This Kawasaki disease criteria calculator provides the diagnosis rule for Kawasaki syndrome in children based on fever onset and clinical findings. There is in depth information on the diagnosis of this condition below the form.
How does this Kawasaki disease criteria calculator work?
This health tool helps diagnosis Kawasaki disease based on the compulsory and optional criteria in the National Institute for Health and Care Excellence (NICE) and on a diagnosis rule for positivity.
The Kawasaki disease criteria calculator presents the required criteria, in all cases, which is:
■ Fever for at least five days generally high and spiking (often to 40° C or more), persisting for one to two weeks or longer if left untreated.
And the other criteria (five principal findings plus differential diagnosis) from which at least 4 must be selected:
■ Distinctive changes in extremities that include redness, swelling and induration of the hands and feet. One to three weeks after the onset of fever, desquamation of the fingers and toes may occur. One to two months after the onset of fever Beau's lines (white lines across the fingernails) may appear.
■ Polymorphic exanthema present on the trunk and extremities in a variety of forms: urticarial exanthem, a morbilliform maculopapular eruption (occasionally with target lesions) or a diffuse scarlatiniform rash. Bullae and vesicles are not seen. The rash usually appears within five days after the onset of fever.
■ Bilateral bulbar conjunctival injection that is not associated with an exudate and is in most cases painless.
■ Changes in aspect of lips and oral cavity including: strawberry tongue, redness and cracking of the lips, and erythema of the oropharyngeal mucosa, without any ulcerative lesions.
■ Cervical lymphadenopathy that is usually unilateral, slightly tender, firm nodes, at least one with a diameter of 1.5 cm or greater.
■ Exclusion of other diseases with similar findings.
Kawasaki disease guidelines
Kawasaki disease or the mucocutaneous lymph node syndrome is a rare disease affecting children under the age of five. Main characteristic is fever onset with high temperature for more than five days. Other characteristic symptoms include rashes, redness in fingers or toes, red eyes, cracked lips and swollen neck glands.
The development of the condition usually takes place over a six-week period in three characteristic phases:
■ Phase 1 – Acute onset of symptoms (week 1 – 2) including high fever unresponsive to usual antipyretic antibiotics, blotchy red rash without any blisters that is spreading to the torso and extremities, swollen lymph glands as response of the immune system trying to defeat infection, swollen mouth and throat with characteristic "strawberry tongue" and bilateral conjunctival injection.
■ Phase 2 – Subacute phase (week 2 – 4) with less severe but still lasting symptoms, fever subsides and new symptoms including peeling skin on the fingers and toes, abdominal pain, vomiting, diarrhea, jaundice, headaches or joint pain occur. This is the phase where complications are most likely to occur.
■ Phase 3 – Convalescent phase (week 4 – 6) that starts recovery with symptoms improving but the child still lacking energy. Complications are less likely to occur from this phase on.
Causes of the disease are not yet fully understood but some hypotheses are forwarded in studies:
■ Infection – because symptoms are consistent with infection, however pathogen agent not identified yet;
■ Autoimmune condition;
■ Genetic predisposition – several genes may increase chances of developing the syndrome;
■ Regional localization – more common occurrence in Northeast Asia: Japan and Korea;
■ Reaction to environment pollution.
With early diagnosis and treatment (within 10 days of symptom onset), full recovery takes place within six to eight weeks. Left untreated, it may lead to severe complications (i.e. due to the blood vessel inflammation and swelling, complications to the coronary arteries may occur).
Diagnosis consists of physical examination, evaluation of symptoms and application of the NICE guidelines presented in the above calculator. Urine and blood samples may be collected to check for white blood cells and WBC count.
Differential diagnosis takes place to exclude the following conditions amongst others: scarlet fever, measles, glandular fever, toxic shock syndrome and viral meningitis.
Standard treatment consists of intravenous immunoglobulin (IVIG) which provides antibodies and aspirin.
Fever in infants and children
This is a common symptom caused by infections and other diseases and is characterized by high body temperature as response of the immune system.
The symptoms of Kawasaki disease are often similar to those of other fever causing pediatric conditions such as:
■ Childhood illnesses i.e. whooping cough;
■ Ear infections;
■ Kidney or urinary tract infections (UTIs).
Medical assistance should be sought in the following cases:
■ Under 3 month old infant with a temperature of 38° C (101° F) or above;
■ 3 to 6 month old infant with a temperature of 39° C (102° F) or above.
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