Kawasaki disease: know the clinical presentation

Kawasaki disease is one of the most common vasculatures of childhood, affecting mainly medium-sized arteries, with a predilection for coronary arteries. This is the topic of this week’s post for content from The Clinical Decision White Book.

Its etiology is still unknown, but a relationship with an infectious trigger is suggested. It is believed, then, that the disease is caused by an unknown infectious agent in a child with a genetic predisposition to the condition.

To learn about the diagnostic criteria for the disease, click here and access the calculator in the White Book.

Clinical presentation of Kawasaki disease

The disease occurs mostly in young children, with 80% of patients under 5 years of age. Adolescents and adults can meet the criteria for toxic shock syndrome.

They are usually there Fever high (up to 40°C), remitting and not responding to antibiotics; It lasts for 1-2 weeks without treatment, but it may last for 3-4 weeks. Prolonged fever is a risk factor for coronary heart disease.

In addition to fever, there are five clinical features of the disease, which can occur at different times in the course of the disease:

• bilateral bulging conjunctival hyperemia without discharge;
• Erythema of the mucous membrane of the mouth and pharynx with crimson tongue, dryness and cracking of the lips without ulceration.
• Erythema and swelling of the hands and feet.
• Various forms of erythema (macular-papular, multiforme or scalingiform) appear in the groin area;
• Non-suppurative cervical lymphadenopathy, usually unilateral, with lymph nodes 1.5 cm in diameter.

Read also: Immunobiology in asthma: a reality in pediatrics

Perineal desquamation is common in the acute phase. In turn, crusting around the fingers and toes begins 1-3 weeks after the onset of the disease and may progress to involve the entire hand and foot.

Other features that may be present are: severe irritability, aseptic meningitis, diarrhoea, mild hepatitis, ascites of the gallbladder, urethritis and urethritis with sterile suppuration, otitis media, arthritis (usually limited and affecting the hands, knees, ankles or hips).

attention! Always inquire about previous symptoms, as changes often do not occur at the same time and may have already resolved at the time of medical care.

Injury to the heart is the most important manifestation of Kawasaki disease. Myocarditis, presenting with disproportionate tachycardia with fever, and pericarditis with a small pericardial effusion may occur. Coronary aneurysms develop in up to 25% of untreated patients. Giant aneurysms (inner diameter ≥ 8 mm) lead to an increased risk of rupture, thrombosis, stenosis, and myocardial infarction.

In general, the disease is divided into three stages:

• Acute fever stage: It lasts from one to two weeks. There is a fever and other acute signs. Cardiac manifestations are myocarditis. In some cases, there may be macrophage activation syndrome.
• Subacute stage: Generally, it lasts until the fourth week. It begins when the fever and other acute signs are gone, but irritability, loss of appetite, and conjunctival congestion may persist. It is associated with crusting, thrombocytosis, development of coronary aneurysms and an increased risk of sudden death in those who have developed aneurysms;
• convalescence stage: It begins when all clinical signs of the disease have disappeared and continues until ESR and CRP return to normal, approximately 6-8 weeks after disease onset.

See also: Clinical Drops: Check Out New Pediatrics Content!

Outcomes predicting more severe progression (coronary aneurysm formation): male sex, <1 year or >8 years, prolonged fever, recurrent fever after febrile period, recurrence of fever >36 hours after administration of immunoglobulin, decreased hemoglobin or levels Platelets, increased neutrophils and rods, hyponatremia, decreased age-adjusted serum albumin and IgG levels.