Original article
Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease*

https://doi.org/10.1016/S0022-3476(05)80026-5Get rights and content

Study objectives

(1) To determine those diseases that most often mimic Kawasaki disease (KD) in the United States. (2) To examine the physical findings and laboratory studies that influenced experienced clinicians to exclude the diagnosis of KD. (3) To compare epidemiologic features of patients with KD and patients referred for evaluation of possible KD in whom alternative diagnoses were established.

Design:

Case comparison study.

Setting:

Seven pediatric tertiary care centers.

Patients:

Consecutive sample of 280 patients with KD and 42 comparison patients examined within the first 14 days after onset of fever.

Measurements and main results:

(1) Infectious diseases, particularly measles and group A β-hemolytic streptococcal infection, most closely mimicked KD and accounted for 35 (83%) of 42 patients in the comparison group. (2) The standard diagnostic clinical criteria for KD were fulfilled in 18 (46%) of 39 patients in whom other diagnoses were established. (3) Patients with KD were significantly less likely to have exudative conjunctivitis or pharyngitis, generalized adenopathy, and discrete intraoral lesions, and more likely to have a perineal distribution of their rash. The patients with KD were also more likely to have anemia and elevated erythrocyte sedimentation rate; leukocyte count <10×103/mm3 and platelet count <200×103/mm3 were significantly less prevalent in patients with KD. (4) Residence within 200 yards of a body of water was more common among KD patients.

Conclusions:

(1) Measles and streptococcal infection should be excluded in patients examined for possible KD. (2) Laboratory studies that may be useful in discriminating patients with KD from those with alternative diagnoses include hemoglobin concentration, erthyrocyte sedimentation rate, and serum alanine aminotransferase activity. (3) Residence near a body of water may be a risk factor for the development of KD.

References (10)

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  • Otorhinolaryngological manifestations and delayed diagnosis in Kawasaki disease

    2019, International Journal of Pediatric Otorhinolaryngology
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    This is also comparable to what was found in our study (41.5%). Among the oropharyngeal attacks, cheilitis is the most frequent symptom in series (respectively 94%, 74% and 63% for series of Burns et al. [10], Kryzer and Derkay [11], Sung and Al [13]) as well as in our study (83%). This symptom should attract the attention of the clinician since it is not classical during ordinary ENT infections.

  • Kawasaki Disease Substantially Impacts Health-Related Quality of Life

    2018, Journal of Pediatrics
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    Similar comparisons between KD and acute, noncomplex pneumonia subjects, revealed a substantial deterioration for the former group. KD shares common lymphomucocutaneous features with infectious processes.32 However, extreme irritability is a hallmark KD symptom,33 which leads to a pronounced degree of behavioral dysfunction and potentially explains the profound HRQoL decline with illness onset.

  • Laboratory Manifestations of Infectious Diseases

    2018, Principles and Practice of Pediatric Infectious Diseases
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*

Presented in part at the 30th Interscience Congress of Antimicrobial Agents and Chemotherapy, Atlanta, Ga., October 1990.

Supported in part by U.S. Public Health Service grants HL-01855 and HL-34545, and by CRC grant RR69, General Clinical Research Centers, Program of the Division of Resources, National Institutes of Health.

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