disease occur in children between 1 and 8 years of age. The illness is characterized by fever and the following clinical features: (1) bilateral bulbar conjunctival injection without exudate; (2) erythematous mouth and pharynx, strawberry tongue, and red, cracked lips; (3) a polymorphous, generalized, erythematous rash that can be morbilliform, maculopapular, or scarlatiniform or may resemble erythema multiforme; (4) changes in the peripheral extremities consisting of induration of the hands and feet with erythematous palms and soles or periungual desquamation; and (5) acute, nonsuppurative cervical lymphadenopathy with at least one node 1.5 cm in diameter. For diagnosis of classic Kawasaki disease, patients should have fever for at least 5 days and at least 4 of these 5 features and no alternative explanation for the findings. Irritability, abdominal pain, diarrhea, and vomiting commonly are associated features. Other findings include urethritis with sterile pyuria (70% of cases), anterior uveitis (25%–50%), mild hepatic dysfunction (40%), arthritis or arthralgia (10%–20%), aseptic meningitis (25%), pericardial effusion (20%–40%), gallbladder hydrops (<10%), and myocarditis manifested by congestive heart failure (<5%). Fine desquamation in the groin area can occur in the acute phase of disease.

Incomplete Kawasaki disease can be diagnosed in febrile patients when fewer than 4 of the characteristic features are present. Incomplete Kawasaki disease is more common in infants younger than 12 months of age than in older children. Infants with Kawasaki disease also have a higher risk of developing coronary artery aneurysms than do older children, making diagnosis and timely treatment . . . [Go to Full Text]


Related text in Red Book:

Influenza

Red Book 2006: 401-411. [Extract] [Full Version]  

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Red Book 2006: 441-452. [Extract] [Full Version]  



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