Revision of Diagnostic Guideline of Kawasaki Disease

Diagnostic guideline of Kawasaki Disease has not been revised since 1984. There has been several progressions during these years concerning management of Kawasaki disease. So a subcommittee for the revision of the diagnostic guideline was organized in the Kawasaki Disease Research Committee to meet the present situation. A draft of new diagnostic guideline was made this year and the final revision will be published next year. Major alterations in this new daft are summarized as follows:1. Cases with 4 or less febrile days shortened by early IVIG treatment were proposed to be equivalent to cases with 5 or more febrile days in the previous criteria. The reason is that many experienced pediatricians have made a diagnosis of Kawasaki disease for the cases even before the 5th febrile day when there were other principal symptoms of Kawasaki Disease. The latest 16th Japanese nationwide surveillance has shown that approximately 10% of patients (total 12,829) started to receive IVGG treatment on or before the 3rd day of illness and 30% of them before 4th day. And also some cases became afebrile before the 5th febrile day when single high dose IVIG was given. 2. The clinical importance of atypical (incomplete) cases is emphasized in the new diagnostic guideline since even atypical cases often developed coronary artery abnormalities and also the incidence of coronary artery abnormality is not significantly different between typical cases and them. 3. The order of 6 principal symptoms of Kawasaki disease was rearranged from head to toe (except for fever and cervical lymphadenopathy) to remember easily: 1. Fever, 2.Conjunctiva congestion, 3.Changes of lips and oral cavity, 4. Rash, 5.Changes of extremities, 6. Cervical lymphadenopathy.