Testing & diagnosis for kawasaki disease in children

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Contact the Kawasaki Disease Program

One challenge in diagnosing Kawasaki disease is distinguishing it from other childhood diseases that have similar symptoms, such as some viral infections, including measles, adenovirus, enterovirus and Epstein-Barr virus—as well as illnesses caused by bacterial toxins, such as scarlet fever, toxic shock syndrome or bacterial infection of the lymph nodes in the neck.

A prolonged high fever (at least four days), along with several other symptoms, must be present for your child’s doctor/NP/PA to consider Kawasaki disease as the cause of his illness — and other illnesses need to be ruled out. To arrive at a diagnosis, your child’s doctor will start by taking a full medical history and conducting a thorough physical exam. Diagnostic tests may include:

  • electrocardiogram (ECG or EKG): a test that records the electrical activity of the heart and shows abnormal rhythms (arrhythmias)
  • echocardiogram (cardiac ultrasound): a diagnostic tool that uses sound waves to produce a moving picture of the heart and heart valves in order to: 
    • measure the coronary arteries
    • evaluate the structure and function of the heart muscle and heart valves      
  • complete blood count (CBC): a measurement of the size, number and maturity of blood cells in a specific volume of blood; detects elevation in the numbers of white blood cells, which normally multiply in the presence of infection   
  • erythrocyte sedimentation rate (ESR, “sed rate”) and/or c-reactive protein (CRP): non-specific markers of inflammation in the blood
  • urinalysis: testing of a urine sample for protein, red blood cells or white blood cells; helps rule out other diseases

Observations and lab results that can support a diagnosis of Kawasaki disease include:

  • extreme irritability
  • inflammation of the joints (arthritis)
  • elevated white blood cell count
  • elevated liver function tests
  • signs of inflammation in the blood and urine
  • anemia

Incomplete Kawasaki disease

It is possible to have Kawasaki disease without showing all of these signs. Such cases are called “incomplete” (or atypical) Kawasaki disease. Infants younger than 6 months are most likely to have incomplete Kawasaki disease, and infants have the highest risk for developing coronary artery injury.

Boston Children’s development of interventional catheterization 

You’ll be comforted to know that Boston Children’s pioneered the use of interventional catheterization for many congenital heart defects and is a leader in the use of this procedure. 

Heart surgery at Boston Children’s 

Watch a fascinating webcast of heart surgery at Boston Children’s.

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- Sandra L. Fenwick, President and CEO

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