{ "schemaVersion": 2, "eyebrow": "Pediatric Cardiology", "title": "Kawasaki Disease", "summary": "Kawasaki disease requires prompt clinical recognition and coronary surveillance because no confirmatory test exists, incomplete presentations remain at risk for coronary aneurysm, and treatment should not be deferred for a negative early echocardiogram or rigid completion of fever-duration criteria.", "seoDescription": "Physician-focused Kawasaki disease diagnosis, coronary artery imaging, incomplete presentations, acute IVIG-based treatment, and follow-up considerations.", "clinicalQuestion": "How should clinicians recognize, treat, and monitor Kawasaki disease to limit coronary artery complications?", "specialty": "Pediatrics", "audience": "U.S. physicians and medical trainees", "tags": [ "Kawasaki disease", "incomplete Kawasaki disease", "coronary artery aneurysm", "IVIG resistance", "pediatric vasculitis", "echocardiography" ], "keyTakeaways": [ "Kawasaki disease is a clinical diagnosis; no diagnostic laboratory test is available, and a negative early echocardiogram does not exclude disease. [7][9]", "Do not defer diagnosis or treatment solely to satisfy the historic fever duration when the clinical syndrome is convincing. [7]", "Incomplete presentations with systemic inflammation can still carry coronary artery aneurysm risk and warrant echocardiographic evaluation. [7]", "Coronary aneurysms occur in approximately 20% to 25% of untreated patients; IVIG plus aspirin reduces coronary abnormalities. [4][8]", "Echocardiography is recommended at diagnosis and again 6 to 8 weeks after illness onset; an additional study at 10 to 14 days is recommended in the cited review. [7]" ], "sections": [ { "id": "diagnostic-approach", "eyebrow": "Recognition", "heading": "Diagnose clinically and act before coronary injury evolves", "intro": "The central error is delayed treatment of a compatible inflammatory syndrome while awaiting diagnostic certainty.", "paragraphs": [ "There is no confirmatory test for Kawasaki disease (KD). North American clinical criteria require fever plus four of five principal clinical features; classic descriptions use at least 5 days of fever, but this duration should not force delay when the phenotype is sufficiently convincing. [7][14]", "Principal manifestations include polymorphous rash, bilateral nonpurulent conjunctivitis, oral mucosal erythema or strawberry tongue, extremity erythema or edema, and unilateral cervical lymphadenopathy. [8] KD is an acute systemic vasculitis with particular clinical importance because coronary artery aneurysms are its major morbidity-producing complication. [8]", "Laboratory findings support systemic inflammation but do not establish KD. Elevated C-reactive protein, erythrocyte sedimentation rate, or leukocytosis should heighten concern in a child with incomplete clinical features. Reported associated findings include early transaminase elevation, sterile pyuria, and thrombocytosis. [7][18]" ], "bullets": [ "Treat the diagnosis as probabilistic: compatible phenotype plus inflammation may justify action before all classic criteria accumulate. [7]", "Obtain echocardiography promptly, but do not use a normal early study to rule out KD or postpone treatment. [7][16]", "Include multisystem inflammatory syndrome in children (MIS-C) in the differential diagnosis; it was specifically added to the updated American Heart Association diagnostic framework. [1]" ], "subsections": [ { "heading": "Incomplete Kawasaki disease", "paragraphs": [ "Incomplete KD should be considered when a child has fever, some principal manifestations, and objective inflammation but does not fulfill complete clinical criteria. These patients can develop coronary artery aneurysms; early echocardiography may demonstrate coronary vasculitis, but its absence does not exclude the diagnosis. [7]", "Coronary findings may carry decisive diagnostic weight in incomplete disease, although practice varies internationally. [13] In U.S. practice, involve pediatric cardiology and clinicians experienced in KD when the clinical-inflammatory pattern is concerning, particularly in infants and younger children, who may have greater coronary involvement risk. [12]" ], "bullets": [ "Do not label an incomplete presentation as low risk merely because fewer mucocutaneous findings are present. [7]", "Escalate assessment when fever and inflammation persist, clinical features accrue sequentially, or coronary abnormalities are identified. [7][16]" ] } ], "table": { "caption": "Clinical features that should prompt evaluation for Kawasaki disease. [7][8][14]", "columns": [ "Finding", "Interpretation and next action" ], "rows": [ [ "Fever with at least four principal clinical features", "Meets North American clinical framework for complete KD; obtain echocardiography and initiate timely KD-directed management. [7]" ], [ "Fever with fewer principal features plus elevated CRP, ESR, or leukocytosis", "Consider incomplete KD; evaluate for coronary involvement and avoid reassurance from a negative early echocardiogram. [7]" ], [ "Coronary artery abnormality on echocardiography", "Supports KD in the appropriate clinical context and identifies a patient requiring risk-stratified cardiovascular follow-up. [7][8]" ], [ "Kawasaki-like phenotype with concern for SARS-CoV-2-associated hyperinflammation", "Evaluate MIS-C as an alternative or overlapping diagnosis; coronary aneurysms and KD-like features have been reported in MIS-C. [1][6]" ] ] } }, { "id": "acute-treatment", "eyebrow": "Acute Management", "heading": "Use IVIG-based treatment promptly and identify treatment resistance", "intro": "Acute therapy aims to suppress inflammation and reduce coronary artery injury.", "paragraphs": [ "Intravenous immune globulin (IVIG) and aspirin are established acute therapy. Randomized evidence indicates that IVIG plus aspirin reduces coronary artery abnormalities and systemic inflammation in acute KD. [4] A cited treatment report describes 2 g/kg IVIG as a single infusion as the standard initial regimen, but the supplied excerpts do not provide sufficient evidence to specify aspirin dose, duration, contraindications, or local protocol details. [20]", "Failure to respond to initial IVIG identifies a group at increased risk for cardiac complications. [20] Second IVIG, infliximab, and corticosteroids have all been used for IVIG-resistant KD. [21] Selection should be directed with pediatric rheumatology and cardiology because the supplied sources do not establish a universal preferred rescue regimen." ], "bullets": [ "Do not delay IVIG-based therapy for a normal initial echocardiogram when clinical suspicion is high. [7][16]", "Recognize IVIG nonresponse as a coronary-risk signal requiring reassessment and escalation rather than observation alone. [20][21]", "Primary adjunctive therapy may be considered in selected high-risk patients, but optimal treatment for patients with coronary Z score at least 2.5 at diagnosis remains unsettled. [20]" ], "subsections": [ { "heading": "Adjunctive anti-inflammatory therapy", "paragraphs": [ "Evidence for initial treatment intensification is heterogeneous. In Japanese patients predicted to be IVIG-unresponsive, adding glucocorticoids to IVIG reportedly reduced the probability of coronary artery aneurysm. [20] Generalizability depends on the risk-stratification method and practice setting.", "A phase 3 randomized trial of infliximab added to standard therapy reported less treatment resistance than placebo and no infusion-attributable serious adverse events in the supplied excerpt. [22] These data support infliximab as an option in selected settings but do not establish dosing, U.S. labeling status, or universal first-line use from the supplied evidence." ], "bullets": [ "Corticosteroid benefit cited here is strongest for Japanese children selected as high risk by multivariable prediction scores. [20]", "Infliximab, repeat IVIG, and corticosteroids are all reported options for IVIG-resistant disease; treatment choice remains individualized. [21]" ] } ], "table": { "caption": "Acute treatment decisions supported by the supplied evidence. [4][20][21][22]", "columns": [ "Clinical situation", "Evidence-informed action", "Important limitation" ], "rows": [ [ "Suspected acute KD", "Initiate IVIG plus aspirin-based treatment promptly when KD is diagnosed clinically; this combination reduces coronary abnormalities. [4]", "The supplied sources do not support a complete aspirin dosing or monitoring protocol." ], [ "High coronary risk or coronary Z score at least 2.5 at presentation", "Consider first-line intensification in expert consultation. [20]", "Optimal proactive regimen is not established. [20]" ], [ "IVIG-resistant KD", "Reassess coronary status and consider repeat IVIG, infliximab, or corticosteroids with subspecialty involvement. [20][21]", "The excerpts do not define a preferred sequence or regimen." ] ] } }, { "id": "coronary-imaging-follow-up", "eyebrow": "Cardiovascular Surveillance", "heading": "Use serial echocardiography to define coronary risk", "intro": "Coronary status—not resolution of mucocutaneous findings—determines long-term cardiovascular surveillance.", "paragraphs": [ "All patients with KD should undergo echocardiography at diagnosis and at 6 to 8 weeks after illness onset; the cited review also recommends an intermediate echocardiogram at 10 to 14 days. [7] Early imaging can identify coronary vasculitis in incomplete presentations, but a normal early examination does not exclude KD. [7]", "Coronary artery dimensions should be interpreted using body-size-adjusted Z scores. The supplied source categorizes dilation as Z score at least 2.0 to less than 2.5, small aneurysm as at least 2.5 to less than 5.0, medium aneurysm as at least 5 to less than 10 with absolute luminal dimension under 8 mm, and uses persistent Z scores below 2 as a no-involvement category. [8]", "Young children may be at greatest risk of coronary involvement. [12] Patients with aneurysms require continued cardiology-directed surveillance because coronary artery aneurysms account for substantial KD morbidity and mortality, and myocardial infarction risk is highest soon after disease onset. [1][8]" ], "bullets": [ "Document coronary anatomy at baseline even when treatment begins before imaging is completed. [7][16]", "Repeat imaging after treatment because early coronary findings can be absent or evolve during the acute illness. [7]", "Use the coronary Z-score category to communicate risk and determine the intensity of cardiology follow-up. [8]" ], "subsections": [], "table": { "caption": "Coronary artery categories cited in a clinical management algorithm. [8]", "columns": [ "Category", "Z-score definition", "Clinical implication" ], "rows": [ [ "No involvement at any time", "Z score always less than 2. [8]", "Follow-up pathway differs from aneurysm categories. [8]" ], [ "Dilation only", "Z score at least 2.0 to less than 2.5. [8]", "Requires distinction from aneurysmal disease in longitudinal assessment. [8]" ], [ "Small aneurysm", "Z score at least 2.5 to less than 5.0. [8]", "Represents coronary artery involvement requiring risk-stratified follow-up. [8]" ], [ "Medium aneurysm", "Z score at least 5 to less than 10 with absolute luminal dimension less than 8 mm. [8]", "Requires more intensive cardiovascular assessment than dilation alone. [8]" ] ] } }, { "id": "differential-diagnosis", "eyebrow": "Diagnostic Pitfalls", "heading": "Separate KD from MIS-C without missing either disorder", "intro": "Overlapping inflammatory and mucocutaneous phenotypes require parallel diagnostic thinking.", "paragraphs": [ "MIS-C is an important differential diagnosis in children with KD-like illness and has been incorporated into updated KD guidance. [1] In a U.S. MIS-C cohort, 40% had KD-like features and 8% had coronary artery aneurysms defined by Z score of at least 2.5. [6]", "The distinction matters because treatment evidence and disease trajectory differ. In a comparative treatment study, initial treatment with IVIG alone in MIS-C was associated with delayed recovery and increased coronary aneurysm risk relative to treatment approaches that included glucocorticoids; this evidence applies to MIS-C rather than establishing treatment for classic KD. [3]" ], "bullets": [ "When considering KD, actively assess for MIS-C rather than assuming mucocutaneous findings establish classic KD. [1][6]", "Avoid extrapolating MIS-C treatment data directly to classic KD or vice versa. [3][4]" ], "subsections": [], "table": { "caption": "KD and MIS-C overlap relevant to diagnostic assessment. [1][3][6]", "columns": [ "Issue", "Decision relevance" ], "rows": [ [ "KD-like clinical features in MIS-C", "Reported in 40% of a U.S. MIS-C cohort; phenotype overlap cannot independently distinguish the disorders. [6]" ], [ "Coronary aneurysms in MIS-C", "Reported in 8% of the cited U.S. cohort using Z score at least 2.5; coronary imaging remains relevant in suspected MIS-C. [6]" ], [ "Initial immunomodulation", "Comparative MIS-C evidence suggests IVIG alone may be inferior to IVIG plus glucocorticoids for recovery and coronary outcomes; do not treat this as KD-specific evidence. [3]" ] ] } } ], "faq": [ { "question": "Can a normal echocardiogram exclude Kawasaki disease?", "answer": "No. Early echocardiography may show coronary vasculitis in incomplete KD, but a negative study does not exclude the diagnosis and should not delay treatment when clinical suspicion is high. [7][16]" }, { "question": "When should incomplete Kawasaki disease be suspected?", "answer": "Consider it in a febrile child with fewer than the full set of principal clinical features plus systemic inflammation, especially elevated CRP, ESR, or leukocytosis. Coronary disease can occur despite incomplete clinical criteria. [7]" }, { "question": "What is the standard initial IVIG regimen in Kawasaki disease?", "answer": "A cited treatment source describes 2 g/kg IVIG as a single infusion as standard initial therapy. IVIG plus aspirin reduces coronary artery abnormalities, but the supplied excerpts do not support a complete aspirin dosing regimen. [4][20]" }, { "question": "How often should echocardiography be performed after Kawasaki disease diagnosis?", "answer": "The cited review recommends echocardiography at diagnosis, at 10 to 14 days after disease onset, and at 6 to 8 weeks after onset. [7]" }, { "question": "Which patients warrant concern for IVIG resistance?", "answer": "Patients who fail to respond to initial IVIG are at increased risk for cardiac complications. Repeat IVIG, infliximab, and corticosteroids have been advocated, but the supplied sources do not establish a universal preferred rescue sequence. [20][21]" } ], "references": [ { "number": 1, "title": "Diagnosing and Managing Kawasaki Disease | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/diagnosing-managing-kawasaki-disease-nejm-jw.NA58286", "authors": "clinician.nejm.org", "host": "clinician.nejm.org" }, { "number": 2, "title": "Cardiovascular Risk Reduction in High-Risk Children | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/PA200704040000001", "authors": "clinician.nejm.org", "host": "clinician.nejm.org" }, { "number": 3, "title": "Treatment of Multisystem Inflammatory Syndrome in Children", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2102968", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 4, "title": "Randomized Trial of Pulsed Corticosteroid Therapy for ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa061235", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 5, "title": "Multisystem Inflammatory Syndrome in Children — Initial ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2102605", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 6, "title": "Multisystem Inflammatory Syndrome in U.S. Children and ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2021680", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 7, "title": "Management of Kawasaki disease | Archives of Disease in Childhood", "detail": "adc.bmj.com", "url": "https://adc.bmj.com/content/99/1/74", "authors": "adc.bmj.com", "host": "adc.bmj.com" }, { "number": 8, "title": "Kawasaki disease - Symptoms, diagnosis and treatment", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/236", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 9, "title": "Kawasaki disease: how to distinguish from other febrile ...", "detail": "ep.bmj.com", "url": "https://ep.bmj.com/content/105/3/152", "authors": "ep.bmj.com", "host": "ep.bmj.com" }, { "number": 10, "title": "A machine-learning algorithm for diagnosis of multisystem ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/landig/article/PIIS2589-7500(22)00149-2/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 11, "title": "the KD-CAA prevention (KD-CAAP) trial", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00297-X/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 12, "title": "Subgroups of children with Kawasaki disease: a data ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(23)00166-9/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 13, "title": "Diagnostic approaches to Kawasaki disease worldwide", "detail": "academic.oup.com", "url": "https://academic.oup.com/rheumatology/article/65/7/keag340/8719060", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 14, "title": "Incomplete (atypical) Kawasaki disease", "detail": "journals.lww.com", "url": "https://journals.lww.com/pidj/fulltext/2002/06000/incomplete__atypical__kawasaki_disease.15.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 15, "title": "Clinical prediction model: Multisystem inflammatory syndrome ...", "detail": "shmpublications.onlinelibrary.wiley.com", "url": "https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.13290", "authors": "shmpublications.onlinelibrary.wiley.com", "host": "shmpublications.onlinelibrary.wiley.com" }, { "number": 16, "title": "Diagnosis of Kawasaki disease - Singh - 2018", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/1756-185X.13224", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 17, "title": "Multimodal Echocardiographic Assessment in Intravenous ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/echo.70589", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 18, "title": "Revision of diagnostic guidelines for Kawasaki disease ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/ped.14326", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 19, "title": "Aspirin Dose in Kawasaki Disease: The Ongoing Battle", "detail": "acrjournals.onlinelibrary.wiley.com", "url": "https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.23504", "authors": "acrjournals.onlinelibrary.wiley.com", "host": "acrjournals.onlinelibrary.wiley.com" }, { "number": 20, "title": "Effective infliximab therapy for the early regression of ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0167527317380567", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 21, "title": "Infliximab versus second intravenous immunoglobulin for ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2352464221002704", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 22, "title": "Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0140673613622989", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 23, "title": "Articles Pharmacologic interventions for Kawasaki disease ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S235239642200130X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 24, "title": "Value of cystatin C for Kawasaki disease with coronary ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/tp/_layouts/15/oaks.journals/downloadpdf.aspx?an=01727407-202504000-00003", "authors": "journals.lww.com", "host": "journals.lww.com" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Diagnosing and Managing Kawasaki Disease | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/diagnosing-managing-kawasaki-disease-nejm-jw.NA58286", "authors": "clinician.nejm.org", "host": "clinician.nejm.org", "snippet": "###### Topics\n\n### Background\n\nKawasaki disease is a rare illness that causes inflammation of the blood vessels and high fever, usually in young children. Risk for myocardial infarction (MI) is highest soon after Kawasaki disease onset. This updated AHA statement for diagnosing and managing Kawasaki", "score": 0.73846215 }, { "number": 2, "title": "Cardiovascular Risk Reduction in High-Risk Children | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/PA200704040000001", "authors": "clinician.nejm.org", "host": "clinician.nejm.org", "snippet": "The AAP recently endorsed recommendations from an expert panel of the American Heart Association for cardiovascular risk management in high-risk pediatric populations. This statement includes detailed recommendations for risk assessment and treatment of children at high risk for coronary artery dise", "score": 0.56431514 }, { "number": 3, "title": "Treatment of Multisystem Inflammatory Syndrome in Children", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2102968", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "by AJ McArdle · 2021 · Cited by 436 — ... treatment for Kawasaki's disease) may delay recovery and increase the risk of coronary-artery aneurysm. We found no evidence of delayed", "score": 0.5324014 }, { "number": 4, "title": "Randomized Trial of Pulsed Corticosteroid Therapy for ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa061235", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "by JW Newburger · 2007 · Cited by 537 — Treatment of acute Kawasaki disease with intravenous immune globulin and aspirin reduces the risk of coronary-artery abnormalities and systemic", "score": 0.4858686 }, { "number": 5, "title": "Multisystem Inflammatory Syndrome in Children — Initial ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2102605", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "by MBF Son · 2021 · Cited by 444 — Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a", "score": 0.23842646 }, { "number": 6, "title": "Multisystem Inflammatory Syndrome in U.S. Children and ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2021680", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "by LR Feldstein · 2020 · Cited by 3368 — Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki's disease–like features were documented in 74 (40%)", "score": 0.21805303 }, { "number": 7, "title": "Management of Kawasaki disease | Archives of Disease in Childhood", "detail": "adc.bmj.com", "url": "https://adc.bmj.com/content/99/1/74", "authors": "adc.bmj.com", "host": "adc.bmj.com", "snippet": "There is no diagnostic test for KD, thus the diagnosis rests on combinations of clinical criteria and laboratory findings (table 2). For the diagnosis to be established according to the Diagnostic Guidelines of the Japan KD Research Committee, five of the six criteria in table 2 should be present.42", "score": 0.5786631 }, { "number": 8, "title": "Kawasaki disease - Symptoms, diagnosis and treatment", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/236", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "### History and exam\n\n#### Key diagnostic factors\n\n#### Other diagnostic factors\n\n#### Risk factors\n\npadlock-locked\n\n### Diagnostic investigations\n\n#### 1st investigations to order\n\n#### Investigations to consider\n\n#### Emerging tests\n\npadlock-locked\n\n### Treatment algorithm\n\n### presentation ≤10 da", "score": 0.38062134 }, { "number": 9, "title": "Kawasaki disease: how to distinguish from other febrile ...", "detail": "ep.bmj.com", "url": "https://ep.bmj.com/content/105/3/152", "authors": "ep.bmj.com", "host": "ep.bmj.com", "snippet": "by A Kelly · 2020 · Cited by 5 — Kawasaki disease (KD) is challenging to diagnose because there is no specific laboratory test and the presentation is often similar to common childhood", "score": 0.3474712 }, { "number": 10, "title": "A machine-learning algorithm for diagnosis of multisystem ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/landig/article/PIIS2589-7500(22)00149-2/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "by JY Lam · 2022 · Cited by 74 — We developed a deep-learning algorithm called KIDMATCH (Kawasaki Disease vs Multisystem Inflammatory Syndrome in Children) using clinical signs and laboratory ...Read more", "score": 0.1636194 }, { "number": 11, "title": "the KD-CAA prevention (KD-CAAP) trial", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00297-X/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "by D Eleftheriou · 2026 — European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative Rheumatology (Oxford).", "score": 0.14946958 }, { "number": 12, "title": "Subgroups of children with Kawasaki disease: a data ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(23)00166-9/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "by H Wang · 2023 · Cited by 66 — Risk of coronary artery involvement was highest in the young subgroup, including the largest left anterior descending artery and right coronary", "score": 0.3001303 }, { "number": 13, "title": "Diagnostic approaches to Kawasaki disease worldwide", "detail": "academic.oup.com", "url": "https://academic.oup.com/rheumatology/article/65/7/keag340/8719060", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by J Marčiulynaitė · 2026 — Incomplete KD is most often identified with fever and three criteria, though many clinicians assign decisive diagnostic weight to CALs, even in the absence of ...Read more", "score": 0.50168514 }, { "number": 14, "title": "Incomplete (atypical) Kawasaki disease", "detail": "journals.lww.com", "url": "https://journals.lww.com/pidj/fulltext/2002/06000/incomplete__atypical__kawasaki_disease.15.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Classic diagnostic criteria for KD consist of daily high spiking fever for at least 5 days with at least four of five other principal manifestations of the", "score": 0.498902 }, { "number": 15, "title": "Clinical prediction model: Multisystem inflammatory syndrome ...", "detail": "shmpublications.onlinelibrary.wiley.com", "url": "https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.13290", "authors": "shmpublications.onlinelibrary.wiley.com", "host": "shmpublications.onlinelibrary.wiley.com", "snippet": "Jan 28, 2024 — ... incomplete KD. b Kawasaki disease criteria refers to the American Heart Association diagnostic criteria. Clinical characteristics and ...Read more", "score": 0.4613328 }, { "number": 16, "title": "Diagnosis of Kawasaki disease - Singh - 2018", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/1756-185X.13224", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Nov 13, 2017 — Echocardiography findings must be interpreted carefully and treatment should not be delayed if facilities for echocardiography are not easily", "score": 0.459295 }, { "number": 17, "title": "Multimodal Echocardiographic Assessment in Intravenous ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/echo.70589", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "A structured lifecycle echocardiographic framework for intravenous immunoglobulin (IVIG)-resistant or high-risk Kawasaki disease spans", "score": 0.28273353 }, { "number": 18, "title": "Revision of diagnostic guidelines for Kawasaki disease ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/ped.14326", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Elevation of hepatic transaminases early in the course of the disease. · Increased leukocytes in the urine sediment of an infant. · Thrombocytosis", "score": 0.27658108 }, { "number": 19, "title": "Aspirin Dose in Kawasaki Disease: The Ongoing Battle", "detail": "acrjournals.onlinelibrary.wiley.com", "url": "https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.23504", "authors": "acrjournals.onlinelibrary.wiley.com", "host": "acrjournals.onlinelibrary.wiley.com", "snippet": "These recommendations are intended to aid physicians in diagnosing suspected KD and assist decisions for use of intravenous immunoglobulin (IVIG)", "score": 0.14710155 }, { "number": 20, "title": "Effective infliximab therapy for the early regression of ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0167527317380567", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Our survey data indicated that the number of patients receiving standard initial IVIG treatment (2 g/kg/day as a single infusion) increased annually, although the median days of illness at IVIG administration were unchanged (data not shown). In addition, previous studies have reported lower proporti", "score": 0.73023266 }, { "number": 21, "title": "Infliximab versus second intravenous immunoglobulin for ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2352464221002704", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by JC Burns · 2021 · Cited by 127 — A second infusion of IVIG, infliximab, and corticosteroids have all been advocated for treatment of IVIG resistant Kawasaki disease. We", "score": 0.59061456 }, { "number": 22, "title": "Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0140673613622989", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "(12 [14%] of 86 patients _vs_ 27 [31%] of 87 patients; risk ratio 0·46; 95% CI 0·25–0·86; p=0·010). No difference was found in the incidence of adverse events between the groups (9% _vs_ 7%; p=0·78). Combined primary therapy with IVIG and ciclosporin was safe and effective for favourable coronary ar", "score": 0.5683445 }, { "number": 23, "title": "Articles Pharmacologic interventions for Kawasaki disease ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S235239642200130X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by WT Lei · 2022 · Cited by 28 — Infliximab significantly improved resolution compared to the high-dosage IVIG only group. IVIG and aspirin might have an additional effect on shortening the", "score": 0.54724693 }, { "number": 24, "title": "Value of cystatin C for Kawasaki disease with coronary ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/tp/_layouts/15/oaks.journals/downloadpdf.aspx?an=01727407-202504000-00003", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "by K Liang · 2025 · Cited by 1 — KD patients with a high Z score at diagnosis (Z-score +2 or +2.5 or higher) have an Figure 2 Receiver operating characteristic curves for Cys C", "score": 0.5078369 } ], "publishedAt": "2026-08-21T01:30:45.406701+00:00", "updatedAt": "2026-08-21T01:30:45.406701+00:00", "readingMinutes": 5, "slug": "kawasaki-disease" }