With a persistent fever, Kawasaki Disease must be on your differential, but have you not seen many cases or had difficulty with the diagnosis? Look no further, as we bring an expert to walk us through the diagnosis and management of KD! We discuss Kawasaki Disease with Dr. Adriana Tremoulet who is the assistant director of the Kawasaki Disease Research Center at the University of California, San Diego. She has led numerous Phase I through III trials regarding the management of KD, and she walks us through the diagnosis and management of this fascinating disease!
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“The eyes cannot see what the mind does not know.”
The first step to diagnosing Kawasaki Disease (KD) is to include it on the differential that we are creating. Once you’ve done that, on your history and physical evaluate for the five core criteria (in addition to fever):
Expert opinion: Dr. Tremoulet also recommends sitting down with the parents to review any photos that they may have of their child over the preceding days. This can help you identify criteria that may have come and gone prior to presentation!
Images (from top left in clockwise order): Ocular injection with peri-limbic sparing, strawberry tongue, cervical lymphadenopathy, periungual peeling of feet, rash, and erythema of feet. Consent obtained from patients by the Kawasaki Disease Foundation and graciously shared with The Cribsiders.
When faced with incomplete Kawasaki Disease, the American Heart Association recommends further laboratory work-up to help characterize overall inflammation to aid in identifying children at risk for a coronary artery aneurysm.
It is difficult to determine who is at greater risk for Kawasaki Disease since there is no mechanism or etiology fully known. Most of what is known is retrospectively established, but it includes the following groups are at a higher incidence of Kawasaki Disease or at higher risk for coronary aneurysms:
It can be difficult to tell the difference between the two, and it is possible that there may be overlap between the two syndromes. If you need a refresher on MIS-C, see Episode #5 with Dr. Tremoulet! MIS-C tends to have more frequent follow-up due to their severe myocardial dysfunction.
Listeners will explain the basic pathophysiology, clinical presentation, diagnosis, and management of Kawasaki Disease to improve both inpatient care and outpatient follow-up.
After listening to this episode listeners will…
Dr. Tremoulet reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures.
Lee N, Tremoulet A, Chui C, Berk J. “#16: Kawasaki Disease: Don’t Be Rash, Make the Diagnosis!”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ January 6, 2020.
The Cribsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit cribsiders.vcuhealth.org and search for this episode to claim credit.
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Great podcast/review. Question for Dr. Tremoulet - has colchicine been considered/studied as a second line therapy for KD?