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Kawasaki Disease: Sensitivity and Specificity

Introduction: Kawasaki disease is a difficult disease to diagnose. The diagnosis relies on a constellation of symptoms.

[The following is taken from review article by Burns and Glode cited below]

The diagnosis is confirmed by the presence of fever for at least 5 days and of four of the five criteria below, and by the lack of another known disease process to explain the illness.

  • Bilateral conjunctival injection
  • Changes of the mucous membranes of the upper respiratory tract: injected pharynx; injected, fissured lips; strawberry tongue
  • Polymorphous rash
  • Changes of the extremities: peripheral oedema, peripheral erythema, periungual desquamation
  • Cervical adenopathy
  • The following is a review article on Kawasaki disease that includes an extensive differential diagnosis for each of the important symptoms in the constellation of findings that define Kawasaki disease: Burns JC, Glodé MP. "Kawasaki syndrome." 1: Lancet. 2004 Aug 7-13;364(9433):533-44. PMID: 18387169

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    Tags: Autoimmune Pediatrics Vasculitis Tag this Diagnosis.

    Differential Diagnoses include: Acute Streptococcal Pharyngitis

    The sensitivity and specificity of findings for Kawasaki Disease are listed below. See the left navigation bar to change the display.

    Specific Findings

    Finding SensitivitySpecificity Comments, Study
    Elevated ALT Edit 18.1%100%

    >100 U/l

    Study: J Pediatr 1991 May;118(5):680-6. PMID 2019921

    Anemia Edit 29.2%93.1%

    Hb < -3 S.D. for age

    Study: J Pediatr 1991 May;118(5):680-6. PMID 2019921

    Anemia and Elevated ESR Edit 54.4%92.3%

    Hb < -2 S.D. for age, ESR > 50mm/hr

    Study: J Pediatr 1991 May;118(5):680-6. PMID 2019921

    Residence near Water Edit 41.1%85.7%

    within 200 yards

    Study: J Pediatr 1991 May;118(5):680-6. PMID 2019921

    Sensitive Findings

    Finding SensitivitySpecificity Comments, Study
    Clinical Criteria Edit 90%54%

    as above, fever for 5 days plus at least 4/5:

  • Bilateral conjunctival injection
  • Changes of the mucous membranes of the upper respiratory tract: injected pharynx; injected, fissured lips; strawberry tongue
  • Polymorphous rash
  • Changes of the extremities: peripheral oedema, peripheral erythema, periungual desquamation
  • Cervical adenopathy
  • Mimics (from the J Peds article) include measles and group A Strep

    Differential Diagnosis: Acute Streptococcal Pharyngitis

    Study: sens: Acta Paediatr 1994 Oct;83(10):1057-60. PMID 7841704

    spec: J Pediatr 1991 May;118(5):680-6. PMID 2019921

    Poorly Diagnostic Findings

    Finding SensitivitySpecificity Comments, Study
    Elevated ESR Edit 59.8%82.8%

    >60 mm/hr

    Study: J Pediatr 1991 May;118(5):680-6. PMID 2019921