Patient selection - one of the following:
(1) infant with fever >= 7 days
(2) child with fever >= 5 days AND 2-3 compatible clinical findings (classic Kawasaki disease has >= 4)
Classic clinical findings:
(1) bilateral conjunctival injection without exudate
(2) cervical lymphadenopathy
(3) polymorphous skin rash (maculopapular, diffuse erythroderma, erythema multiforme-like)
(4) changes affecting the lips and oral mucosa
(5) changes affecting the distal extremities (erythema and edema of hands and feet early, then periungual desquamation)
Parameters:
(1) CRP in mg/dL
(2) ESR in mm/h
If CRP is < 3.0 mg/dL and ESR < 40 mm/h then
(1) perform serial re-evaluation if fevers persist
(2) perform echocardiography if typical peeling occurs.
Else look for:
(1) changes on echocardiography
(2) anemia for age
(3) thrombocytosis (platelet count > 450,000 per µL) after day 7 of fever
(4) serum albumin <= 3.0 g/dL
(5) elevated serum ALT
(6) WBC count >= 15,000 per µL
(7) urine with >= 10 WBC per high power field
If the echocardiography is positive or if more than 3 laboratory findings are present then treat for Kawasaki Disease. Else perform serial re-evaluation and repeat echocardiography if fevers persist.
