What are the diagnostic criteria for Kawasaki disease?

We must pay attention to our health problems in daily life and take preventive measures for some diseases. This can reduce a lot of unnecessary trouble. Take Kawasaki disease as an example. Below I will introduce to you how to diagnose Kawasaki disease. I hope it can help friends in need.

Diagnostic criteria

The Japanese Mucocutaneous Lymph Node Syndrome Research Committee (1984) proposed that the diagnosis of this disease should be confirmed by meeting at least five of the following six main clinical symptoms: fever of unknown cause, lasting for 5 days or more; bilateral conjunctival congestion; diffuse congestion of the oral and pharyngeal mucosa, red and cracked lips, and bayberry tongue; hard swelling of the hands and feet and redness of the palms and soles at the beginning of the disease, and membranous peeling of the fingertips during the recovery period; erythema multiforme on the trunk, but without blisters and scabs; non-suppurative swelling of the cervical lymph nodes, with a diameter of 1.5 cm or more. However, if two-dimensional echocardiography or coronary angiography finds coronary artery aneurysm or dilatation, the diagnosis can be confirmed if four of the main symptoms are positive.

Incomplete or atypical cases are reported to increase, about 10% to 20%, with only 2 to 3 main symptoms but typical coronary artery lesions. They mostly occur in infants. The incidence of coronary artery aneurysms in typical cases and atypical cases is similar. Once Kawasaki disease is suspected, an echocardiogram should be performed as soon as possible.

Testing

In the acute phase, the total white blood cell count and percentage of granulocytes increase, and the nuclei shift to the left. Mild anemia can be seen in more than half of the patients. The erythrocyte sedimentation rate increases significantly, reaching more than 100 mm in the first hour. Serum protein electrophoresis shows an increase in globulin, especially a significant increase in α2 globulin. Albumin decreases. IgG, IgA, and IgA increase. Platelets begin to increase in the second week. The blood is in a hypercoagulable state. The antistreptococcal hemolysin O titer is normal. Rheumatoid factor and antinuclear bodies are both negative. C-reactive protein increases. Serum complement is normal or slightly high. Leukocytosis and/or proteinuria can be seen in the urine sediment. Electrocardiograms can show a variety of changes, with abnormal ST segment and T wave being the most common, and can also show prolonged PR and QR intervals, abnormal Q waves, and arrhythmias.

Two-dimensional echocardiography is suitable for cardiac examination and long-term follow-up. Various cardiovascular lesions such as pericardial effusion, left ventricular enlargement, mitral regurgitation, and coronary artery dilatation or aneurysm formation can be found in half of the patients. It is best to check once a week during the acute and subacute stages of the disease. It is the most reliable non-invasive examination method for monitoring coronary artery aneurysms. In cases of aseptic meningitis, the lymphocyte count in cerebrospinal fluid can be as high as 50-70/mm3. In some cases, serum bilirubin or alanine transaminase can be slightly elevated. Bacterial culture and virus isolation are both negative results.