Pediatric emergency medicine trisk 3004 3004

explicit in 2004 when an expert panel published revised criteria for diagnosing and
treating children with suspected KD.
Fever is probably the most consistent manifestation of KD. It reflects the elevated
levels of proinflammatory cytokines (e.g., TNF-α, IL-1), which are also believed to
mediate the underlying vascular inflammation. A diagnosis of KD should be
considered in all children with prolonged, unexplained fever, irritability, and laboratory
signs of inflammation, especially in the presence of mucocutaneous inflammation.
Conversely, the diagnosis must be suspect in the absence of fever.
TABLE 101.16
DIAGNOSTIC CRITERIA FOR KAWASAKI DISEASE
Fever ≥5 days unresponsive to antibiotics
If the fever disappears because of intravenous gamma-globulin therapy before the
fifth day of illness, a fever of <5 days’ duration fulfills fever criterion for case
definition.
At least four of the five following physical findings with no other more reasonable
explanation for the observed clinical findings:
1. Bilateral conjunctival injection
2. Changes in the oropharyngeal mucous membranes (erythematous and/or fissured
lips, strawberry tongue, injected pharynx)
3. Changes of peripheral extremities, including erythema and/or edema of the
hands or feet (acute phase) or periungual desquamation (convalescent phase) (
Fig. 101.11 )
4. Polymorphous rash, primarily truncal; nonvesicular
5. Cervical lymphadenopathy ≥1.5 cm diameter