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Section 3. Summaries of Infectious Diseases
Kawasaki Disease
Clinical ManifestationsEtiology
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 younger than 12 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, often with later periungual desquamation; and (5) acute, nonsuppurative, usually unilateral, 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 4 days and at least 4 of these 5 features without alternative explanation for the findings. The epidemiologic case definition also allows diagnosis of Kawasaki disease when a person has fewer than 4 principal clinical criteria in the presence of coronary artery aneurysms. Irritability, abdominal pain, diarrhea, and vomiting commonly are associated features. Other findings include urethritis with sterile pyuria (70% of cases), mild anterior uveitis (25%–50%), mild hepatic dysfunction (40%), arthritis or arthralgia (10%–20%), meningismus with cerebrospinal fluid pleocytosis (25%), pericardial effusion of at least 1 mm (less than 5%), gallbladder hydrops (less than 10%), and myocarditis manifested by congestive heart failure (less than 5%). Fine desquamation in the groin area can occur in the acute phase of disease. 159
Incomplete Kawasaki disease can be diagnosed in febrile patients when fever plus fewer than 4 of the characteristic features
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