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Kawasaki Disease Diagnostic Criteria
Classic clinical criteria for diagnosing Kawasaki disease in a febrile child.
Kawasaki Disease Diagnostic Criteria
Fever for ≥5 days
Bilateral bulbar conjunctival injection without exudate
Oral/pharyngeal mucosal changes (erythematous or cracked lips, strawberry tongue, diffuse mucosal injection)
Polymorphous rash
Peripheral extremity changes (acute erythema/edema of hands or feet, or periungual desquamation in the subacute phase)
Cervical lymphadenopathy ≥1.5 cm, usually unilateral
Result0 of 5 principal criteria (fever <5 days)
Fever duration and/or criteria count do not meet the classic diagnostic threshold; reassess if fever persists or additional features develop.
- Principal criteria present
- 0/5
When to use
- A febrile child with mucocutaneous and lymph node findings in whom Kawasaki disease is suspected.
- Deciding whether echocardiography and IVIG therapy are indicated to prevent coronary artery aneurysms.
Formula
Classic (complete) Kawasaki disease = fever ≥5 days PLUS ≥4 of 5 principal criteria: (1) bilateral conjunctival injection, (2) oral/lip changes, (3) polymorphous rash, (4) extremity changes, (5) cervical lymphadenopathy ≥1.5 cm. Fewer criteria with fever suggest incomplete Kawasaki disease requiring further work-up.
Pearls and pitfalls
- In infants <6 months with prolonged fever and no other explanation, consider echocardiography even without meeting full criteria - incomplete Kawasaki disease is common in this age group.
- Coronary artery aneurysms are the major complication; timely IVIG reduces this risk substantially.
References
- McCrindle BW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017;135(17):e927-e999.
- Kawasaki T. Acute febrile mucocutaneous lymph node syndrome with characteristic desquamation of fingers and toes in children. Arerugi. 1967;16(3):178-222.