Written by Kimi Dunbar
Spoon Feed
There are no changes to diagnostic criteria for KD, but advances have been made in identification of the individuals at high risk of cardiac sequelae.
Beyond the CRASH and burn
This article summarizes Kawasaki Disease (KD) updates based on clinical data published since the 2017 AHA statement on KD, focusing on diagnosis, cardiac imaging and long term management. Importantly, diagnostic criteria have not changed. Very abridged key points are summarized below:
- Children < 6 months or with Z scores ≥2.5 at diagnosis are considered high-risk for development of coronary artery aneurysms (CAA).
- MIS-C has features that overlap with KD. Patients with prominent GI symptoms, elevated troponin/BNP or thrombocytopenia/lymphopenia are more likely to have MIS-C, while patients with rash, conjunctival injection, or mucosal changes are more likely to have KD.
- Z-score is a normalization of the measurement of the coronary artery (CA) based on body size. A small error in the measurement of the CA dimension can have a massive impact on the Z-score. Accurate weight and height measurements are critical, and sedation should be considered for uncooperative children <3 years.
- There is no standard Z-score equation; several are used, though the same equation should be used with patients for comparison over time. The maximum Z-score reached during illness is the strongest predictor of outcome.
- Intensification of primary therapy (IVIG) with adjuvant agents such as steroids, infliximab, anakinra, cyclosporine may be of use in high-risk patients, especially those presenting with KD+ shock.
- Kids with KD are at high risk of MI and may present with non-specific symptoms such as pain, fussiness, restlessness, pallor, sweating, vomiting, and skin discoloration. The risk of MI is the highest in the first 2-3 months after initial diagnosis.
How will this change my practice?
This article is meaty, filled with specifics on the nuances of adjunct therapy and cardiac imaging. As a hospitalist, I’m going to pay close attention to non-specific symptoms in kids less than 6 months and patients with a history of KD. We see non-specific symptoms like irritability a lot, and MI usually isn’t on the differential – consideration of past medical history is pretty darn important to trigger a higher index of suspicion in this population.
Source
Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association. Circulation. 2024 Dec 3;150(23):e481-e500. doi: 10.1161/CIR.0000000000001295. Epub 2024 Nov 13. PMID: 39534969
