Archives of Pediatric Infectious Diseases

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Kawasaki Disease; A Review Article

Reza Shiari 1 , *
Author Information
1 Department of Pediatric Rheumatology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Article information
  • Archives of Pediatric Infectious Diseases: January 01, 2014, 2 (1); 154-159
  • Published Online: July 13, 2013
  • Article Type: Review Article
  • Received: April 26, 2013
  • Revised: June 19, 2013
  • Accepted: July 3, 2013
  • DOI: 10.5812/pedinfect.11628

To Cite: Shiari R. Kawasaki Disease; A Review Article, Arch Pediatr Infect Dis. 2014 ; 2(1):154-159. doi: 10.5812/pedinfect.11628.

Copyright © 2013, Pediartric Infections Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction and History
2. Etiology
3. Clinical Manifestations of KD
4. Laboratory Findings
5. Management
6. Incomplete and Atypical KD
7. Treatment
8. Treatment of Resistant KD
9. Another Treatment Decision
10. Long-term Management and Follow-up of KD
11. Conclusion
  • 1. Yanagawa H, Nakamura Y, Ojima T, Yashiro M, Tanihara S, Oki I. Changes in epidemic patterns of Kawasaki disease in Japan. Pediatr Infect Dis J. 1999; 18(1): 64-6[PubMed]
  • 2. Kawasaki T. [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children]. Arerugi. 1967; 16(3): 178-222[PubMed]
  • 3. Yamamoto T, Kimura J. [Acute febrile mucocutaneous lymph node syndrome (Kawasaki): subtype of mucocutaneous ocular syndrome of erythema multiforme complicated with carditis]. . Jpn J Pediatr. 1968; 21: 336–9
  • 4. Shigematsu I. [Epidemiology of mucocutaneous lymph node syndrome]. J Jpn Pediatr Soc 1972; 76: 695–6
  • 5. Nakamura Y, Yanagawa H. The worldwide epidemiology of Kawasaki disease. Prog Pediatr Cardiol. 2004; 19: 99–108
  • 6. Yeung RS. Kawasaki disease: update on pathogenesis. Curr Opin Rheumatol. 2010; 22(5): 551-60[DOI][PubMed]
  • 7. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. 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. Circulation. 2004; 110(17): 2747-71[DOI][PubMed]
  • 8. Nigro G, Zerbini M, Krzysztofiak A, Gentilomi G, Porcaro MA, Mango T, et al. Active or recent parvovirus B19 infection in children with Kawasaki disease. Lancet. 1994; 343(8908): 1260-1[PubMed]
  • 9. Leung DY, Meissner HC, Fulton DR, Murray DL, Kotzin BL, Schlievert PM. Toxic shock syndrome toxin-secreting Staphylococcus aureus in Kawasaki syndrome. Lancet. 1993; 342(8884): 1385-8[PubMed]
  • 10. Kikuta H, Sakiyama Y, Matsumoto S, Hamada I, Yazaki M, Iwaki T, et al. Detection of Epstein-Barr virus DNA in cardiac and aortic tissues from chronic, active Epstein-Barr virus infection associated with Kawasaki disease-like coronary artery aneurysms. J Pediatr. 1993; 123(1): 90-2[PubMed]
  • 11. Normann E, Naas J, Gnarpe J, Backman H, Gnarpe H. Demonstration of Chlamydia pneumoniae in cardiovascular tissues from children with Kawasaki disease. Pediatr Infect Dis J. 1999; 18(1): 72-3[PubMed]
  • 12. Hsu YH, Wang YH, Hsu WY, Lee YP. Kawasaki disease characterized by erythema and induration at the Bacillus Calmette-Guerin and purified protein derivative inoculation sites. Pediatr Infect Dis J. 1987; 6(6): 576-8[PubMed]
  • 13. Uehara R, Yashiro M, Nakamura Y, Yanagawa H. Kawasaki disease in parents and children. Acta Paediatr. 2003; 92(6): 694-7[PubMed]
  • 14. Mojtahedzadeh s, Saket S, Shiari R, Shirvani F, Karimi A. [The relationship between history of ischemic heart disease in parents of children with Kawasaki Disease with severity of heart complications and disease recurrence in these children]. Yafte. 2011; 12(4): 61-6
  • 15. Lang B. Recognizing Kawasaki disease. Paediatr Child Health. 2001; 6(9): 638-43[PubMed]
  • 16. Friter BS, Lucky AW. The perineal eruption of Kawasaki syndrome. Arch Dermatol. 1988; 124(12): 1805-10[PubMed]
  • 17. Yoskovitch A, Tewfik TL, Duffy CM, Moroz B. Head and neck manifestations of Kawasaki disease. Int J Pediatr Otorhinolaryngol. 2000; 52(2): 123-9[PubMed]
  • 18. Berard R, Scuccimarri R, Chedeville G. Leukonychia striata in Kawasaki disease. J Pediatr. 2008; 152(6): 889[DOI][PubMed]
  • 19. Kuniyuki S, Asada M. An ulcerated lesion at the BCG vaccination site during the course of Kawasaki disease. J Am Acad Dermatol. 1997; 37(2 Pt 2): 303-4[PubMed]
  • 20. Shiari R. Neurologic Manifestations of Childhood Rheumatic Diseases. Iran J Child Neurol. 2012; 6(4): 1-7
  • 21. Mason WH, Takahashi M. Kawasaki syndrome. Clin Infect Dis. 1999; 28(2): 169-85[DOI][PubMed]
  • 22. Halimiasl A, Hosseini AH, Shiari R, Ghadamli P, Mojtahedzadeh S. Concomitant Coronary Artery Aneurysm and Myocarditis as a Rare Manifestation of Kawasaki Disease: A Case Report. J Compr Ped. 2012; 3(1): 34-6
  • 23. Rowe PC, Quinlan A, Luke BK. Value of degenerative change in neutrophils as a diagnostic test for Kawasaki syndrome. J Pediatr. 1991; 119(3): 370-4[PubMed]
  • 24. Saket S, Mojtahedzadeh S, Karimi A, Shiari R, Shirvani F. [Relationship between electrolyte abnormalities, ESR, CRP and platelet count with severity of Kawasaki disease]. Yafte. 2009; 11(3): 5-14
  • 25. Latino GA, Manlhiot C, Yeung RS, Chahal N, McCrindle BW. Macrophage activation syndrome in the acute phase of Kawasaki disease. J Pediatr Hematol Oncol. 2010; 32(7): 527-31[DOI][PubMed]
  • 26. Mansour Ghnaee R, Shiari R, Karimi A, Armin S, Fa-himzad A, Shiva F, et al. A case series report of Iranian children; Hemophagocytic Lymphohistiocytosis syndrome. Arch Pediatr Infect. 2012; 1(1): 31-5
  • 27. Sato YZ, Molkara DP, Daniels LB, Tremoulet AH, Shimizu C, Kanegaye JT, et al. Cardiovascular biomarkers in acute Kawasaki disease. Int J Cardiol. 2013; 164(1): 58-63[DOI][PubMed]
  • 28. Dahdah N, Siles A, Fournier A, Cousineau J, Delvin E, Saint-Cyr C, et al. Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol. 2009; 30(6): 810-7[DOI][PubMed]
  • 29. Kato H. Cardiovascular involvement in Kawasaki disease: evaluation and natural history. Prog Clin Biol Res. 1987; 250: 277-86[PubMed]
  • 30. Fujiwara H, Hamashima Y. Pathology of the heart in Kawasaki disease. Pediatrics. 1978; 61(1): 100-7[PubMed]
  • 31. Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation. 1993; 87(5): 1776-80[PubMed]
  • 32. Capannari TE, Daniels SR, Meyer RA, Schwartz DC, Kaplan S. Sensitivity, specificity and predictive value of two-dimensional echocardiography in detecting coronary artery aneurysms in patients with Kawasaki disease. J Am Coll Cardiol. 1986; 7(2): 355-60[PubMed]
  • 33. Foster BJ, Bernard C, Drummond KN. Kawasaki disease complicated by renal artery stenosis. Arch Dis Child. 2000; 83(3): 253-5[PubMed]
  • 34. Newburger JW. Kawasaki disease: who is at risk? J Pediatr. 2000; 137(2): 149-52[DOI][PubMed]
  • 35. Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, et al. Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int. 2007; 49(4): 421–6
  • 36. Chang FY, Hwang B, Chen SJ, Lee PC, Meng CC, Lu JH. Characteristics of Kawasaki disease in infants younger than 6 months of age. Pediatr Infect Dis J. 2006; 25(3): 241–4
  • 37. Gordon DJ, Sloan SR, de Jong JL. A pediatric case series of acute hemolysis after administration of intravenous immunoglobulin. Am J Hematol . 2009; 84(771–2)
  • 38. Lang B, Duffy CM. Controversies in the management of Kawasaki disease. Best Pract Res Clin Rheumatol. 2002; 16(3): 427–42
  • 39. Muta H, Ishii M, Egami K, Furui J, Sugahara Y, Akagi T, et al. Early intravenous gamma-globulin treatment for Kawasaki disease: the nationwide surveys in Japan. J Pediatr. 2004; 144(4): 496-9
  • 40. Freeman AF, Shulman ST. Refractory Kawasaki disease. Pediatr Infect Dis J . 2004; 23(5): 463–4
  • 41. Wooditch AC, Aronoff SC. Effect of initial corticosteroid therapy on coronary artery aneurysm formation in Kawasaki disease: a meta-analysis of 862 children. Pediatrics. 2005; 116(4): 989–95
  • 42. Mori M, Imagawa T, Katakura S, Miyamae T, Okuyama K, Ito S, et al. Efficacy of plasma exchange therapy for Kawasaki disease intractable to intravenous gamma-globulin. Mod Rheumatol. 2004; 14(1): 43-7
  • 43. McCandless RT, Minich LL, Tani LY, Williams RV. Does abciximab promote coronary artery remodeling in patients with Kawasaki disease? Am J Cardiol. 2010; 105(11): 1625-8
  • 44. Burns JC, Best BM, Mejias A, Mahony L, Fixler DE, Jafri HS, et al. Infliximab treatment of intravenous immunoglobulin-resistant Kawasaki disease. J Pediatr. 2008; 153(6): 833–8
  • 45. Burns JC, Mason WH, Hauger SB, Janai H, Bastian JF, Wohrley JD, et al. Infliximab treatment for refractory Kawasaki syndrome. J Pediatr. 2005; 146(5): 662–7
  • 46. Raman V, Kim J, Sharkey A, Chatila T. Response of refractory Kawasaki disease to pulse steroid and cyclosporine A therapy. Pediatr Infect Dis J. 2001; 20(6): 635–7
  • 47. Ahn SY, Kim DS. Treatment of intravenous immunoglobulin-resistant Kawasaki disease with methotrexate. Scand J Rheumatol. 2005; 34(2): 136–9
  • 48. Wallace CA, French JW, Kahn SJ. Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics. 2000; 105
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