Kawasaki Disease Diagnostic Criteria

Typical Kawasaki disease is characterized by fever ≥ 5 days and ≥ 4 of the 5 clinical criteria below.

Fever ≥ 5 days

Clinical criteria (0 of 5 selected)

Bilateral non-purulent conjunctivitisMucosal changes of the oropharynx (injected pharynx, red lips, dry fissured lips, strawberry tongue)Changes in extremities (oedema and/or erythema of the hands or feet, periungual desquamation)Polymorphous rash (usually diffuse maculopapular, occasional scarlatiniform or erythema multiform-like)Cervical lymphadenopathy (at least one lymph node > 1.5 cm)

Coronary artery abnormality evidenced on echocardiogramIf present, diagnosis can be made with fewer than 4 clinical criteria.

Incomplete Kawasaki Disease

Clinical features suggestive of KD but fewer than 4 principal clinical criteria
Frequently encountered in infants < 12 months
Delayed diagnosis frequently leads to late institution of treatment and higher incidence of coronary artery complications
Diagnosis should be considered in any young infants presenting with unexplained prolonged fever and elevated inflammatory markers
Low threshold for echocardiography

Evaluation process for suspected Incomplete KD

KD, Kawasaki disease; CRP, C-reactive protein; ESR, red blood cell sedimentation rate. Tap the image to enlarge.

Atypical Kawasaki Disease

Kawasaki disease with atypical clinical presentations such as acute abdomen, acute pancreatitis, cholestatic jaundice, acute kidney injury and pneumonia.

Other helpful clinical features

Supportive findings, not part of the diagnostic criteria above.

Neurological	Irritability, encephalopathy, aseptic meningitis
Cardiovascular	Myocarditis, pericarditis, valvular regurgitation, non-coronary medium-sized artery aneurysms
Gastrointestinal	Diarrhoea, vomiting, abdominal pain, hepatitis, hydrops of gallbladder, paralytic ileus
Genitourinary	Sterile pyuria, proteinuria, testicular swelling
Skin	Erythema or induration of BCG scar, perianal erythema or excoriation
Musculoskeletal	Transient arthritis

Source: Paediatric Protocols for Malaysian Hospitals, 5th Edition. Ministry of Health Malaysia.