Evaluation of suspected incomplete Kawasaki disease Evaluation of suspected incomplete Kawasaki disease. 1In the absence of gold standard for diagnosis, this algorithm cannot be evidence based but rather represents the informed opinion of the expert committee. Consultation with an expert should be sought any time assistance is needed. 2Infants 6 months old or younger on day 7 or more of fever without other explanation should undergo laboratory testing, and if evidence of systemic inflammation is found, should have an echocardiogram, even if the infants have no clinical criteria. 3Patient characteristics suggesting Kawasaki disease are listed in Table 482-1. Characteristics suggesting disease other than Kawasaki disease include exudative conjunctivitis, exudative pharyngitis, discrete intraoral lesions, bullous or vesicular rash, or generalized lymphadenopathy. Consider alternative diagnoses (see Table 482-2).4 Supplemental laboratory criteria include albumin less than or equal to 3.0 g/dL, anemia for age, elevation of alanine aminotransferase, platelets after 7 days greater than or equal to 450,000/μL, white blood cell count greater than or equal to 15,000/μL, and urine greater than or equal to 10 white blood cells per high-power field. 5The child can be treated before the echocardiogram (Echo). 6Echocardiogram is considered positive for purposes of this algorithm if any of the following 3 conditions are met: z-score of left anterior descending (LAD) coronary artery or right coronary artery (RCA) greater than or equal to 2.5, coronary arteries meet Japanese Ministry of Health criteria for aneurysms, or 3 or more other suggestive features exist, including perivascular brightness, lack of tapering, decreased left ventricular function, mitral regurgitation, pericardial effusion, or z scores in LAD or RCA of 2 to 2.5. 7If the echocardiogram is positive, treatment should be given to children within 10 days of fever onset and for those beyond day 10 with clinical and laboratory signs (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]) of ongoing inflammation. 8Typical peeling begins under nail bed of fingers and then toes. Source: Acquired Cardiovascular Disease, Rudolph's Pediatrics, 23e Citation: Kline MW. Rudolph's Pediatrics, 23e; 2017 Available at: http://accesspediatrics.mhmedical.com/DownloadImage.aspx?image=/data/books/2126/rudped23_ch482_f001.png&sec=168750692&BookID=2126&ChapterSecID=168743824&imagename= Accessed: October 30, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved