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Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association Jane W. Newburger, Masato Takahashi, Michael A. Gerber, Michael H. Gewitz, Lloyd Y. Tani, Jane C. Burns, Stanford T. Shulman, Ann F. Bolger,Patricia Ferrieri, Robert S. Baltimore, Walter R. Wilson, Larry M. Baddour, Matthew E. Levison, Thomas J. Pallasch, Donald A. Falace and Kathryn A. Taubert Circulation 2004;110;2747-2771 DOI: 10.1161/01.CIR.0000145143.19711.78
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AHA Scientific Statement
Diagnosis, Treatment, and Long-Term Management ofKawasaki Disease
A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association
Endorsed by the American Academy of Pediatrics
Jane W. Newburger, MD, MPH; Masato Takahashi, MD; Michael A. Gerber, MD; Michael H. Gewitz, MD; Lloyd Y. Tani, MD; Jane C. Burns, MD; Stanford T.Shulman, MD; Ann F. Bolger, MD; Patricia Ferrieri, MD; Robert S. Baltimore, MD; Walter R. Wilson, MD; Larry M. Baddour, MD; Matthew E. Levison, MD; Thomas J. Pallasch, DDS; Donald A. Falace, DMD; Kathryn A. Taubert, PhD
Background—Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oralmucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results—A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasakidisease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for 5 days and 4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those whohave persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor- antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment,and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions—Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The...