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Kawasaki disease: characteristics, diagnosis, and unusual presentations
Ankur Kumar Jindal1, Rakesh Kumar Pilania1, Ashwini Prithvi1
1Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
Insights
Kawasaki disease (KD) diagnosis relies on clinical signs, as atypical presentations occur in half of patients. Echocardiography is key for cardiac assessment but has limitations in diagnosing this pediatric vasculitis.
Area of Science:
- Pediatric rheumatology
- Cardiology
- Vascular inflammation
Background:
- Kawasaki disease (KD) is a common pediatric vasculitis.
- Untreated KD poses a significant risk for coronary artery abnormalities.
- Diagnosis is challenging due to incomplete and unusual presentations.
Purpose of the Study:
- To review incomplete and unusual presentations of Kawasaki disease.
- To discuss controversies surrounding 2D echocardiography in KD diagnosis and management.
- To highlight the clinical basis of KD diagnosis.
Main Methods:
- Literature review using PubMed.
- Focus on diagnosis and unusual presentations of KD.
- Analysis of clinical features and echocardiographic findings.
Main Results:
- KD diagnosis is primarily clinical, relying on recognizing sequential or incomplete features.
- No definitive laboratory test exists for KD.
- Atypical and incomplete KD forms are observed in up to 50% of cases.
- 2D echocardiography is the standard for cardiac assessment but has limitations.
Conclusions:
- Clinical vigilance is crucial for diagnosing Kawasaki disease, especially atypical forms.
- Limitations in 2D echocardiography necessitate careful interpretation in KD patients.
- Further research may clarify echocardiographic controversies and improve diagnostic accuracy.
Abstract:
Introduction: Kawasaki disease (KD) is one of the commonest pediatric vasculitides and is associated with a significant risk of development of coronary artery abnormalities if left untreated. Areas covered: In this review, we have highlighted the incomplete and unusual presentations of KD and also emphasize the controversies pertaining to 2D echocardiography in KD. A PubMed search was performed regarding diagnosis and unusual presentations of KD. Expert opinion: Diagnosis of KD is essentially clinical and based on recognition of typical clinical features that may appear sequentially and all signs and symptoms may not be present at one point of time. There is no confirmatory laboratory test for diagnosis of this condition. Further complicating the picture is the fact that incomplete and atypical forms KD may be seen in up to 50% patients. Although 2D echocardiography continues to be the preferred imaging modality for cardiac assessment in patients with KD, it has its limitations.
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