LYCOS RETRIEVER 
Kawasaki Disease: Fevers
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Due to the findings of high fever and enlarged lymph glands, Kawasaki Disease is thought to be an inflammatory process. Because the inflammation often involves the blood vessels of the body, Kawasaki Diseaseis felt to be a vasculitis (an inflammation of a blood vessel).The cause of this inflammatory response is not known.
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The course of Kawasaki disease can be divided into three clinical phases: acute, subacute and convalescent. The acute febrile phase usually lasts seven to 14 days. This phase, which ends with the resolution of fever, is characterized by conjunctival injection, mouth and lip changes, swelling and erythema of the hands and feet, rash and cervical lymphadenopathy (Figures 1, 2 and 3).27 The subacute phase covers the period from the end of the fever to about day 25. During this phase, patients may have desquamation of the fingers and toes (Figure 4),27 arthritis and arthralgia, and thrombocytosis. The convalescent phase begins when clinical signs disappear and continues until the erythrocyte sedimentation rate becomes normal, usually six to eight weeks after the onset of illness.
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In order to confirm the diagnosis of Kawasaki disease there should be at least five days of fever, unexplained by any other known disease. Other infectious diseases that can be confused with Kawasaki disease include: Streptococcal pharyngitis, viral pharyngitis, scarlet fever, Rocky mountain spotted fever, mononucleosis, and toxic shock syndrome. A drug reaction can ... present with similar findings. Although Kawasaki disease is generally benign and self-limited, it is associated with coronary artery aneurysms in 17 to 31 percent of cases. These complications generally occur in the third to fourth week of illness. Apart from the up to 2.8% of patients who develop fatal complications, the prognosis of this disease for uneventful recovery is excellent.
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Typical Kawasaki disease has a well-characterized clinical course. The case definition requires the presence of fever greater than 101ºF for at least five days in association with at least four of the following signs: 1) bilateral bulbar conjunctival infection, 2) inflammatory changes of the lips (erythema, dryness, fissuring, peeling, cracking, bleeding) and mouth (“strawberry tongue” and diffuse erythema of the oral mucosa and pharynx), 3) generalized polymorphous rash, 4) bilateral redness and swelling of the hands and feet; and 5) cervical adenopathy with at least one node enlarged to more than 1.5 cm in diameter. The first four types of findings each occur in 80% of cases while lymphadenopathy occurs in 50% to 75%. Fever often precedes other signs, which may appear stepwise over several days. [1,12,13]
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Kawasaki disease is an illness that causes inflammation of the blood vessels in the whole body. While its symptoms can mimic many infectious and non-infectious diseases, such as scarlet fever, toxic shock syndrome and measels, it was first recognized as a separate illness in 1967 by Dr. Tomisaku Kawasaki, a Japanese pediatrician. Characterized by the following symptoms: fever; rash; swelling of the hands and feet; redness of the whites of the eyes; irritation and infammation of the lips, mouth and throat and swollen lymph nodes in the neck; the immediate effects of the disease are rarely serious... in some cases long-term heart complications may result.
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The Kawasaki disease criteria can be met by many other diseases. The most common processes that mimic Kawasaki disease are viral infections with exanthems (especially adenovirus and measles), acute streptococcal and staphylococcal infections, and drug hypersensitivity reactions. In adenovirus infections, conjunctivitis and pharyngitis usually are exudative, and perineal prominence of rash and distal extremity changes are unusual. Rocky Mountain Spotted fever, infectious mononucleosis and leptospirosis can have presentations suggestive of Kawasaki disease. [1,15]
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