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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
French national diagnostic and care protocol for Kawasaki disease
C Galeotti1, F Bajolle2, A Belot3
1Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
Insights
Kawasaki disease (KD) is a critical pediatric vasculitis impacting coronary arteries. Early diagnosis and IVIG plus aspirin treatment significantly improve outcomes, reducing cardiac complications in children.
Area of Science:
- Pediatric Rheumatology
- Cardiology
- Vascular Biology
Background:
- Kawasaki disease (KD) is an acute vasculitis primarily affecting young children, with a predilection for coronary arteries.
- Diagnosis is clinical, relying on American Heart Association criteria, often presenting with prolonged fever and irritability.
- Atypical or incomplete KD forms pose diagnostic challenges, necessitating prompt recognition and management.
Purpose of the Study:
- To summarize the clinical presentation, diagnosis, and management of Kawasaki disease.
- To highlight the importance of early intervention in preventing coronary artery abnormalities.
- To outline treatment strategies and long-term prognosis for affected children.
Main Methods:
- Clinical diagnosis based on American Heart Association criteria, including fever duration and associated symptoms.
- Assessment of biological inflammatory markers to aid diagnosis.
- Review of standard treatment protocols and management of complications.
Main Results:
- Prompt diagnosis and treatment with IVIG and aspirin before 10 days of fever reduce coronary aneurysm risk.
- Most children recover without sequelae, but those with initial coronary involvement require long-term cardiac monitoring.
- Management strategies vary based on coronary involvement, including antiplatelet or anticoagulant therapy.
Conclusions:
- Early recognition and treatment of Kawasaki disease are crucial for favorable outcomes.
- Intravenous immunoglobulin (IVIG) combined with aspirin is the standard of care for KD.
- Long-term cardiological follow-up is essential for children with coronary artery abnormalities secondary to KD.
Abstract:
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
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