Most cases of Kawasaki begins with the onset of prolonged fever as the children are brought for medical care after unrelenting fever. For cases to be definitively diagnosed, the fever is expected to have at least lasted for 5 days before medical reporting.

In affected children, there is a higher case of irritability than should be expected of fever of the magnitude often presnted. The fever may continue in the midst of antibiotic therapy for other conditions suspected earlier.

Many parents often suggest an abrupt onset of the fever symptoms. Some non-specific symptoms follow the onset of fever [7]. In order of decreasing frequency, the symptoms that have been noted in the past include the following:

• Irritability
• Vomiting
• Decreased oral intake
• Cough
• Diarrhea
• Rhinorrhea
• Weakness
• Abdominal pain
• Joint pain

• Cervical Lymphadenopathy

  Twenty‐nine of the 136 patients initially presented with only cervical lymphadenopathy and fever and were classified into the lymphadenopathy‐KD (LKD); they were compared with the remaining 107 KD patients with other presentations (other‐KD). [doi.org]

  Incomplete Kawasaki disease may therefore be characterized by a less frequent association of rash, cervical lymphadenopathy and coronary involvement. [ncbi.nlm.nih.gov]

• Fever

  Kawasaki disease often begins with a fever of 102°F (38.9°C) or higher that does not go away. The fever is often as high as 104°F (40°C). A fever lasting at least 5 days is a common sign of the disorder. The fever may last for up to 2 weeks. [medlineplus.gov]

  Only 15% of patients have persistent fever (fever lasting beyond 36 hours after the end of the IVIG infusion) or have recrudescent fever. Patients with persistent or recrudescent fever need additional therapy. [clinicaladvisor.com]

  Most cases of Kawasaki begins with the onset of prolonged fever as the children are brought for medical care after unrelenting fever. [symptoma.com]

  Incomplete (atypical) Kawasaki disease occurs in persons with fever lasting five or more days and with two or three of these findings. [aafp.org]

  Symptoms Kawasaki disease often begins with a fever of 102°F (38.9°C) or higher that does not go away. The fever is often as high as 104°F (40°C). A fever lasting at least 5 days is a common sign of the disorder. [mountsinai.org]

• Anemia

  The hyperinflammatory condition associated with Kawasaki disease may have contributed to the severity of anemia. [ncbi.nlm.nih.gov]

  Moreover, overt bleeding and anemia are associated with the use of aspirin, and anemia is common in patients with KD. [doi.org]

• Congestive Heart Failure

  Congestive heart failure rapidly developed and double valve replacement was performed. Pathologic study of the excised valve tissue disclosed active valvulitis. [ncbi.nlm.nih.gov]

  Kawasaki disease occasionally causes inflammation of the heart muscle (myocarditis) or weakening of the heart muscle (cardiomyopathy) or decreases the heart's ability to pump blood (congestive heart failure). [cnn.com]

  heart failure, diabetes mellitus, myasthenia gravis, hypothyroidism, liver cirrhosis, primary adrenocortical insufficiency or adrenocortical hyperfunction, central serous chorioretinopathy. [clinicaltrials.gov]

  Three patients had other complications; two patients (one in each treatment group) had generalized edema without congestive heart failure, and one (in the single-infusion group) had nasal congestion, cough, and nausea of acute onset early in the course [doi.org]

• Edema of the Hand

  […] of the hands and feet, and swollen lymph nodes in the neck Kawasaki disease affects children of all ethnic backgrounds throughout the world, although susceptibility is shaped by genetic influences. [merriam-webster.com]

  Table 1 Timeline of Case 1 On examination, she was alert, had dry, red lips and non pitting edema on her hands and feet. She had cervical nodes measuring about 0.5 cm. Her cardiovascular exam was normal. [bmcpediatr.biomedcentral.com]

  The patient developed arthritis on his fists, elbows, knees, and ankles, edema and desquamation of the hands and feet, which prevented him from walking. [jped.com.br]

• Edema of the Hands and Feet

  […] of the hands and feet, and swollen lymph nodes in the neck Kawasaki disease affects children of all ethnic backgrounds throughout the world, although susceptibility is shaped by genetic influences. [merriam-webster.com]

  Table 1 Timeline of Case 1 On examination, she was alert, had dry, red lips and non pitting edema on her hands and feet. She had cervical nodes measuring about 0.5 cm. Her cardiovascular exam was normal. [bmcpediatr.biomedcentral.com]

  The patient developed arthritis on his fists, elbows, knees, and ankles, edema and desquamation of the hands and feet, which prevented him from walking. [jped.com.br]

• Abdominal Pain

  Progressive bowel oedema was detected in the patient presenting with severe abdominal pain and distension. [ncbi.nlm.nih.gov]

• Abdominal Cramps

  Sometimes, children have abdominal cramps. After a few days, they also get a rash that can appear anywhere. The rash does not have a specific pattern and may only last a short while. [medbroadcast.com]

• Tachycardia

  We report the case of a 41-year-old man with symptomatic and haemodynamically unstable ventricular tachycardia in whom substrate ablation was performed for the ventricular tachycardia before insertion of an implantable cardioverter-defibrillator. [ncbi.nlm.nih.gov]

  Symptoms High-grade fever, strawberry tongue, anterior uveitis, tachycardia, irritability. Mortality Rate 1 % without treatment, less than 0.01 % with treatment. [house.wikia.com]

• Vascular Disease

  The TM C1418T (rs1042579) polymorphism is associated with a high risk of cardiac-cerebral vascular diseases. [ncbi.nlm.nih.gov]

  […] title=Category:Kawasaki_disease&oldid=356462833" Categories: Vascular diseases Autoimmune diseases and disorders Connective tissue diseases with dermal involvement Diseases and disorders named after people Paediatric pathology Non-topical/index: Uses [commons.wikimedia.org]

  Before cataract surgery is planned, active scleritis associated with collagen vascular diseases such as rheumatoid arthritis should be controlled with oral steroid and/or antimetabolite therapy so that the risk of scleral or corneal necrosis is reduced [aao.org]

  Kei Takahashi, Toshiaki Oharaseki, Yuki Yokouchi, Nobuyuki Hiruta and Shiro Naoe, Kawasaki Disease as a Systemic Vasculitis in Childhood, Annals of Vascular Diseases, 3, 3, (173), (2010). [doi.org]

• Hypertension

  Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001 ; 37 : 1236–1241. [doi.org]

  IVMP was well tolerated; transient hypertension developed in one child, but it did not require treatment. [ncbi.nlm.nih.gov]

  […] tuberculosis, such as family member with TB or taking INH Untreated Lyme disease Severe comorbidities (diabetes mellitus requiring insulin, CHF of any severity, MI, CVA or TIA within 3 months of screening visit, unstable angina pectoris, uncontrolled hypertension [clinicaltrials.gov]

• Strawberry Tongue

  Symptoms High-grade fever, strawberry tongue, anterior uveitis, tachycardia, irritability. Mortality Rate 1 % without treatment, less than 0.01 % with treatment. [house.wikia.com]

  Persistent fever Swollen fingers/toes Cracked lips / Strawberry tongue Bloodshot eyes Rash Swollen glands Find out more about Kawasaki Disease [societi.org.uk]

  Clinically, it is characterised by fever, polymorphic rash, conjunctivitis, mucosal erythema with strawberry tongue, induration of the hands and feet, and unilateral cervical lymphadenopathy. [bestpractice.bmj.com]

  Other symptoms include: Rash, often in the torso and genital areas Eye inflammation or conjunctivitis without discharge Swelling and redness of the hands and feet followed by peeling of the skin on the fingers and toes Red, chapped lips "Strawberry tongue [ucsfchildrenshospital.org]

  Within KD, oral mucositis - represented by diffuse mucous membrane erythema, lip and tongue reddening and lingual papillae hypertrophy with subsequent development of strawberry tongue - can occur both in the acute stage of the disease (0-9 days), and [ncbi.nlm.nih.gov]

• Cracked Lips

  The cracking lips are a classic sign of the disease. He also has a slight rash over his face, arms, and legs. Red Cracked Lips from Kawasaki Disease. Kawasaki causes very red lips that tend to crack and peel. [newhealthadvisor.com]

  Symptoms include high fever swollen lymph nodes in the neck a rash on the mid-section and genital area red, dry, cracked lips and a red, swollen tongue red, swollen palms of the hands and soles of the feet redness of the eyes kawasaki disease can't be [icd9data.com]

  Until the appearance of red cracked lips, a diagnosis of IKD was considered. A rise in periungual desquamation of the hands confirmed the diagnosis. Intravenous immunoglobulins were administered and aspirin and dipyridamole were used orally. [ncbi.nlm.nih.gov]

  Persistent fever Swollen fingers/toes Cracked lips / Strawberry tongue Bloodshot eyes Rash Swollen glands Find out more about Kawasaki Disease [societi.org.uk]

  The most common symptoms include prolonged fever, rash, bloodshot eyes, red cracked lips and tongue, and lymph node swelling. The exact cause of KD is unknown. The symptoms of KD often go away on their own, and the child recovers. [rheumatology.org]

• Tonsillar Exudate

  Photophobia and eye pain are seldom present erythema of oral and/or pharyngeal mucosa – may include strawberry tongue, red pharynx and/or red and cracked lips, but no tonsillar exudates or ulcers erythema and oedema of hands and feet – this is a common [racgp.org.au]

• Conjunctival Injection

  She presented with bulbar conjunctival injection, diarrhea, skin erythema, and redness around the bacillus Calmette-Guerin (BCG) inoculation site. [ncbi.nlm.nih.gov]

• Arthritis

  Key words Kawasaki Disease adult coronary artery aneurysms vasculitis adenopathy arthritis mucocutaneous lymph node syndrome This is a preview of subscription content, log in to check access. [doi.org]

  ( Septic arthritis, Reactive arthritis, Rheumatoid arthritis, Psoriatic arthritis, Felty's syndrome, Juvenile idiopathic arthritis, Still's disease ) - crystal ( Gout, Chondrocalcinosis ) - Osteoarthritis ( Heberden's node, Bouchard's nodes ) acquired [wikidoc.org]

  Musculoskeletal - arthritis, arthralgia. Others - anterior uveitis, BCG-site inflammation.[7] Differential diagnosis Measles. Rubella. Infectious mononucleosis. Enteroviruses. Parvovirus B19 infection. [patient.info]

  The other possibility is that this was a case of an evolving systemic juvenile idiopathic arthritis (SJIA), given the less than 6 week presentation, with fever, arthritis, rash and a positive lab workup. [casesjournal.biomedcentral.com]

  […] osteomyelitis Sarcoidosis Sarcoidose Saturnine gout Saturnine gigt Scheuermann's osteochondritis Scheuermanns osteochondritis Scleroderma Sklerodermi Septic arthritis Septisk arthritis Seronegative arthritis Seronegative gigt Shigella arthritis Shigella [k10.dk]

• Arthralgia

  However, his fever and arthralgia persisted. He was administered single 5 mg/kg doses of IFX. He became afebrile the next day and his arthralgia improved. [ncbi.nlm.nih.gov]

  Associated features were lymphadenopathy, pyuria, aseptic meningitis, diarrhea, arthritis, and arthralgia. Although usually a self-limited illness, one patient died with massive coronary artery thrombosis on the 19th day of illness. [doi.org]

• Skin Rash

  It affects young children who usually present with persistent high fever, redness of the mucous membranes of the mouth, redness of the palms and soles, skin rashes, lymphadenitis, and joint pain and swelling An acute, febrile, mucocutaneous condition [icd9data.com]

  This report describes a 7-year-old boy with KD shock syndrome (KDSS) who presented with persistent fever, injected conjunctiva, a polymorphic skin rash, echocardiography indicating coronary artery dilatation, and shock. [ncbi.nlm.nih.gov]

  Original Paper First Online: 12 July 2005 Abstract We report the association of painful pustulo-vesicular skin rash with Kawasaki disease. [doi.org]

• Rash of the Hands and Feet

  Symptoms include high fever swollen lymph nodes in the neck a rash on the mid-section and genital area red, dry, cracked lips and a red, swollen tongue red, swollen palms of the hands and soles of the feet redness of the eyes kawasaki disease can't be [icd9data.com]

  Making the Diagnosis To be diagnosed with Kawasaki disease, a child must have a fever lasting at least 5 days, along with 4 of the following symptoms: rash red, swollen hands or feet changes in the lips (dry, cracked) or mouth ( strawberry tongue ) reddened [medbroadcast.com]

  Symptoms include High fever that lasts longer than 5 days Swollen lymph nodes in the neck A rash on the mid-section and genital area Red, dry, cracked lips and a red, swollen tongue Red, swollen palms of the hands and soles of the feet Redness of the [fpnotebook.com]

• Palpable Purpura

  Palpable purpura is manifested in 46% of the patients at the time the disease is presented and about 90% of the patients have positive ANCA in serum 3,4,6,11. [web.archive.org]

• Photosensitivity

  Typical symptoms include intermittent itching; burning; a gritty, pulling, or foreign body sensation; and photosensitivity. [merckmanuals.com]

  There are both photosensitive and nonphotosensitive forms of the disorder. TTD patients have not been reported to have a predisposition to cancer (summary by Faghri et al., 2008). [ncbi.nlm.nih.gov]

• Eczema

  […] associations of Kawasaki disease with antecedent respiratory illness and exposure to carpet-cleaning fluids have not been consistently confirmed. 12,13,27–30 Other factors that are reportedly associated with Kawasaki disease include having preexisting eczema [circ.ahajournals.org]

• Irritability

  The first signs of Kawasaki disease include fever and irritability. In most patients, the fever comes on rapidly and is higher than 101.3° F. [ucsfchildrenshospital.org]

  This fever can be accompanied by irritability. [house.wikia.com]

  A previously healthy full term 15 day old Caucasian male with an unremarkable antenatal and perinatal history, presented on Day 2 of illness with fever, rash, irritability, and poor feeding. [ncbi.nlm.nih.gov]

  Clinical signs include fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips, and throat. [cdc.gov]

  The symptoms of Kawasaki disease include... fever rash swollen hands and feet irritation and redness of the whites of the eyes swollen lymph glands in the neck irritation and inflammation of the mouth, lips and throat Doctors don't know what causes Kawasaki [web.archive.org]

• Lethargy

  Although most patients had irritability or lethargy, none of them had significant neurological symptoms or signs during the acute phase, except one who showed neck stiffness. [ncbi.nlm.nih.gov]

  There can be fever, lethargy, breathing difficulty, vomiting and diarrhea. Patients also usually have a red skin rash, swollen lymph nodes and inflammation of the inside surfaces of the mouth and the conjunctiva of the eyes. [cnn.com]

  Symptoms and Signs The illness tends to progress in stages, beginning with fever lasting at least 5 days, usually remittent and > 39 ° C, associated with irritability, occasional lethargy, or intermittent colicky abdominal pain. [web.archive.org]

  Symptoms and Signs The illness tends to progress in stages, beginning with fever lasting at least 5 days, usually unremittent and > 39 ° C (about 102.2° F), and is associated with irritability, occasional lethargy, or intermittent colicky abdominal pain [merck.com]

• Seizure

  This indicated acute encephalopathy with biphasic seizures and late reduced diffusion (AESD); severe neurological sequelae remained. This is the first report of AESD as a complication of KD. [ncbi.nlm.nih.gov]

  There is no evidence that links Kawasaki Disease with autism or a seizure disorder. [kawasakikidsfoundation.org]

• Neurologic Manifestation

  Approximately 25% of affected individuals have neurologic manifestations (acquired microcephaly, diminished or absent deep tendon stretch reflexes, progressive sensorineural hearing loss, and progressive cognitive impairment). [ncbi.nlm.nih.gov]

  PubMed Abstract Steinlin M, Blaser S, Gilday D: Neurological manifestations of paediatric systemic lupus erythematous. Pediatric Neurology 1995, 13 : 191-7. [web.archive.org]

  View Article PubMed Google Scholar Steinlin M, Blaser S, Gilday D: Neurological manifestations of paediatric systemic lupus erythematous. Pediatric Neurology. 1995, 13: 191-7. 10.1016/0887-8994(95)00110-2. [biomedcentral.com]

There are no specific laboratory tests for diagnosing the Kawasaki disease. However, diagnosis is dependent on the occurrence of certain abnormalities commonly seen at various stages of the disease. At first, acute-phase reactants (ie, C-reactive protein levels (CRP) erythrocyte sedimentation rate (ESR), and alpha1-antitrypsin levels) are often elevated. They often return to baseline between 6 and 10 weeks after the onset of the illness [8].

In the acute stage of the disease, mild-to-moderate normochromic anaemia is seen following complete blood counts (CBCs).

• Pericardial Effusion

  The presence of early desquamating perineal erythema led to the consideration of KD diagnosis, confirmed by the echocardiographic assessment of right and left coronary artery dilatations with pericardial effusion on the fifth day of hospital stay. [ncbi.nlm.nih.gov]

  Abnormal findings are non-specific and include a reticulogranular pattern, peribronchial cuffing, pleural effusion, atelectasis and/or air trapping 1. [radiopaedia.org]

  Echo may show pericardial effusion, LV dilation, mitral insufficiency and/or decreased systolic function. Follow up echo should be done in 3-5 weeks. [utmb.edu]

• Pyuria

  Associated features were lymphadenopathy, pyuria, aseptic meningitis, diarrhea, arthritis, and arthralgia. Although usually a self-limited illness, one patient died with massive coronary artery thrombosis on the 19th day of illness. [ncbi.nlm.nih.gov]

  […] vomiting, diarrhea, abdominal pain, irritability, cough, rhinorrhea and decreased oral intake. ( Baker 2009 ) Although there is no diagnostic laboratory test, elevated WBC and platelet counts, transaminases, and acute phase reactants, as well as anemia and pyuria [mdcalc.com]

• Thrombocytosis

  The typical laboratory features of Kawasaki disease, such as elevated erythrocyte sedimentation rate, leukocytosis, anemia, positive C-reactive protein and thrombocytosis were also seen in the incomplete cases. [ncbi.nlm.nih.gov]

  […] disease: Acute stage fever that is refractory to antibiotics general malaise and irritability non-exudative conjunctivitis (90%) anterior uveitis (70%) perianal erythema (70%) lymphadenitis (75%) strawberry tongue Subacute stage desquamation of the digits thrombocytosis [radiopaedia.org]

• Echocardiogram Abnormal

  Many (but not all) patients that have coronary artery abnormalities as a result of KD have an abnormal echocardiogram at diagnosis. [clinicaladvisor.com]

  […] clinical trials is as follows: Consultations A cardiologist should be consulted for the following: Assistance with determining the appropriate timing of initial and/or subsequent echocardiographic studies Management of patients with electrocardiogram or echocardiogram [emedicine.medscape.com]

• Left Ventricular Hypertrophy

  ECG may show arrhythmias, decreased voltage, or left ventricular hypertrophy. Echocardiography should detect coronary artery aneurysms, valvular regurgitation, pericarditis, or myocarditis. [web.archive.org]

• Ischemic Changes

  Cardiac catheterization is recommended for patients with angina pains or ischemic changes on a stress test. It may be used as a diagnostic and interventional tool. [utmb.edu]

Children with Kawasaki disease are cared for as inpatients on paediatric/paediatric cardiology units and then put on bed rest. This is as a result of risk of myocardial events [9].

The major foundation of the managing the condition is the use of intravenous immunoglobulin (IVIg) and aspirin to reduce fever, myocardial inflammation and also prevent or reduce cardiac sequelae which is often the major cause of morbidity and mortality associated with this illness.

If treatment is prompt, prognosis is good. There is a dearth of data but in the United States, death is recorded in less than 1% of children infected [6]. In children younger than younger than a year, the death rate is approximately 4%. For those aged 1 year and older, the death rate is approximately less that 1%. On average, the mortality rate in Japan is between 0.1-0.3%. The highest mortality cases are seen 15-45 days after fever kicks in. Till today, there are no cases of adult death as a result of Kawasaki disease.

The etiology of the Kawasaki disease is still unclear. However, immunologic and epidemiologic evidence suggest a causative agent that is infectious [3]. Genetic predisposition and autoimmune reactions are possible etiological factors that have been suggested as well.

Kawasaki disease is believed to have an infectious etiology because there is record of consistence occurrence of epidemics especially in spring and in late winter. The epidemics occur at 3 year intervals and there is a wide geographic spread of the epidemics when they occur. Other causes of suspicion of infectious etiology include adenopathy, eye signs, characteristic fever and the self-limited nature of the disease.

It is also believed that maternal antibodies may provide passive immunity as the condition is unusual among infants younger than 4 months of age. With all the infectious etiology suspicions, epidemiologic data suggests that person-to-person transmission of the disease is very much unlikely.

The highest annual incidence of the Kawasaki disease is seen in Japan with 120-180 cases reported for children aged 5 years and under. The incidence of this condition is on the rise each year in the country [4].

In Europe, surveys show that there is a peak annual incidence of 90 cases for every 100,000 children of Asian descent aged 5 years and below.

Statistical analysis of hospital records in England show an incidence of 8 cases amongst 100,000 children aged 5 and below.

As pointed out above, incidence appears to be variable and local outbreaks occur in winter and spring, while following a three-year cycle. This suggests an infective aetiology.

In the USA, the incidence is 9.1 cases per 100,000 children of white descent and 32.5 cases per 100,000 children of Asian and Pacific Island descent.

Even with the visible mucocutaneous clinical findings that the disease is defined with, the disease is still regarded best as generalised vasculitis involving small arteries and medium sized arteries in some cases. The vascular inflammation seen with the disease is most common in the coronary vessels but the vasculitis is also present in capillaries, small arterioles and the larger arteries.

In the early stages of the Kawasaki disease, the endothelial cells and the vascular media become edematous with the internal elastic lamina remaining intact. 7-9 days after fever kicks in, there is an influx of neutrophils and this is almost immediately followed by a proliferation of immunoglobulin A–producing plasma cells and CD8+ (cytotoxic) lymphocytes [5].

A concomitant progressive increase in the serum platelet count brings about the greatest vascular damage. When the illness progresses to this stage, the risk of death is very significant.

Kawasaki disease can't be prevented.

Kawasaki disease is a self-limiting systemic vasculitis often regarded as idiopathic. It is seen mostly in children between 6 months and 5 years of age [1]. The condition is seen mostly among the general Asian population with China and Japan posting the greater numbers. However, Kawasaki disease has been reported around the world.

A Japanese paediatrician named Tomisaku Kawasaki was the first to describe the case in 1967. The disease was not described until the 1950s so it is thought to be a relatively new disease.

Originally, the condition was regarded as a benign illness that troubles patients suffering from it a great deal but it was discovered later that its complication of the coronary artery aneurysm formation was a major cause of death and significant morbidity [2]. Kawasaki is now the most common cause of heart disease in children, taking over from rheumatic fever. Before the delineation of the disease, cases of it were regarded as periarteritis/polyarteritis nodosa. To reduce its attendant complications, early diagnosis is recommended.

Kawasaki disease is a condition that affects the walls of the medium sized arteries in the body. It also involves the artery that is responsible for supplying blood to the heart muscle. The disease can also affect the skin and the membranes found inside the mouth, throat and nose. 

This condition is rare and is seen in children the most especailly those in Japan or have Asian ancestry. 

The main signs of Kawasaki disease are high fever and peeling of the skin and this can be very frightening for the patient and everyone around them. 

Fortunately, Kawasaki can be treated and most of the time children affected with the condition recover from it without any problems in the future. 

There is no way to prevent the disease but the chances of an individual developing it is very low as long as they don't have any Asian roots. 

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8. Morens DM, Anderson LJ, Hurwitz ES. National surveillance of Kawasaki disease. Pediatrics 1980; 65:21.
9. Huang GY, Ma XJ, Huang M, et al. Epidemiologic pictures of Kawasaki disease in Shanghai from 1998 through 2002. J Epidemiol 2006; 16:9.
10. Baker AL, Lu M, Minich LL, et al. Associated symptoms in the ten days before diagnosis of Kawasaki disease. J Pediatr 2009; 154:592.