Diagnosing Kawasaki disease in children can be challenging as there isn’t one definitive test. Doctors rely on recognizing a combination of specific signs and symptoms to identify this condition.
According to the National Institute for Health and Care Excellence (NICE), Kawasaki disease is suspected when a child experiences a high temperature lasting for five days or more, accompanied by at least one other key symptom.
These key symptoms are critical for diagnosis and include:
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Bilateral Conjunctival Injection: Redness and swelling in both eyes, affecting the whites of the eyes, without any discharge or fluid leaking. This is different from typical “pink eye” where discharge is common.
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Oral Mucosal Changes: Changes in the mouth and throat, such as dry, cracked, and red lips. The tongue may become red and swollen, often referred to as “strawberry tongue.” The inside of the mouth and the back of the throat can also appear red.
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Peripheral Extremity Changes: Changes in the hands and feet. This can manifest as swelling or pain in the hands and feet. Redness or peeling skin on the palms of the hands and soles of the feet is also a significant indicator. Initially, the fingers and toes might become red or feel firm, followed by swelling.
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Rash: The appearance of a rash on the body. The characteristics of the rash can vary.
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Cervical Lymphadenopathy: Swollen lymph nodes in the neck. This is often just one lymph node that is noticeably larger than normal.
It’s important to note that young children under one year old might not present with as many of these classic key symptoms compared to older children, making diagnosis potentially more complex in this age group.
Sometimes, doctors might diagnose Kawasaki disease even if a child has a high temperature with only one key symptom, or if the fever has been present for just four days, especially if other clinical findings are suggestive. Furthermore, the symptoms of Kawasaki disease can sometimes appear and disappear intermittently throughout the course of the illness, which can further complicate diagnosis. It’s crucial to inform the doctor if your child has experienced any of these symptoms recently, even if they are no longer present during the examination.
Diagnostic Tests to Support Kawasaki Disease Diagnosis
While there’s no single definitive test for Kawasaki disease, several tests are used to rule out other conditions and to support the clinical diagnosis.
These tests may include:
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Urine Sample: A urine sample is analyzed to check for the presence of white blood cells, which can indicate inflammation in the body.
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Blood Tests: Various blood tests are crucial. These may include a white blood cell count and a platelet count. Elevated white blood cell counts and platelet counts can be seen in Kawasaki disease, reflecting inflammation. Other blood markers of inflammation might also be assessed.
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Lumbar Puncture: In some cases, a lumbar puncture (spinal tap) might be performed. This involves taking a sample of cerebrospinal fluid to rule out other conditions like meningitis, especially if neurological symptoms are present or if the diagnosis is uncertain.
It’s important to understand that these tests, when considered individually, are not conclusive for Kawasaki disease. However, when the results are combined with the presence of key clinical symptoms, they contribute significantly to confirming the diagnosis.
Assessing Heart Problems in Kawasaki Disease Diagnosis
Kawasaki disease can lead to serious complications, primarily affecting the heart. Therefore, assessing heart health is an integral part of the diagnostic process and ongoing management.
Essential heart assessments include:
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Electrocardiogram (ECG): An ECG records the electrical activity of the heart and can detect abnormalities in heart rhythm or signs of heart muscle strain.
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Echocardiogram (Ultrasound of the Heart): This is a crucial test. An echocardiogram uses sound waves to create images of the heart, allowing doctors to visualize the heart muscle, valves, and coronary arteries.
During the acute phase of Kawasaki disease, typically within the first one to two weeks of illness, echocardiograms may reveal several heart abnormalities. These could include:
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Tachycardia: A rapid heart rate, which is a general sign of illness and stress on the body.
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Pericardial Effusion: Fluid accumulation around the heart.
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Myocarditis: Inflammation of the heart muscle itself.
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Coronary Artery Aneurysms: Swelling or bulging of the coronary arteries. This is the most serious potential heart complication of Kawasaki disease and early diagnosis and treatment are aimed at preventing these aneurysms.
In conclusion, diagnosing Kawasaki disease is a clinical process that relies on recognizing a constellation of symptoms along with supportive laboratory and cardiac investigations. Early recognition and prompt medical intervention are crucial to minimize the risk of heart complications. If you suspect your child has Kawasaki disease, seek immediate medical attention.
