Published online December 1, 2004
PEDIATRICS Vol. 114 No. 6 December 2004, pp. 1708-1733 (doi:10.1542/peds.2004-2182)
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Kawasaki Disease (Mucocutaneous...
Group A Streptococcal Infections

AMERICAN HEART ASSOCIATION: Endorsed Clinical Report

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Jane W. Newburger, MD, MPH, Masato Takahashi, MD, Michael A. Gerber, MD, Michael H. Gewitz, MD, Lloyd Y. Tani, MD, Jane C. Burns, MD, Stanford T. Shulman, MD, Ann F. Bolger, MD, Patricia Ferrieri, MD, Robert S. Baltimore, MD, Walter R. Wilson, MD, Larry M. Baddour, MD, Matthew E. Levison, MD, Thomas J. Pallasch, DDS, Donald A. Falace, DMD and Kathryn A. Taubert, PhD

ABSTRACT

Background. Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ~15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.

Methods and Results. A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo electrocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-{alpha} antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata.

Conclusions. Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

Key Words: AHA Scientific Statements • vasculitis • therapy • aneurysm • diagnosis

Abbreviations: MI, myocardial infarction • CI, confidence interval • Ig, immunoglobulin • TNF-{alpha}, tumor necrosis actor-{alpha} • 2D, 2-dimensional • 2DE, 2-dimensional echocardiography • IVIG, intravenous immunoglobulin • ESR, erythrocyte sedimentation rate • CRP, C-reactive protein • LV, left ventricular • RCA, right coronary artery • LAD, left anterior descending coronary artery • LMCA, left main coronary artery • LCX, left circumflex coronary artery • IVUS, intravascular ultrasound • MRA, magnetic resonance angiography • CT, computed tomography • MRI, magnetic resonance imaging • IL, interleukin • INR, international normalized ratio • tPA, tissue plasminogen activator • ECG, electrocardiogram




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