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Clinical Review

Kawasaki disease

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1514 (Published 05 May 2009) Cite this as: BMJ 2009;338:b1514
  1. Anthony Harnden, university lecturer in general practice1,
  2. Masato Takahashi, professor of paediatrics emeritus2,
  3. David Burgner, associate professor of paediatrics3
  1. 1Department of Primary Health Care, University of Oxford, Headington, Oxford OX3 7LF
  2. 2University of Southern California, Keck School of Medicine, Children’s Hospital, Los Angeles, 90027 CA, USA
  3. 3School of Paediatrics and Child Health, University of Western Australia, Child and Adolescent Health Service, GPO Box D184, Perth WA 6840, Australia
  1. Correspondence to: A Harnden anthony.harnden{at}dphpc.ox.ac.uk

    Summary points

    • Kawasaki disease is an acute febrile illness that mainly affects children under 5

    • It is the most common cause of acquired heart disease in children in the developed world

    • Diagnosis is based on fever of at least five days’ duration and four of five diagnostic clinical criteria

    • The typical clinical features appear sequentially and are rarely all there at presentation.

    • The diagnosis should be considered in any child with prolonged fever, irrespective of other features

    • Intravenous immunoglobulin and aspirin given 5-10 days after onset of fever reduce the incidence of coronary artery lesions from around 20% to around 5%

    Parents worry about meningitis, but few have heard of Kawasaki disease, and most doctors have never seen a case. But Kawasaki disease is an important diagnosis not to miss in febrile children because treatment within the first 10 days of illness may prevent acute and long term coronary artery damage, which on rare occasions can be fatal.1 Diagnostic difficulty arises because many of the early clinical features of Kawasaki disease mimic other more common self limiting febrile illnesses. To make an early diagnosis of Kawasaki disease doctors should have a high index of suspicion in an irritable child with five or more days of fever, irrespective of other clinical features. This article aims to give an overview of Kawasaki disease for doctors who manage febrile children.

    Sources and selection criteria

    We searched PubMed and Cochrane databases using the keywords “Kawasaki disease” or “mucocutaneous lymph node syndrome”. We reviewed abstracts from the last three international Kawasaki disease symposiums (2001, 2005, 2008). Our focus was on systematic reviews, national guidelines, and randomised controlled trials. We reviewed the reference lists of all articles retrieved together with those in our personal reference libraries. For the treatment section we looked at systematic reviews and randomised controlled trials only.

    What is Kawasaki disease and who gets it?

    Kawasaki …

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