BMJ  2003;327:918 (18 October), doi:10.1136/bmj.327.7420.918

Commentary

cardiological issues

Nick Archer, consultant paediatric cardiologist1

1 John Radcliffe Hospital, Oxford OX3 9DU Nick.Archer@orh.nhs.uk

The first 150 words of the full text of this article appear below.

Nearly all respondents on bmj.com listed Kawasaki disease in the differential diagnosis, even though the duration of illness was only five days. One criterion of Kawasaki disease is fever for 10 days, but intravenous immunoglobulin has been shown to reduce the risk of coronary damage definitely only if administered by day 10.1 Later administration has not been so thoroughly evaluated, and intravenous immunoglobulin may be more effective when given within 5 days than between 5 and 10 days.2 Thus the dilemma when confronted with a febrile child is at what point to acknowledge that Kawasaki disease is likely.

Acute self limiting feverish illnesses are common in young children, and some diagnoses do have specific treatments, particularly streptococcal and other bacterial infections. Streptococcal and staphylococcal sepsis may be linked with Kawasaki disease.3 Treatment with intravenous immunoglobulin is associated with some risks, although they are not well quantified in Kawasaki disease. Thus, . . . [Full text of this article]

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