| What can a delay in diagnosing Kawasaki Disease lead to? | ADVERSE CLINICAL OUTCOMES | DELAY IN DIAGNOSING KAWASAKI DISEASE CAN RESULT IN ADVERSE CLINICAL OUTCOMES This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India. Standard Treatment Workflow (STW) | 51 | relationship | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | DELAY IN DIAGNOSING KAWASAKI DISEASE CAN RESULT IN ADVERSE CLINICAL OUTCOMES This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. | 1 | page=1,block=0 | 0.700 | valid |
| What are the changes described for the lips and oral cavity? | Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. Lips and oral cavity: Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa B. Changes in extremities: Erythema of palms, soles Dorsal edema of hands & feet Periungual peeling of fingers, toes (2nd & 3rd week) C. Polymorphous exanthem: Rash – maculopapular or erythema multiforme-like D. Eyes: Bilateral conjunctival injection without exudate E. Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral Any child with fever for more than 5 days should be evaluated for KD Strawberry tongue Periungual peeling of finger Edema of feet Conjunctival injection Maculopapular rash July/ 2024 | 257 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | Lips and oral cavity: Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa B. | 1 |
| What cardiac dysfunctions can be detected by echocardiography in Kawasaki Disease? | LV dysfunction, mitral regurgitation, pericardial effusion | • CBC: Leukocytosis –Neutrophilia, Anemia, Thrombocytosis (in 2nd week) • CRP- • ESR- • LFT: SGOT, SGPT - , Albumin • Serum electrolytes – Sodium • Urine microscopy- Sterile pyuria • ECHO- Coronary artery dimensions, perivascular brightness, lack of tapering, LV dysfunction, mitral regurgitation, pericardial effusion WHEN TO START IVIG? • In children who meet diagnostic criteria as soon as possible (ideally within 10 days of fever onset) • Even after 10 days of illness if evidence of systemic inflammation is present (elevated ESR/ CRP) with fever • Recurrent KD (repeat episode after complete resolution of previous episode) Unavailability of ECHO should not delay IVIG if diagnostic criteria are met CONSIDER KD IN DIFFERENTIAL DIAGNOSIS IF PROLONGED FEVER OCCURS IN: • Infants < 6 months with irritability • Infants with unexplained aseptic meningitis • Infants or children with unexplained or culture –negative shock • Infants or children with cervical lymphadenitis unresponsive to antibiotics • Infants or children with retropharyngeal phlegmon unresponsive to antibiotics | 260 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf |
| What coronary artery changes can be observed on an echocardiogram in Kawasaki Disease? | Coronary artery dimensions, perivascular brightness, lack of tapering | • CBC: Leukocytosis –Neutrophilia, Anemia, Thrombocytosis (in 2nd week) • CRP- • ESR- • LFT: SGOT, SGPT - , Albumin • Serum electrolytes – Sodium • Urine microscopy- Sterile pyuria • ECHO- Coronary artery dimensions, perivascular brightness, lack of tapering, LV dysfunction, mitral regurgitation, pericardial effusion WHEN TO START IVIG? • In children who meet diagnostic criteria as soon as possible (ideally within 10 days of fever onset) • Even after 10 days of illness if evidence of systemic inflammation is present (elevated ESR/ CRP) with fever • Recurrent KD (repeat episode after complete resolution of previous episode) Unavailability of ECHO should not delay IVIG if diagnostic criteria are met CONSIDER KD IN DIFFERENTIAL DIAGNOSIS IF PROLONGED FEVER OCCURS IN: • Infants < 6 months with irritability • Infants with unexplained aseptic meningitis • Infants or children with unexplained or culture –negative shock • Infants or children with cervical lymphadenitis unresponsive to antibiotics • Infants or children with retropharyngeal phlegmon unresponsive to antibiotics | 189 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf |
| What symptoms are associated with the respiratory system? | Cough, rhinorrhea | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. Lips and oral cavity: Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa B. Changes in extremities: Erythema of palms, soles Dorsal edema of hands & feet Periungual peeling of fingers, toes (2nd & 3rd week) C. Polymorphous exanthem: Rash – maculopapular or erythema multiforme-like D. Eyes: Bilateral conjunctival injection without exudate E. Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral Any child with fever for more than 5 days should be evaluated for KD Strawberry tongue Periungual peeling of finger Edema of feet Conjunctival injection Maculopapular rash July/ 2024 | 44 | list | 0.740 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. |
| What musculoskeletal symptoms are described? | Arthritis, arthralgia | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. Lips and oral cavity: Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa B. Changes in extremities: Erythema of palms, soles Dorsal edema of hands & feet Periungual peeling of fingers, toes (2nd & 3rd week) C. Polymorphous exanthem: Rash – maculopapular or erythema multiforme-like D. Eyes: Bilateral conjunctival injection without exudate E. Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral Any child with fever for more than 5 days should be evaluated for KD Strawberry tongue Periungual peeling of finger Edema of feet Conjunctival injection Maculopapular rash July/ 2024 | 123 | list | 0.700 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. |
| What are the guidelines for Kawasaki Disease based on? | expert opinions and available scientific evidence | DELAY IN DIAGNOSING KAWASAKI DISEASE CAN RESULT IN ADVERSE CLINICAL OUTCOMES This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India. Standard Treatment Workflow (STW) | 275 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. | 1 | page=1,block=0 | 0.700 | valid |
| What is a specific sign involving the cervical lymph nodes? | Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. Lips and oral cavity: Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa B. Changes in extremities: Erythema of palms, soles Dorsal edema of hands & feet Periungual peeling of fingers, toes (2nd & 3rd week) C. Polymorphous exanthem: Rash – maculopapular or erythema multiforme-like D. Eyes: Bilateral conjunctival injection without exudate E. Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral Any child with fever for more than 5 days should be evaluated for KD Strawberry tongue Periungual peeling of finger Edema of feet Conjunctival injection Maculopapular rash July/ 2024 | 621 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | Eyes: Bilateral conjunctival injection without exudate E. Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral Any child with fever for more than 5 days should be evaluated for KD Strawberry tongue Periungual peeling of finger Edema of feet Conjunctival injection Maculopapular rash July/ 2024 |
| What is a specific sign involving the extremities in the second and third week? | Periungual peeling of fingers, toes (2nd & 3rd week) | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. Lips and oral cavity: Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa B. Changes in extremities: Erythema of palms, soles Dorsal edema of hands & feet Periungual peeling of fingers, toes (2nd & 3rd week) C. Polymorphous exanthem: Rash – maculopapular or erythema multiforme-like D. Eyes: Bilateral conjunctival injection without exudate E. Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral Any child with fever for more than 5 days should be evaluated for KD Strawberry tongue Periungual peeling of finger Edema of feet Conjunctival injection Maculopapular rash July/ 2024 | 432 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | Changes in extremities: Erythema of palms, soles Dorsal edema of hands & feet Periungual peeling of fingers, toes (2nd & 3rd week) C. | 1 |
| What is a specific sign involving the eyes? | Bilateral conjunctival injection without exudate | GIT: Diarrhea, vomiting, abdominal pain RS: Cough, rhinorrhea CVS: Signs of CCF, new onset murmur, gallop MUSCULOSKELETAL: Arthritis, arthralgia CNS: Extreme Irritability OTHERS: Induration at BCG scar site Treatment SPECIFIC SIGNS A. Lips and oral cavity: Erythema & Lip cracking Strawberry tongue and/or Diffuse erythema of oral & pharyngeal mucosa B. Changes in extremities: Erythema of palms, soles Dorsal edema of hands & feet Periungual peeling of fingers, toes (2nd & 3rd week) C. Polymorphous exanthem: Rash – maculopapular or erythema multiforme-like D. Eyes: Bilateral conjunctival injection without exudate E. Cervical lymphadenopathy (>1.5cm diameter) - mostly unilateral Any child with fever for more than 5 days should be evaluated for KD Strawberry tongue Periungual peeling of finger Edema of feet Conjunctival injection Maculopapular rash July/ 2024 | 569 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651146_4_kawasaki_disease_new.pdf | Eyes: Bilateral conjunctival injection without exudate E. | 1 | page=1,block=71 | 0.700 |