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{{Kawasaki disease}}
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{{SI}}
'''For patient information, click [[Kawasaki disease (patient information)|here]]'''


{{CMG}}; {{AE}} {{CZ}} {{AKK}}
{{CMG}}; {{AE}} {{SH}}, {{AKK}}


{{SK}} Mucocutaneous lymph node syndrome; Lymph node syndrome; Acute febrile vasculitic syndrome
===[[The Heart in Kawasaki Disease | For the heart in Kawasaki disease click here]]===
===[[The Heart in Kawasaki Disease | For the heart in Kawasaki disease click here]]===
==Overview==
'''Kawasaki disease''', also known as '''lymph node syndrome''', '''mucocutaneous node disease''', '''infantile polyarteritis''' and '''Kawasaki syndrome''', is a poorly understood self-limited [[vasculitis]] that affects many organs, including the [[skin]] and [[mucous membrane]]s, [[lymph node]]s, [[blood vessel]] walls, and the [[heart]]. It does not seem to be contagious. It was first described in 1967 by Dr. Tomisaku Kawasaki in Japan..  Kawasaki disease is predominantly a disease of young children, with 80% of patients younger than 5 years of age. Additional risk factors in the United States include Asian race and male sex.  Kawasaki disease can cause vasculitic changes (inflammation of blood vessels) in the coronary arteries and subsequent coronary artery aneurysms.  Common symptoms of kawasaki disease include high grade fever, red eyes, bright red and cracked lips,
red mucous membranes in the mouth, strawberry tongue, white coating on the tongue or prominent red bumps (papillae) on the back of the tongue, red palms of the hands and the soles of the feet, swollen hands and feet, and rash.  Intravenous Immunoglobulin (IVIG) and [[aspirin]] are indicated in kawasaki disease.


==Historical Perspective==
==[[Kawasaki disease overview|Overview]]==
The Historical data on Kawasaki is described below:<ref name="BurnsKushner2000">{{cite journal|last1=Burns|first1=Jane C.|last2=Kushner|first2=Howard I.|last3=Bastian|first3=John F.|last4=Shike|first4=Hiroko|last5=Shimizu|first5=Chisato|last6=Matsubara|first6=Tomoyo|last7=Turner|first7=Christena L.|title=Kawasaki Disease: A Brief History|journal=Pediatrics|volume=106|issue=2|year=2000|pages=e27–e27|issn=0031-4005|doi=10.1542/peds.106.2.e27}}</ref><ref name="CDCKawasaki">Kawasaki Disease. Centers for Disease Control and Prevention (2013). http://www.cdc.gov/kawasaki/ Accessed on July 28, 2016.</ref><ref>{{cite journal | author = Kawasaki T | title = [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children] | format=in Japanese | journal = Arerugi | volume = 16 | issue = 3 | pages = 178-222 | year = 1967 | id = PMID 6062087}}</ref><ref>{{cite journal | author = Kawasaki T | title = [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children] | format=in Japanese | journal = Arerugi | volume = 16 | issue = 3 | pages = 178-222 | year = 1967 | id = PMID 6062087}}</ref><ref>Episode 86 (4x16) - The Little Things (2 March, 2006)</ref><ref>{{cite journal | author = Kawasaki T | title = [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children] | format=in Japanese | journal = Arerugi | volume = 16 | issue = 3 | pages = 178-222 | year = 1967 | id = PMID 6062087}}</ref>
*In 1961, Dr. Tomisaku Kawasaki saw his first case of Kawasaki disease.
*In 1967, Kawasaki published his first report of Kawasaki disease in Japanese.
*In 1960s, pathologist Noboru Tanaka and pediatrician Takajiro Yamamoto disputed the early assertion of Kawasaki that Kawasaki disease was a self-limited illness with no sequelae.
*In 1970, first Japanese nationwide survey of Kawasaki disease was conducted and 10 autopsy cases of sudden cardiac death after Kawasaki disease were documented.
*In 1973, at the University of Hawaii hospital, pathologist Eunice Larson, in collaboration with Benjamin Landing at the Los Angeles Children's Hospital, retrospectively established a diagnosis of Kawasaki disease in a 1971 autopsy case.
*In 1974, Tomisaku Kawasaki published the first English-language report of 50 patients with Kawasaki disease.
*By 1974, the link between Kawasaki disease and coronary artery vasuclitis was well established.
*In 1976, he first cases of Kawasaki disease outside of Japan were reported in Hawaii.
*In 1988, the Committee on infectious diseases of the American Academy of Pediatrics declared IVIG treatment as the recommended therapy for Kawasaki disease.
*In 2006 march, Kawasaki disease was mentioned in the television programs Nip/Tuck and Without a Trace In the episode All In of the TV series House, it was inexplicably mentioned as a possible diagnosis for a 6 year old boy that was admitted with bloody diarrhea and coordination problems, as well as an elderly woman with unexplained respiratory, cardiovascular and neural deficiencies. Maxie Jones, a fictional character on General Hospital suffers from it. According to John Travolta and Kelly Preston, their son Jett Travolta also suffers from the disease.


==Classification==
==[[Kawasaki disease historical perspective|Historical Perspective]]==
*Patients whose illness does not meet the diagnostic criteria of Kawasaki disease case definition, but who have fever and coronary artery abnormalities are classified as:
**Atypical or incomplete Kawasaki disease


==Pathophysiology==
==[[Kawasaki disease classification|Classification]]==
The exact pathogenesis of [disease name] is not fully understood.


OR
==[[Kawasaki disease pathophysiology|Pathophysiology]]==


It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
==[[Kawasaki disease causes|Causes]]==


OR
==[[Kawasaki disease differential diagnosis|Differentiating Kawasaki disease from other Diseases]]==


[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
==[[Kawasaki disease epidemiology and demographics|Epidemiology and Demographics]]==


OR
==[[Kawasaki disease risk factors|Risk Factors]]==


Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
==[[Kawasaki disease screening|Screening]]==


OR
==[[Kawasaki disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.
 
==Causes==
*The cause of kawasaki disease has not been identified.
*The current [[etiology|etiological]] theories center primarily on [[immune system|immunological]] causes for the disease.
*Much research is being performed to discover a definitive [[toxin]] or [[antigen]]ic substance, possibly a [[superantigen]], that is the specific cause of the disease.
*An unknown virus may play a role as an inciting factor as well.
*There are several hypothesis for the causes of Kawasaki disease, the Infectious agents which are thought to induce kawasaki disease are:<ref name="pmid18448971">{{cite journal |vauthors=Pinna GS, Kafetzis DA, Tselkas OI, Skevaki CL |title=Kawasaki disease: an overview |journal=Curr. Opin. Infect. Dis. |volume=21 |issue=3 |pages=263–70 |date=June 2008 |pmid=18448971 |doi=10.1097/QCO.0b013e3282fbf9cd |url=}}</ref><ref name="pmid9832593">{{cite journal |vauthors=Yanagawa H, Nakamura Y, Yashiro M, Ojima T, Tanihara S, Oki I, Zhang T |title=Results of the nationwide epidemiologic survey of Kawasaki disease in 1995 and 1996 in Japan |journal=Pediatrics |volume=102 |issue=6 |pages=E65 |date=December 1998 |pmid=9832593 |doi= |url=}}</ref>
**[[Parvovirus]] B19
**[[Meningococcal]] septicemia
**[[Adenoviridae|Adenovirus]]
**Bacterial toxin–mediated [[Superantigen|superantigens]]
**[[Cytomegalovirus]]
**[[Epstein Barr virus|Epstein-Barr virus]]
**Human lymphotropic virus infection
**[[Klebsiella pneumoniae]] bacteremia
**[[Mycoplasma pneumoniae]]
**[[Mite]]-associated bacteria
**[[Measles]]
**[[Propionibacterium acnes]]
**[[Human parainfluenza viruses|Parainfluenza type 3 virus]]
**[[Rotavirus]] infection
**[[Rickettsiae|Rickettsia]] species
**[[Tick-borne disease|Tick-borne diseases]]
 
==Differentiating Kawasaki disease from other diseases==
Different [[rash]]-like conditions can be confused with [[Kawasaki disease]] and are thus included in its differential diagnosis. The various conditions that should be differentiated from [[Kawasaki disease]] include:<ref name="pmid25250996">{{cite journal| author=Hartman-Adams H, Banvard C, Juckett G| title=Impetigo: diagnosis and treatment. | journal=Am Fam Physician | year= 2014 | volume= 90 | issue= 4 | pages= 229-35 | pmid=25250996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25250996  }} </ref><ref name="pmid27265069">{{cite journal| author=Mehta N, Chen KK, Kroumpouzos G| title=Skin disease in pregnancy: The approach of the obstetric medicine physician. | journal=Clin Dermatol | year= 2016 | volume= 34 | issue= 3 | pages= 320-6 | pmid=27265069 | doi=10.1016/j.clindermatol.2016.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27265069  }} </ref><ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid26612370">{{cite journal| author=Ibrahim F, Khan T, Pujalte GG| title=Bacterial Skin Infections. | journal=Prim Care | year= 2015 | volume= 42 | issue= 4 | pages= 485-99 | pmid=26612370 | doi=10.1016/j.pop.2015.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612370  }} </ref><ref name="pmid26566601">{{cite journal| author=Ramoni S, Boneschi V, Cusini M| title=Syphilis as "the great imitator": a case of impetiginoid syphiloderm. | journal=Int J Dermatol | year= 2016 | volume= 55 | issue= 3 | pages= e162-3 | pmid=26566601 | doi=10.1111/ijd.13072 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26566601  }} </ref><ref name="pmid25855021">{{cite journal| author=Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y| title=Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan. | journal=Med Mycol J | year= 2015 | volume= 56 | issue= 1 | pages= E1-5 | pmid=25855021 | doi=10.3314/mmj.56.E1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855021  }} </ref><ref name="pmid23176858">{{cite journal| author=CEDEF| title=[Item 87--Mucocutaneous bacterial infections]. | journal=Ann Dermatol Venereol | year= 2012 | volume= 139 | issue= 11 Suppl | pages= A32-9 | pmid=23176858 | doi=10.1016/j.annder.2012.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23176858  }} </ref>
 
{| class="wikitable"
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Disease}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Features}}
|-
| style="background: #DCDCDC; padding: 5px;" |[[Kawasaki disease]]
|
* Commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Impetigo]] 
|
*It commonly presents with pimple-like lesions surrounded by [[erythematous]] [[skin]]. Lesions are [[pustules]], filled with [[pus]], which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of [[trauma]] to the [[skin]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Insect bite]]s
|
* The insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a [[rash]] and swelling in the injured area, often with formation of [[vesicles]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Measles]]
|
* Commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]], with observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Monkeypox]]
|
* The presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rubella]]
|
* Commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. ''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
|-
| style="background: #DCDCDC; padding: 5px;" |Atypical [[measles]]
|
* The symptoms commonly begin about 7-14 days after infection and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in measles.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Coxsackievirus]]
|
* The most commonly caused disease is the [[Coxsackie A]] disease, presenting as ''hand, foot and mouth disease''. It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]]  or above the [[tonsils]]. Adults can also be affected. The [[rash]], which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Acne]]
|
* It is typical of teenagers, usually appears on the [[face]] and upper neck, but the [[chest]], [[human back|back]] and [[shoulder]]s may have [[acne]] as well. The upper [[arm]]s can also have [[acne]], but lesions found there are often [[keratosis pilaris]], not [[acne]]. The typical [[acne]] lesions are [[comedones]] and [[inflammatory]] [[papules]], [[pustules]], and [[nodules]]. Some of the large [[nodules]] were previously called "[[cyst]]s"
|-
| style="background: #DCDCDC; padding: 5px;" |[[Syphilis]]
|It commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]] It is classically described as:
* Non-pruritic bilateral symmetrical mucocutaneous [[rash]]
* Non-tender regional [[lymphadenopathy]]
* Condylomata lata and
* Patchy [[alopecia]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Molluscum contagiosum]]
|
* The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Mononucleosis]]
|
* Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]].
|-
| style="background: #DCDCDC; padding: 5px;" |Toxic [[erythema]]
|
* It is a common [[rash]] in infants, with clustered and [[vesicular]] appearance.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rat-bite fever]]
|
* It commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple plaques.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Parvovirus B19]]
|
*The [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Cytomegalovirus]]
|
* The common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]]  and [[loss of appetite]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Scarlet fever]]
|
* It commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rocky Mountain spotted fever]]
|
* The [[symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Stevens-Johnson syndrome]]
|
* The [[symptoms]] may include [[fever]], [[sore throat]]  and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the eyes occurs in about 30% of children. A [[rash]] of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Varicella-zoster virus]]
|
* It commonly starts as a painful [[rash]] on one side of the face or body. The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Chickenpox]]
|
* It commonly starts with [[conjunctival]] and catarrhal [[symptoms]] and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a [[chickenpox]] blister can also spread the disease.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Meningococcemia]]
|
* It commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], mental status changes, [[nausea]] and [[vomiting]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rickettsialpox|Rickettsial pox]]
|
* The first [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]] but the most distinctive [[symptom]] is the [[rash]] that breaks out, spanning the person's entire body.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Meningitis]]
|
* It commonly presents with [[headache]], [[nuchal rigidity]], [[fever]], [[petechiae]] and [[altered mental status]].
|}
 
{| class="wikitable"
|+
! rowspan="2" |Disease
! rowspan="2" |Epidemiology
! rowspan="2" |Predisposing factors
! colspan="2" |'''Clinical features'''
! rowspan="2" |'''Lab abnormalities'''
|-
|'''Signs'''
|'''Symptoms'''
|-
|[[Kawasaki disease|Kawasaki]]
[[Kawasaki disease|disease]]
|Occurs in children, usually age 1-4 years
|Interaction of genetic and environmental factors, possibly including an infection in combination with genetic predisposition to an autoimmune mechanism ([[Vasculitis|autoimmune vasculitis]])
|Non-[[suppurative]], painless bilateral conjunctival [[inflammation]] ([[conjunctivitis]]), strawberry tongue (marked redness with prominent [[Papillae of the tongue|gustative papillae]]), deep transverse grooves across the nails may develop (Beau’s lines), [[lymphadenopathy]] present(acute, non-[[purulent]], cervical), may lead to [[Coronary arteries|coronary artery]] [[Aneurysm|aneurysms]].
|High and persistent fever that is not very responsive to normal treatment with [[acetaminophen]] or [[Non-steroidal anti-inflammatory drug|NSAIDs]],  diffuse [[Maculopapular|macular-papular]] [[erythematous]] rash
|Liver function tests may show evidence of hepatic [[inflammation]] and low serum [[albumin]] levels, low hemoglobulin and age-adjusted hemoglobulin concentrations, '''[[thrombocytosis]]''', [[anemia]].  [[Echocardiography|Echocardiographic]] abnormalities, such as [[valvulitis]] ([[Mitral valve|mitral]] or [[Tricuspid valve|tricuspid]] [[Regurgitation (circulation)|regurgitation]]) and [[Coronary arteries|coronary artery]] lesions, are significantly more common in [[Kawasaki disease]]. <ref name="pmid26222065">{{cite journal |vauthors=Lin YJ, Cheng MC, Lo MH, Chien SJ |title=Early Differentiation of Kawasaki Disease Shock Syndrome and Toxic Shock Syndrome in a Pediatric Intensive Care Unit |journal=Pediatr. Infect. Dis. J. |volume=34 |issue=11 |pages=1163–7 |year=2015 |pmid=26222065 |doi=10.1097/INF.0000000000000852 |url=}}</ref> [[Pyuria]] of uretheral origin.
|-
|Toxic shock syndrome
|Occurs in  both adults and children (9:1 female predominance)
|Occurs in association with [[vaginitis]] during [[menstruation]] following tampon use (S. aureus); as a complication of soft tissue infections ([[Streptococcus pyogenes|S. pyogenes]] or GAS) or in females undergoing medical [[abortion]] ([[Clostridium sordellii|C. sordellii]]).
|[[Hypotension]], [[tachycardia]], [[mucous membrane]] [[Hyperaemia|hyperemia]] (vaginal, oral, [[Conjunctiva|conjunctival]])
|Fever, diarrhea, vomiting, diffuse scarlantiform rash
|[[Hyponatremia]] and [[uremia]]. Hepatic dysfunction (total [[bilirubin]], serum asparate aminotransferase or serum alanine aminotransferase levels >2 times upper normal limit), [[leukocytosis]] with a [[Polymorphonuclear cells|polymorphonuclear shift]] to the left. [[Platelet|Platelets]] < 100,000 per mm<sup>3</sup> ([[thrombocytopenia]]), [[pyuria]] of [[renal]] origin.
|-
|[[Scarlet fever]]
|Distributed equally among both genders. Most commonly affects children between five and fifteen years of age.
|Occurs after streptococcal [[pharyngitis]]/[[tonsillitis]]
|Pastia's sign (puncta and skin crease accentuation of the [[erythema]]), strawberry tongue, cervical [[lymphadenopathy]] may be present. [[Scarlet fever]] appears similar to [[Kawasaki disease|Kawasaki's disease]] in some aspects, but lacks the eye signs or the swollen, red fingers and toes
|Characteristic sandpaper-like rash which appears days after the illness begins (although the rash can appear before illness or up to 7 days later), rash may first appear on the neck, underarm, and groin
|[[Leukocytosis]] with [[left shift]] and possibly [[eosinophilia]] a few weeks after convalescence. Anti-deoxyribonuclease B, [[Antistreptolysin O titer|antistreptolysin-O]] titers (antibodies to streptococcal [[extracellular]] products), antihyaluronidase, and antifibrinolysin may be positive.
|}
Kawasaki disease must be differentiated from other causes of fever and rash in infants
{|
 
|}
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 83%;"
|+ '''Differential Diagnosis of Measles.''' Table adapted from CDC Pinkbook.<ref name="CDC90">{{cite web | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | url = http://www.cdc.gov/vaccines/pubs/pinkbook/table-of-contents.html }}</ref>
|-
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Disease}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Agent}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Typical Season}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Typical Age}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Prodrome}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Fever}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Duration of the rash (days)}}
! style="width: 500px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Rash}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Other Signs & Symptoms}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Kawasaki disease]]'''
| style="background: #DCDCDC; padding: 5px;" | Unknown
| style="background: #F5F5F5; padding: 5px;" | Winter - Spring
| style="background: #DCDCDC; padding: 5px;" | < 5 years
| style="background: #F5F5F5; padding: 5px;" | 3 days of abrupt [[fever]]
| style="background: #DCDCDC; padding: 5px;" | High; [[fever]] of 5 days is a diagnostic criteria
| style="background: #F5F5F5; padding: 5px;" | 5 - 7
| style="background: #DCDCDC; padding: 5px;" | Erythematous, morbilliform, maculopapular or scarlatiniform, central distribution; erythematous, indurated palms and soles
| style="background: #F5F5F5; padding: 5px;" | Acute: dry, fissured and injected lips, [[strawberry tongue]]; [[irritability]]; cervical [[lymphadenopathy]]; [[conjunctival injection]]; peripheral [[edema]]; Subacute: finger-tip desquamation; Complications: [[arthritis]], [[carditis]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Measles]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Paramyxovirus]]<br>Measles virus
| style="background: #F5F5F5; padding: 5px;" | Winter - Spring
| style="background: #DCDCDC; padding: 5px;" | 1 to 20 years
| style="background: #F5F5F5; padding: 5px;" | 2-4 days of [[cough]], [[conjunctivitis]], and [[coryza]]
| style="background: #DCDCDC; padding: 5px;" | High
| style="background: #F5F5F5; padding: 5px;" | 5 - 6
| style="background: #DCDCDC; padding: 5px;" | Erythematous, irregular size, maculopapular; starts on temples and behind ears; progresses down from face; fades to brownish
| style="background: #F5F5F5; padding: 5px;" | Koplik's spots: C blue-white papules (salt grains) on bright red [[mucosa]] opposite premolar [[teeth]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Roseola Infantum (exanthem subitum)'''
| style="background: #DCDCDC; padding: 5px;" | Human [[herpes virus]] type 6
| style="background: #F5F5F5; padding: 5px;" | Any season
| style="background: #DCDCDC; padding: 5px;" | 6 months to 2 years
| style="background: #F5F5F5; padding: 5px;" | None
| style="background: #DCDCDC; padding: 5px;" | High
| style="background: #F5F5F5; padding: 5px;" | 1-2; it follows defervescence
| style="background: #DCDCDC; padding: 5px;" | Discrete erythematous macules, rarely involves face, begins as fever ends
| style="background: #F5F5F5; padding: 5px;" | [[Lymphadenopathy]], [[irritability]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Rubella]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Togavirus]]
| style="background: #F5F5F5; padding: 5px;" | Spring
| style="background: #DCDCDC; padding: 5px;" | 7 months to 29 years
| style="background: #F5F5F5; padding: 5px;" | 0 - 4 days; mild malaise, fever; absent in children
| style="background: #DCDCDC; padding: 5px;" | Low grade
| style="background: #F5F5F5; padding: 5px;" | 1 - 3
| style="background: #DCDCDC; padding: 5px;" | Discrete, rose-pink, diffuse, maculopapular; progresses downward from face, may change quickly
| style="background: #F5F5F5; padding: 5px;" | [[Arthralgia]] (usually in adults), tender posterior cervical and suboccipital [[lymphadenopathy]], [[malaise]], [[petechiae]] on [[soft palate]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Scarlet Fever]]'''
| style="background: #DCDCDC; padding: 5px;" | ß-hemolytic [[streptococci]]
| style="background: #F5F5F5; padding: 5px;" | Winter
| style="background: #DCDCDC; padding: 5px;" | > 2 years
| style="background: #F5F5F5; padding: 5px;" | 0 - 6 day, marked
| style="background: #DCDCDC; padding: 5px;" | Low to high
| style="background: #F5F5F5; padding: 5px;" | 2 - 7
| style="background: #DCDCDC; padding: 5px;" | Scarlet "sunburn" with punctate papules "sandpaper", circumoral pallor, increased intensity in [[skin]] folds, blanches stars face/head, upper trunk and progresses downward
| style="background: #F5F5F5; padding: 5px;" | [[Sore throat]], exudative [[tonsillitis]], [[vomiting]], [[abdominal pain]], [[lmphadenopathy]], white then red [[strawberry tongue]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Erythema Infectiosum]] ([[Fifth Disease]])'''
| style="background: #DCDCDC; padding: 5px;" | [[Human parvovirus]] type B19
| style="background: #F5F5F5; padding: 5px;" | Spring
| style="background: #DCDCDC; padding: 5px;" | 5 - 10 years
| style="background: #F5F5F5; padding: 5px;" | None, usually in children, may occur in adults
| style="background: #DCDCDC; padding: 5px;" | None to low-grade
| style="background: #F5F5F5; padding: 5px;" | 2 - 4
| style="background: #DCDCDC; padding: 5px;" | Starts as “slapped cheek”, maculopapular; progresses to reticular (lacy) pattern; can recur with environmental changes such as sunlight exposure
| style="background: #F5F5F5; padding: 5px;" | [[Arthralgia]]/[[arthritis]] in adults, [[adenopathy]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Enterovirus]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Echovirus]]<br>[[Coxsackie virus]]
| style="background: #F5F5F5; padding: 5px;" | Summer - Fall
| style="background: #DCDCDC; padding: 5px;" | Mainly childhood
| style="background: #F5F5F5; padding: 5px;" | 0 - 1 day fever and myalias
| style="background: #DCDCDC; padding: 5px;" | Low to high
| style="background: #F5F5F5; padding: 5px;" | 1 - 5
| style="background: #DCDCDC; padding: 5px;" | Fine, pink, always affects face; variant is Boston exanthem (large ~ 1 cm, discrete maculopapules)
| style="background: #F5F5F5; padding: 5px;" | [[Sore throat]], [[headache]], [[malaise]], no [[lymphadenopathy]], [[gastroenteritis]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Dengue Fever]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Flavivirus]]<br>[[Dengue virus]] types 1 - 4
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | None
| style="background: #DCDCDC; padding: 5px;" | High
| style="background: #F5F5F5; padding: 5px;" |1 - 5
| style="background: #DCDCDC; padding: 5px;" | Generalized maculopapular rash after defervescence; spares palms and soles
| style="background: #F5F5F5; padding: 5px;" | [[Headache]], [[myalgia]], [[abdominal pain]], [[pharyngitis]], [[vomiting]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Drug induced rash]]'''
| style="background: #DCDCDC; padding: 5px;" | Many
| style="background: #F5F5F5; padding: 5px;" | Any
| style="background: #DCDCDC; padding: 5px;" | Any
| style="background: #F5F5F5; padding: 5px;" | Possible due to underlying [[illness]]
| style="background: #DCDCDC; padding: 5px;" | Possible
| style="background: #F5F5F5; padding: 5px;" | Varies
| style="background: #DCDCDC; padding: 5px;" | Typically diffuse but may be concentrated in diaper area, typically no progression, erythema multiform rash can progress over a few days
| style="background: #F5F5F5; padding: 5px;" | Possibly due to underlying [[illness]] or [[complications]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Infectious Mononucleosis]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Epstein-Barr Virus]]
| style="background: #F5F5F5; padding: 5px;" | None
| style="background: #DCDCDC; padding: 5px;" | 10 - 30 years
| style="background: #F5F5F5; padding: 5px;" | 2 - 5 days of [[malaise]] and [[fatigue]]
| style="background: #DCDCDC; padding: 5px;" | Low to high
| style="background: #F5F5F5; padding: 5px;" | 2 - 7
| style="background: #DCDCDC; padding: 5px;" | Trunk and proximal extremities. Rash common if [[Ampicillin]] given
| style="background: #F5F5F5; padding: 5px;" | [[Pharyngitis]], [[lymphadenopathy]], [[splenomegaly]], [[malaise]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Pharyngoconjunctival Fever]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Adenovirus]] types 2, 3, 4, 7, 7a
| style="background: #F5F5F5; padding: 5px;" | Winter - Spring
| style="background: #DCDCDC; padding: 5px;" | < 5 years
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" | Low to high
| style="background: #F5F5F5; padding: 5px;" | 3 - 5
| style="background: #DCDCDC; padding: 5px;" | Starts on face and spreads down to trunk and extremities
| style="background: #F5F5F5; padding: 5px;" | [[Sore throat]], [[conjunctivitis]], [[headache]], [[anorexia]]
|}
 
The following table is a list of differential diagnosis oral lesions presenting similar to measles:
<div style="width: 70%;">
{| class="wikitable"
!Disease
!Presentation
!Risk Factors
!Diagnosis
!Affected Organ Systems
!Important features
!Picture
|-
!
!
!
!
|-
|[[Coxsackie virus]]
|
*[[Fever]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Aches]]
|
*[[Pregnancy]]
*[[immunodeficiency]]
|
*[[History]] and [[Physical exam]]
*[[Throat swabs]]
*Swabs from the lesion
*[[Tzanck test]]
|
*[[Oral cavity]]
*[[Skin]]
|
*Symptomatic treatment
|<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Hand foot mouth disease 07a.jpg|473x473px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
|-
|[[Chickenpox|Chicken pox]]
|
*[[Conjunctival symptoms]]
*[[Catarrhal symptoms]]
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
|
*[[Pregnancy]]
*[[Premature infants]] born to susceptible mothers
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh ≤1000 grams
*[[Immunocompromised]]
|
*[[History]] and [[physical exam]]
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[maculopapular lesions]])
|
*[[Oral cavity]]
*[[Skin]]
|
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
*[[Prednisolone]] is [[contraindicated]]
|<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Chickenpox18a.jpg|700x700px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
|-
|[[Measles]]
|
*[[Fever]]
*[[Rash]]
*[[Cough]]
*[[Coryza]] (runny nose)
*[[Conjunctivitis]] (pink eye)
*[[Malaise]]
*[[Koplick spots]] in mouth
|
*[[Unvaccinated]] individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778  }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
*Crowded and/or [[unsanitary]] conditions
*Traveling to less developed and [[developing countries]]
*[[Immunocompromized]]
*[[Winter]] and [[spring]] seasons
*Born after 1956 and never fully vaccinated
*Health care workers
|
*[[History]] and [[examination]]
*[[PCR]] for [[Measles]]-specific [[IgM antibody]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[virus particles]]
|<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Koplikspot1a.jpg|700x700px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
|-
|[[Herpangina]]
|
*Sudden [[fever]]
*[[Sore throat]] and [[dysphagia]]- These can occur several hours(up to 24 hours), before the appearance of the enanthem.
*[[Vomiting]]
*[[Abdominal pain]]
*[[Myalgia]]
*[[Headache]]
*Pharyngeal lesions
|
*Attendance at a kindergarten/child care center
*Contact with herpangina cases
*Residence in rural areas
*Overcrowding
*Poor hygiene
*Low socioeconomic status
|
*Clincial diagnosis
*Pharyngeal [[viral]] and [[bacterial]] cultures can be taken to exclude [[HSV]] infection and [[streptococcal pharyngitis]].
|
*Skin
*Oral Cavity
|
*Characteristic enanthem- Punctate [[macule]] which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate.
*The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the [[soft palate]] and [[uvula]]. The lesions can also be seen on the [[tonsils]], posterior pharyngeal wall and the [[buccal mucosa]].
|
[[File:Herpangina3.jpg|center|300x300px|alt=Erythema, vesicles and ulcerating lesions in herpangina|Erythema, vesicles and ulcerating lesions in herpangina]]
|-
|Primary herpetic gingivoestomatitis<ref name="KolokotronisDoumas2006">{{cite journal|last1=Kolokotronis|first1=A.|last2=Doumas|first2=S.|title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis|journal=Clinical Microbiology and Infection|volume=12|issue=3|year=2006|pages=202–211|issn=1198743X|doi=10.1111/j.1469-0691.2005.01336.x}}</ref>
|
*Pin-head [[vesicles]] rupture to form painful irregular ulcerations covered by yellow-grey membrane
*Severe pain
*[[Submandibular lymphadenopathy]]
*[[Halitosis]]
*It involves [[buccal mucosa]], [[tongue]], posterior [[pharynx]], and [[gingival]] and palatal [[mucosa]]
|
*Direct contact
*[[HIV infection]]
|
*[[Tzanck test]] demonstrates multinucleated epithelial giant cells<ref name="pmid12626280">{{cite journal| author=Chauvin PJ, Ajar AH| title=Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. | journal=J Can Dent Assoc | year= 2002 | volume= 68 | issue= 4 | pages= 247-51 | pmid=12626280 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12626280  }} </ref>
*Viral [[culture]] is the gold standard for diagnosis
*Direct [[immunofluorescence]]
|
*Oral cavity
*Mucous membranes
|
*Ulcers are common on lips, gums, throat, front of tongue, inside of the cheeks and roof of the mouth
*Treatment is with antiviral agents such as [[Valacyclovir]] and [[Famciclovir]]
|
<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Herpes labialis - opryszczka wargowa.jpg|1600x1600px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
 
|}
 
Koplik spots must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.
 
{| class="wikitable"
!Disease
!Presentation
!Risk Factors
!Diagnosis
!Affected Organ Systems
!Important features
!Picture
|-
! colspan="3" |Diseases predominantly affecting the oral cavity
!
!
!
!
|-
|[[Oral candidiasis|Oral Candidiasis]]
|
* [[Dysphagia]] or [[odynophagia]]
* White patches on the mouth and tongue
|
*[[Newborn]] babies
 
*Denture users
 
*Poorly controlled [[diabetes]]
 
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
 
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]].
 
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment).
 
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]].
 
*[[Organ transplantation]] patients
|
* Clinical diagnosis
* Confirmatory tests rarely needed
|'''Localized candidiasis'''
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
* [[Candida vulvovaginitis]]
* [[Chronic mucocutaneous candidiasis]]
 
'''Invasive candidasis'''
* [[Candidiasis|Candidaemia]]
* [[Endocarditis|Candida endocarditis]]
* [[Osteoarthritis|Candida osteoarticular disease]]
|
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]].
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
|-
|[[Herpes simplex|Herpes simplex oral lesions]]
|
* [[Fever]] 
* [[Sore throat]]
* Painful [[ulcer]]s
|
* Stress
* Recent [[URTI]]
* Female sex
|
* Physical examination
* [[Viral culture]]
* [[Tzanck smear]]
|
* Orofacial Infection
* [[Herpes simplex anogenital infection|Anogenital Infection]]
* [[Herpes simplex ocular infection|Ocular Infection]]
* [[Herpes simplex encephalitis|Herpes Encephalitis]]
* [[Herpes simplex neonatorum|Neonatal Herpes]]
* [[Herpetic whitlow|Herpetic Whitlow]]
* [[Herpes gladiatorum|Herpes Gladiatorum]]
|
* The symptoms of primary [[HSV]] infection generally resolve within two weeks
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]]
|-
|[[Aphthous ulcer|Aphthous ulcers]]
|
* Painful, red spot or bump that develops into an open [[ulcer]]
|
* Being a female
* Between the ages of 10-40
* Family history of [[Aphthous ulcer|aphthous ulcers]]
|
* Physical examination
* Diagnosis of exclusion
|
* Oral cavity
|
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]]
|-
|[[Squamous cell carcinoma]]
|
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
|
* Chronic sun or [[Ultraviolet|UV exposure]]
* Fair [[skin]]
* [[Elderly]] age (>45 yrs)
* [[Male sex]]
* [[Smoking]]
|
*[[Physical exam]]
*[[Biopsy]]
|
*[[Oral Cavity]]
**Floor of [[mouth]]
**Lateral [[tongue]]
*[[Throat]]
*[[Esophagus]]
|
*[[Malignant]]
*Can spread to [[TMJ]]
*Some times associated with [[leukoplakia]]
|[[File:PLoS oral cancer.png|thumb|400x400px|Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]]
|-
|[[Leukoplakia]]
|
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]]
*Lateral borders of [[tongue]]
|
*Atypical [[Tobacco]] use
*Chronic [[irritation]]
*[[Immunodeficiency]]
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]])
|
*[[Physical exam]]
*Diagnosis of exclusion
*[[Biopsy]]
|
*[[Vulva|Vulvar]] lesions occur independent of oral lesions
|
*Associated with [[HIV]]
*Persistant white spots
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]]
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!
| journal = [[Advances in anatomic pathology]]
| volume = 20
| issue = 6
| pages = 416–423
| year = 2013
| month = November
| doi = 10.1097/PAP.0b013e3182a92df1
| pmid = 24113312
}}</ref>
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]]
|-
|[[Melanoma]]
|
*A lesion with [[ABCD]]
**[[Asymmetry]]
**Border irregularity
**Color variation
**[[Diamete]]r changes
*[[Bleeding]] from the lesion
|
*[[Ultraviolet|UV radiations]]
*[[Genetic predisposition]]
*[[Old age]]
*[[Male gender]]
*Family or personal history of [[melanoma]]
*Multiple benign or atypical [[Nevus|nevi]]
|
*[[ABCD]] characteristics
*[[Bleeding]] or [[ulceration]] may show [[malignancy]]
*Serum [[LDH]] may be elevated in case of [[malignancy]]
*[[Biopsy]]
|
*Can [[metastasize]]
*All [[UV radiation]] or sun exposed areas can be effected independently
*1-2 to hundreds of [[granules]]
|
*[[Neural crest cell]] derivative
*Development begins with disruption of [[nevus]] growth control
*Progression involves [[MAPK/ERK pathway]]
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]]
|-
|[[Fordyce spots]]
|
*Rice-like [[granules]] or [[spots]]
*Small, [[painless]], [[raised]], [[pale]], red or white
*1 to 3 mm in [[diameter]]
|
*Greasy skin types
*Some [[Rheumatic|rheumatic disorders]]
*[[Hereditary nonpolyposis colorectal cancer]]
**Lower [[gingiva]] (gums)
**[[Vestibular system|Vestibular mucosa]]
|
*[[Physical exam]]
*Small [[keratin]]-filled [[pseudocysts]]
*May be seen on [[incidental]] [[mucosal]] [[biopsy]]
**[[Biopsy]] not done for them primarily
|
*[[Oral cavity]]
**[[Vermillion border|Vermilion border]] of the lips
**[[Oral mucosa]] of the upper lip
*[[Buccal mucosa]] in the commissural region often bilaterally
*[[Genitals]]
|
*[[Benign neoplasms]] with [[sebaceous]] features
*Visible [[sebaceous glands]]
*No surrounding [[mucosal]] change
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]]
|-
|[[Burning mouth syndrome]]
|
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]]
|
*[[Nutritional deficiencies]]
*Chronic [[anxiety]] or [[depression]]
*[[Diabetes type 2]]
*[[Menopause]]
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste
*[[Female gender ]]
*[[Menopause]]
|
*[[Presentation]]
*[[Physical exam]]
|
*[[Oral cavity]]
|
*Pain typically is low in the morning and builds up over the day
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective
|
|-
|[[Torus palatinus]]
|
*Bony growth on midline of the [[hard palate]]
*[[Nodular]] mass covered with normal [[mucosa]]
|
*[[Genetic predisposition]]
**[[Autosomal dominant]]
|
*[[Physical exam]]
*Types
**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Nodular tori]]
**[[Torus palatinus|Lobular tori]]
|
*[[Hard palate]]
|
*More common in [[Asian]] and Inuit populations
*Twice more common in [[females]]
*Repeated [[trauma]] can cause [[bleeding]]
*[[Surgery]] may be required in symptomatic
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]]
|-
| colspan="4" |'''Diseases involving oral cavity and other organ systems'''
|
|
|
|-
|[[Behçet's disease|Behcet's disease]]
|
*Painful [[mouth sores]]
*[[Acne]] like skin lesions
*Headache, [[fever]], poor [[balance]], [[disorientation]]
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]]
*[[Uveitis]]
*Joint [[swelling]] and joint [[pain]]
*Genital [[sores]] wit [[pain]] and [[scaring]]
*[[Aneurysms]]
|
*Over active [[immune system]]
|
*[[Physical examination]]
|
*[[Mouth]]
*[[Genitals]]
*[[GIT]]
*[[Eye]]
*[[Joints]]
*[[Skin]]
*[[Vascular system]]
*[[Brain]]
|
*[[Outbreaks]] of exaggerated [[inflammation]]
*Affects smaller [[blood vessels]]
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]]
|-
|[[Crohn's disease]]
|
*Chronic, episodic [[diarrhea]] or [[constipation]]
*[[Abdominal pain]]
*[[Vomiting]]
*[[Weight loss]] or [[weight gain]]
|
*[[Smoking]]
*[[Whites]] and [[European]] [[Jews]]
*[[Hormonal contraception]]
*Diets high in microparticles, sweet, fatty or refined foods
*Industrialized country
|
*Typical [[history]] and [[symptoms]]
*[[Skip lesions]] on [[biopsy]]
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]]
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]])
|
*[[Eyes]]
*[[Joints]]
*[[Skin]]
|
*May lead to
**[[Obstruction]]s
**[[Abscess]]es
**Free [[perforation]]
**[[Hemorrhage]]
|
|-
|[[Agranulocytosis]]
|
*[[Fever]] or [[chills]]
*Frequent [[infections]]
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound
*Mouth [[ulcers]]
*[[Abdominal pain]]
*[[Burning sensation when urinating]]
*[[Sore throat]]
|
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref>
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]]
*[[Hematological malignancy|Hematologic malignancies]]
*[[Autoimmune disorders]]
|
*[[Neutropenia]] <100 cells per micro litre
*[[Eosinopenia]]
*[[Basopenia]]
|
*[[Oral cavity]]
*[[Skin]]
*[[GIT]]
*[[Urinary system]]
*[[Conjunctiva]]
|
*[[Immunocompromised|Immunocompromization]]
*Types
**[[Drug-induced]]
**[[Malignant]]
**[[Autoimmune]]
|
|-
|[[Syphilis]]<ref>title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref>
|
*[[Chancre]]
*Regional [[lymphadenopathy]]
|
*[[Multiple sexual partners]]
*Illicit [[drug use]]
*[[Unprotected sex]]
*[[Homosexual men|Men who have sex with men]]
*Residence in highly prevalent areas
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection
*Presence of other [[STI]]s
*Previous history of [[Sexually transmitted disease|STIs]]
*[[Intravenous drug use]]
|
*[[Darkfield microscope|Darkfield microscopy]]
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]])
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]])
|
*[[Oral cavity]]
*[[Penis]]
*[[Cervix]]
*[[Labia]]
*[[Anal canal]]
*[[Rectum ]]
*[[CNS]]
*[[Cardiovascular|CVS]]
|
*[[Primary syphilis]]
**[[Chancre]]
*[[Secondary syphilis]]
**[[Condyloma latum|Condylomata lata]]
*[[Latent syphilis]]
**[[Asymptomatic]]
*[[Tertiary syphilis]]
**[[Gumma|Gummas]]
**[[Neurosyphilis]]
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]]
|-
|[[Coxsackie virus]]
|
*[[Fever]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Aches]]
|
*[[Pregnancy]]
*[[immunodeficiency]]
|
*[[History]] and [[Physical exam]]
*[[Swabbing|Throat swabs]]
*Swabs from the lesion
*[[Tzanck test]]
|
*[[Oral cavity]]
*[[Skin]]
|
*Symptomatic treatment
|[[File:Hand foot mouth disease 07a.jpg|thumb|400x400px|Coxsackie virus stomatitis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>]]
|-
|[[Chickenpox|Chicken pox]]
|
*[[Conjunctival]] symptoms
*[[Catarrhal]] symptoms
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
|
*[[Pregnancy]]
*[[Premature infants]] born to susceptible mothers
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh ≤1000 grams
*[[Immunocompromised]]
|
*[[History]] and [[physical exam]]
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]])
|
*[[Oral cavity]]
*[[Skin]]
|
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
*[[Prednisolone]] is [[contraindicated]]
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]]
|-
|[[Measles]]
|
*[[Fever]]
*[[Rash]]
*[[Cough]]
*[[Coryza]] (runny nose)
*[[Conjunctivitis]] (pink eye)
*[[Malaise]]
*[[Koplick spots]] in mouth
|
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778  }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
*Crowded and/or unsanitary conditions
*Traveling to less developed and developing countries
*Immunocompromized
*Winter and [[spring]] seasons
*Born after 1956 and never fully vaccinated
*Health care workers
|
*[[History]] and [[examination]]
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]]
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]]
|}
</div>
 
== Epidemiology and Demographics ==
Kawasaki disease occurs worldwide, with the highest incidence in Japan, and it most often affects boys and younger children. KS may have a winter-spring seasonality, and community-wide outbreaks have been reported occasionally. In the continental United States, population-based and hospitalization studies have estimated an incidence of KS ranging from 9 to 19 per 100,000 children younger than 5 years of age. Approximately 4248 hospitalizations for Kawasaki disease, of which 3277 (77%) were for children under 5 years of age, were estimated among children younger than 18 years of age in the United States in the year 2000.
 
CDC uses hospital discharge data, a passive KS surveillance system, and special studies to describe the incidence and epidemiology of KS in the United States. The KS surveillance system has been maintained by CDC since 1976 and is based on voluntary reporting of KS cases by health care providers and local and state health authorities. A standardized case report form is used to collect information on patients.
 
For epidemiologic surveillance, CDC defines a case of KS as illness in a patient with fever of 5 or more days duration (or fever until the date of administration of intravenous immunoglobulin if it is given before the fifth day of fever), and the presence of at least 4 of the following 5 clinical signs:
*Rash
*Cervical lymphadenopathy (at least 1.5 cm in diameter)
*Bilateral conjuctival injection
*Oral mucosal changes
*Peripheral extremity changes.
 
Patients whose illness does not meet the above KS case definition but who have fever and coronary artery abnormalities are classified as having atypical or incomplete KS.
 
===Incidence===
By far, the highest incidence of Kawasaki disease occurs in Japan (175 per 100,000), though its incidence in the United States is increasing. Kawasaki disease is predominantly a disease of young children, with 80% of patients younger than 5 years of age. Additional risk factors in the United States include Asian race and male sex.
 
==Risk Factors==
*Common risk factors in the development of Kawasaki disease are believed to be [[environmental]], [[genetic]], and [[viral]].<ref name="Sánchez-ManubensBou2014">{{cite journal|last1=Sánchez-Manubens|first1=Judith|last2=Bou|first2=Rosa|last3=Anton|first3=Jordi|title=Diagnosis and classification of Kawasaki disease|journal=Journal of Autoimmunity|volume=48-49|year=2014|pages=113–117|issn=08968411|doi=10.1016/j.jaut.2014.01.010}}</ref>
*Kawasaki disease affects children of all races and ages and both genders.<ref name="pmid25822554">{{cite journal |vauthors=Saguil A, Fargo M, Grogan S |title=Diagnosis and management of kawasaki disease |journal=Am Fam Physician |volume=91 |issue=6 |pages=365–71 |date=March 2015 |pmid=25822554 |doi= |url=}}</ref>
*Kawasaki disease occurs most often in children of Asian and Pacific Island descent.
*Kawasaki disease is more likely to affect boys than girls.
*Most cases of Kawasaki disease occur in children younger than 5 years of age.
*Kawasaki disease is rare in children older than 8 years of age.
 
==Screening==
 
==Natural History, Complications, and Prognosis==
===Natural History===
 
===Complications===
 
===Prognosis===
The [[cardiac]] complications are, by far, the most important aspect of the disease. Kawasaki disease can cause vasculitic changes (inflammation of blood vessels) in the [[coronary arteries]] and subsequent '''coronary artery [[aneurysm]]s'''. These aneurysms can lead to [[myocardial infarction]] ([[myocardial infarction|heart attack]]) even in young children. Overall, about 10&ndash;18% of children with Kawasaki disease develop coronary artery aneurysms<ref>{{cite journal | author = Belay E, Maddox R, Holman R, Curns A, Ballah K, Schonberger L | title = Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003. | journal = Pediatr Infect Dis J | volume = 25 | issue = 3 | pages = 245-9 | year = 2006 | id = PMID 16511388}}</ref>, with much higher prevalence among patients who are not treated early in the course of illness.  Kawasaki disease is the most common cause of acquired heart disease among children in the United States.
 
With early treatment, rapid recovery from the acute symptoms can be expected and the risk of coronary artery aneurysms greatly reduced.  Untreated, the acute symptoms of Kawasaki disease are self-limited (''i.e.'' the patient will recover eventually), but the risk of coronary artery involvement is much greater. Overall, about 2% of patients die from complications of coronary vasculitis. Patients who have had Kawasaki disease should have an [[echocardiogram]] initially every few weeks, and then every 1&ndash;2 years to screen for progression of cardiac involvement.
 
It is also not uncommon that a [[relapse]] of symptoms may occur soon after initial treatment with [[IVIG]]. This usually requires re-hospitalization and retreatment. Treatment with [[IVIG]] can cause allergic and non-allergic acute reactions, aseptic meningitis, [[fluid overload]] and, rarely, other serious reactions. Aspirin may increase the risk of bleeding from other causes and may be associated with Reye's syndrome. Overall, life-threatening complications resulting from therapy for Kawasaki disease are exceedingly rare, especially compared with the risk of non-treatment.


==Diagnosis==
==Diagnosis==
 
[[Kawasaki disease diagnostic criteria|Diagnostic criteria]] | [[Kawasaki disease history and symptoms|History and Symptoms]] | [[Kawasaki disease physical examination|Physical Examination]] | [[Kawasaki disease laboratory findings|Laboratory Findings]] | [[Kawasaki disease electrocardiogram|Electrocardiogram]] | [[Kawasaki disease x ray|X-Ray Findings]] | [[Kawasaki disease echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Kawasaki disease CT scan|CT-Scan Findings]] | [[Kawasaki disease MRI|MRI Findings]] | [[Kawasaki disease other imaging findings|Other Imaging Findings]] | [[Kawasaki disease other diagnostic studies|Other Diagnostic Studies]]
===Diagnostic Criteria===
 
Kawasaki disease is diagnosed clinically (by [[medical sign]]s and [[symptom]]s), and there exists no specific laboratory test that can tell if someone has it. It is normally difficult to establish the diagnosis, especially early in the course of illness, and frequently children are not diagnosed until they have seen their doctor several times, or visited a number of different health care providers. Many other serious illnesses can cause similar symptoms, and must be considered in the [[differential diagnosis]], including [[scarlet fever]], [[toxic shock]] syndrome, and [[juvenile idiopathic arthritis]].
 
Classically, five days of fever plus four of five [[diagnostic]] criteria must be met in order to establish the diagnosis.
 
The criteria are:
 
(1) Mucositis:  [[erythema]] of the palatine mucosa, fissure erythematous lips, "strawberry tongue"
 
(2) Rash: Polymorphus, usually urticarial erythematous rash mainly in external extremities. The rash can spread to trunk
 
(3) Extremities changes: Edema of hand and feet, erythema of palms & soles, desquamation of fingertips
 
(4) Bilateral non-exudative conjuctival erythema
 
(5) Cervical lymphadenopathy for at least 15 milimeters
 
Many children, especially infants, eventually diagnosed with Kawasaki disease do not exhibit all of the above criteria. In fact, many experts now recommend treating for Kawasaki disease even if only three days of fever have passed and at least three diagnostic criteria are present, especially if other tests reveal abnormalities consistent with Kawasaki disease. In addition, the diagnosis can be made purely by the detection of coronary artery aneurysms in the proper clinical setting.
 
===History and Symptoms===
Kawasaki disease often begins with a high and persistent [[fever]] that is not very responsive to normal doses of [[acetaminophen]] or [[ibuprofen]]. The fever may persist steadily for up to two weeks and is normally accompanied by irritability. Affected children develop red eyes, red [[mucous membrane]]s in the mouth, red cracked lips, a "[[strawberry tongue]]", iritis, keratic precipitates (detectable by an ophthalmologist but usually too small to be seen by the unaided eye), and swollen [[lymph node]]s. [[Skin rash]]es occur early in the disease, and peeling of the skin in the [[genital area]], hands, and feet (especially around the nails and on the palms and soles) may occur in later phases. Some of these symptoms may come and go during the course of the illness. If left untreated, the symptoms will eventually relent, but coronary artery aneurysms will not improve, resulting in a significant risk of death or disability due to myocardial infarction (heart attack).  If treated in a timely fashion, this risk can be mostly avoided and the course of illness cut short.
 
* High-grade fever (greater than 39&nbsp;°C or 102&nbsp;°F; often as high as 40&nbsp;°C  or 104&nbsp;°F) that normally lasts for more than a week if left untreated.
* Red eyes ([[conjunctivitis]]) without pus or drainage, also known as "conjunctival injection"
* Bright red, chapped, or cracked lips
* Red [[mucous membrane]]s in the mouth
* Strawberry tongue, white coating on the tongue or prominent red bumps ([[papillae]]) on the back of the tongue
* Red palms of the hands and the soles of the feet
* Swollen hands and feet
* Rash which may take many forms, but not vesicular (blister-like), on the trunk
* Swollen [[lymph node]]s (frequently only one lymph node is swollen), particularly in the neck area
* Joint pain ([[arthralgia]]) and swelling, frequently symmetrical
* Irritability
* [[Tachycardia]] (rapid heart beat)
* Peeling (desquamation) palms and soles (later in the illness); peeling may begin around the nails
 
===AHA Scientific Statement on Kawasaki Disease===
 
====Recommendations for Cardiovascular Assessment for Diagnosis and Monitoring During the Acute Illness====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Echocardiography should be performed when the diagnosis of KD is considered, but unavailability or technical limitations should not delay treatment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Coronary arteries should be imaged, and quantitative assessment of luminal dimensions, normalized as Z scores adjusted for body surface, should be performed.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' For uncomplicated patients, echocardiog- raphy should be repeated both within 1 to 2 weeks and 4 to 6 weeks after treatment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''4.''' For patients with important and evolving coronary artery abnormalities (Z score >2.5) detected during the acute illness, more fre- quent echocardiography (at least twice per week) should be performed until luminal dimensions have stopped progressing to determine the risk for and presence of thrombosis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' To detect coronary artery thrombosis, it may be reasonable to perform echocardiography for patients with expanding large or giant aneurysms twice per week while dimensions are expanding rapidly and at least once weekly in the first 45 days of illness, and then monthly until the third month after illness onset, because the failure to escalate thromboprophylaxis in time with the rapid expansion of aneurysms is a primary cause of morbidity and mortality . ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
==Physical Examination==
A physical examination will demonstrate many of the features listed above.
 
=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].
 
*A  [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
Blood tests
* [[Complete blood count]] (CBC) may reveal normocytic [[anemia]] and eventually [[thrombocytosis]]
* [[Erythrocyte sedimentation rate]] (ESR) will be elevated
* [[C-reactive protein]] (CRP) will be elevated
* [[Liver function tests]] may show evidence of hepatic inflammation and low [[serum albumin]]
===Imaging Findings===
 
=== Other Diagnostic Studies ===
Other tests (may or may not be performed)
* [[Electrocardiogram]] may show evidence of [[ventricular]] dysfunction or, occasionally, [[arrhythmia]] due to [[myocarditis]]
* [[Echocardiogram]] may show subtle coronary artery changes or, later, true aneurysms.
* [[Ultrasound]] or [[computerized tomography]] may show hydrops (enlargement) of the [[gallbladder]]
* [[Urinalysis]] may show white blood cells and protein in the urine ([[pyuria]] and [[proteinuria]]) without evidence of bacterial growth
* [[Lumbar puncture]] may show evidence of [[aseptic meningitis]]
* [[Angiography]] was historically used to detect coronary artery aneurysms and remains the gold standard for their detection, but is rarely used today unless coronary artery aneurysms have already been detected by echocardiography.


==Treatment==
==Treatment==
===Medical Therapy===
[[Kawasaki disease medical therapy|Medical Therapy]] | [[Kawasaki disease surgery|Surgery]] | [[Kawasaki disease primary prevention|Primary Prevention]] | [[Kawasaki disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Kawasaki disease future or investigational therapies|Future or Investigational Therapies]]
[[Intravenous Immunoglobulin]] ([[IVIG]]) and [[aspirin]] are indicated in the treatment of Kawasaki Disease.  It is imperative that treatment be started as soon as the diagnosis is made to prevent damage to the [[coronary arteries]].  Except for Kawasaki disease and a couple of other indications, aspirin is otherwise normally not recommended for children due to its association with [[Reye's syndrome]].  Children with Kawasaki disease should be hospitalized. 
 
*1. '''Initial treatment''' <ref>{{cite web | title = Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease
| url =http://circ.ahajournals.org/content/110/17/2747.full }}</ref>
:* Preferred regimen: [[IVIG]] 2 g/kg single infusion within the first 7-10 days of illness {{and}} [[Aspirin]] 80-100 mg/kg/day qid , reduce the aspirin dose after the child has been afebrile for 48 to 72 hours, then begin low-dose aspirin (3 to 5 mg/kg/day) and maintain it until the patient shows no evidence of coronary changes by 6 to 8 weeks after the onset of illness
:* Note (1): Other clinicians continue highdose aspirin until day 14 of illness and 48 to 72 hours after fever cessation
:* Note (2): For children who develop coronary abnormalities, aspirin may be continued indefinitely
 
*2. '''Treatment of Patients Who Failed to Respond to Initial Therapy (persistent or recrudescent fever ≥ 36 hours after completion of the initial IVIG infusion)'''
:* Preferred regimen: [[IVIG]] 2 g/kg q24h for 1-3 days {{or}} [[Methylprednisolone]] 30 mg/kg IV for 2-3 hours q24h for 1-3 days
 
===AHA Scientific Statement on Kawasaki Disease===
 
====Recommendations for Initial Treatment With Intravenous Immunoglobulin (IVIG) and Asetil Salisilat Acid (ASA)====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients with complete KD criteria and those who meet the algorithm criteria for incomplete KD should be treated with high-dose IVIG (2 g/kg given as a single intravenous infusion) within 10 days of illness onset but as soon as possible after diagnosis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to administer IVIG to children presenting after the 10th day of illness (ie, in whom the diagnosis was missed earlier) if they have either persistent fever without other explanation or coronary artery abnormalities together with ongoing systemic inflammation, as manifested by elevation of ESR or CRP (CRP >3.0 mg/dL). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' Administrationofmoderate-(30–50mg·kg−1·d−1) to high-dose (80–100 mg·kg−¹·d−¹) ASA is reasonable until the patient is afebrile, although there is no evidence that it reduces coronary artery aneurysms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' IVIG generally should not be administered to patients beyond the tenth day of illness in the absence of fever, significant elevation of inflammatory markers, or coronary artery abnormalities . ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''2.''' The ESR is accelerated by IVIG therapy and therefore should not be used to assess response to IVIG therapy. A persistently high ESR alone should not be interpreted as a sign of IVIG resistance. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
====Recommendations for Adjunctive Therapies for Primary Treatment====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Administration of a longer course of corticosteroids (eg, tapering over 2–3 weeks), together with IVIG 2 g/kg and ASA, may be considered for treatment of high-risk patients with acute KD, when such high risk can be identified in patients before initiation of treatment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Single-dose pulse methylprednisolone should not be administered with IVIG as routine primary therapy for patients with Kawasaki Disease. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
====Recommendations for Additional Therapy in the IVIG-Resistant Patient====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to administer a second dose of IVIG (2 g/kg) to patients with persistent or recrudescent fever at least 36 hours after the end of the first IVIG infusion. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Administration of high-dose pulse steroids (usually methylprednisolone 20–30 mg/kg intravenously for 3 days, with or without a subsequent course and taper of oral prednisone) may be considered as an alternative to a second infusion of IVIG or for retreatment of patients with KD who have had recurrent or recrudescent fever after additional IVIG. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' Administration of a longer (eg, 2–3 weeks) tapering course of prednisolone or prednisone, together with IVIG 2 g/kg and ASA, may be considered in the retreatment of patients with KD who have had recurrent or recrudescent fever after initial IVIG treatment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' Administration of infliximab (5 mg/kg) may be considered as an alternative to a second infusion of IVIG or corticosteroids for IVIG-resistant patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''4.''' Administration of cyclosporine may be considered in patients with refractory KD in whom a second IVIG infusion, infliximab, or a course of steroids has failed. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''5.''' Administration of immunomodulatory monoclonal antibody therapy (except TNF-α block- ers), cytotoxic agents, or (rarely) plasma exchange may be considered in highly refractory patients who have failed to respond to a second infusion of IVIG, an extended course of steroids, or infliximab. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
====Recommendations for Treatment of Coronary Artery Thrombosis====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Coronary artery thrombosis with actual or impending occlusion of the arterial lumen should be treated with thrombolytic therapy or, in patients of sufficient size, by mechanical restoration of coronary artery blood flow at cardiac catheterization.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Thrombolytic agents should be administered together with low-dose ASA and low-dose heparin, with careful monitoring for bleeding.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Treatment of coronary artery thrombosis with substantial thrombus burden and high risk of occlusion with a combination of reduced-dose thrombolytic therapy and abciximab may be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
====Risk-Stratified Recommendations for Long-Term Evaluation and Management====
 
=====No Involvement (Z Score Always <2)=====
 
{| class="wikitable" style="width:80%"
 
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to use echocardiographic coronary artery luminal dimensions converted to BSA-adjusted Z scores to determine risk stratification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable that no additional cardiology assessment be performed. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may be provided by the primary care provider. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' It is reasonable to assess blood pressure, fast- ing lipid profile, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking at least once and ideally at least 1 year from the episode of acute KD; this may be performed by the primary care provider. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, angiotensin-converting enzyme inhibitor [ACEI], statin)'''
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' No additional medical therapy should be given. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to give low-dose ASA for up to 4 to 6 weeks after the episode of acute KD, which should be discontinued thereafter. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit with no restrictions or precautions at any time. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide age-appropriate counseling regarding contraception and pregnancy without modification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
===Dilation Only (Z Score ≥2 but <2.5, or a Decrease in Z Score During Follow-up ≥1)===
 
{| class="wikitable" style="width:80%"
 
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' If luminal dimensions have returned to normal by 4 to 6 weeks after KD onset, it is reasonable to discharge the patient from cardiology care, although ongoing follow-up to 12 months may be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' If dilation remains present at 4 to 6 weeks after KD onset, then it is reasonable to continue follow-up to 12 months. If the luminal dimensions return to normal before then, it is reasonable to discharge the patient from ongoing cardiology care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' Resolution is expected within 1 year. If dilation persists at 1 year, consider whether this represents a dominant branch. If this is a probable explanation, then it is reasonable to discharge the patient from ongoing cardiology care, although ongoing follow-up every 2 to 5 years may be considered. Patients and families should be advised to remember that having had KD is part of the patient’s permanent medical history. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable that no additional cardiology assessment be performed. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may be provided by the primary care provider. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' It is reasonable to assess blood pressure, fasting lipid profile, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking at least once and ideally at least 1 year from the episode of acute KD; this may be performed by the primary care provider. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, ACEI, statin)'''
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' No additional medical therapy should be given. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to give low-dose ASA until 4 to 6 weeks after the acute episode, which should be discontinued thereafter. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit with no restrictions or precautions at any time. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counseling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide age-appropriate counseling regarding contraception and pregnancy without modification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Regression to Normal Z Score or Dilation Only=====
 
{| class="wikitable" style="width:80%"
 
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess every 1 to 3 years. It is reasonable not to perform echocardiogra- phy unless there is evidence for inducible myocardial ischemia or the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myocardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every 3 to 5 years or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Further imaging with angiography (CT, MRI, invasive) may be considered only if there is evidence for inducible myocardial ischemia or ventricular dysfunction. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' It is reasonable to assess blood pressure, fasting lipid profile, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking every 2 years; this may be performed by the primary care provider. It is reasonable to obtain a follow- up fasting lipid profile. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, ACEI, statin)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Empirical treatment with β-blockers is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Ongoing treatment with low-dose ASA may be considered, although it is reasonable to discontinue.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intol- erant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit with no restrictions or precautions at any time .''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide age-appropriate counseling regarding contraception and pregnancy without modification.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Medium Aneurysms (Z Score ≥5 to <10, With an Absolute Luminal Dimension <8 mm)=====
 
======Current or Persistent Medium Aneurysms======
 
{| class="wikitable" style="width:80%"
 
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit with no restrictions or precautions at any time .''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myo- cardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every 1 to 3 years or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Further imaging with angiography (CT, MRI, invasive) may be considered for periodic sur- veillance every 2 to 5 years.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' It is reasonable to assess blood pressure, fasting lipid profile, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking at least once and ideally at least 1 year from the episode of acute KD; this may be performed by the primary care provider. It is reasonable to obtain a follow-up fasting lipid profile.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, ACEI, statin)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Empirical treatment with β-blockers is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients should be treated with low-dose ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intoler- ant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Additional patient and coronary artery characteristics may be considered in decision making regarding intensification of thromboprophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Dual-antiplatelet therapy with an additional antiplatelet agent (eg, a thienopyridine such as clopidogrel) may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Use of anticoagulation (warfarin, LMWH) is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' For patients taking dual-antiplatelet therapy, activities involving a risk of bodily contact, trauma, or injury should be restricted or modified.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit without restrictions or precautions. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to discourage use of oral contraceptive drugs that increase thrombosis risk, to recommend that pregnancy be supervised by a multidisciplinary team including a cardiologist, and to alter thromboprophylaxis management during pregnancy and delivery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Regression to Small Aneurysms=====
 
{| class="wikitable" style="width:80%"
 
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Ongoing follow-up assessment every year is reasonable.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myocardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every 2 to 3 years or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Further imaging with angiography (CT, MRI, invasive) may be considered for periodic surveillance every 3 to 5 years.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' It is reasonable to assess blood pressure, fasting lipid profile, body mass index (and plot), waist circumference, dietary and activ- ity assessment, and smoking every year; this may be performed by the primary care provider. It is reasonable to obtain a follow- up fasting lipid profile.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, ACEI, statin)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Empirical treatment with β-blockers is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients should be treated with low-dose ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intolerant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Dual-antiplatelet therapy with an additional antiplatelet agent (eg, a thienopyridine such as clopidogrel) may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Additional patient and coronary artery characteristics may be considered in decision making regarding intensification or discontinuation of thromboprophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Use of anticoagulation is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' For patients taking dual-antiplatelet therapy, activities involving a risk of bodily contact, trauma, or injury should be restricted or modified.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit without restrictions or precautions. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to discourage use of oral contraceptive drugs that increase thrombo- sis risk, to recommend that pregnancy be supervised by a multidisciplinary team includ- ing a cardiologist, and to alter thromboprophylaxis management during pregnancy and delivery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Regression to Normal Z Score or Dilation Only=====
 
{| class="wikitable" style="width:80%"
 
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to discourage use of oral contraceptive drugs that increase thrombo- sis risk, to recommend that pregnancy be supervised by a multidisciplinary team includ- ing a cardiologist, and to alter thromboprophylaxis management during pregnancy and delivery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myocardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every 2 to 4 years or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' It is reasonable to perform no further imaging with angiography (CT, MRI, invasive) in the absence of evidence of inducible myocardial ischemia.
''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' It is reasonable to assess blood pressure, fasting lipid profile, body mass index (and plot), waist circumference, dietary and activ- ity assessment, and smoking every 2 years; this may be performed by the primary care provider. It is reasonable to obtain a follow- up fasting lipid profile.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, statin)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Empirical treatment with β-blockers is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to continue treatment with low-dose ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intolerant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an additional antiplatelet agent (eg, a thienopyridine such as clopidogrel) is not recommended except in the presence of inducible myocardial ischemia.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Additional patient and coronary artery characteristics may be considered in decision making regarding intensification or discontinuation of thromboprophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Use of anticoagulation (warfarin/LMWH) is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit without restrictions or precautions. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide age-appropriate counseling regarding contraception and pregnancy without modification.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Large and Giant Aneurysms (Z Score ≥10 or Absolute Dimension ≥8 mm)=====
 
{| class="wikitable" style="width:80%"
 
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess patients at 1, 2, 3, 6, 9, and 12 months after the episode of acute KD in the first year and every 3 to 6 months thereafter.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assess- ment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myocardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every 6 to 12 months or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Further imaging with angiography (CT, MRI, invasive) may be considered for diagnostic and prognostic purposes during the first year and may be considered for periodic surveillance every 1 to 5 years thereafter.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess blood pressure, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking every 6 to 12 months; this may be performed by the primary care provider. It is reasonable to obtain a fasting lipid profile during follow- up.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| Medical therapy (β-blockers, ACEI, statin)
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Empirical treatment with β-blockers may be considered .''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients should be treated with low-dose ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intolerant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Use of warfarin to achieve a target international normalized ratio of 2 to 3 is reasonable.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"3.''' Use of LMWH to achieve target anti-factor Xa levels of 0.5 to 1.0 U/mL is reasonable as an alternative to warfarin.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an additional antiplatelet agent (eg, a thienopyridine such as clopidogrel) may be considered together with ASA and warfarin/ LMWH (triple therapy) for thromboprophylaxis in the setting of very extensive or distal coronary artery aneurysms, or if there is a history of coronary artery thrombosis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Additional patient and coronary artery characteristics (Table 9) may be considered in decision making regarding adjustments to strategy for thromboprophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Activities involving a risk of bodily contact, trauma, or injury should be restricted or modified if the patient is on dual-antiplatelet or anticoagulation therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit without restrictions or precautions. Participation in competitive sports or high intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to discourage use of oral contraceptive drugs that increase thrombosis risk, to recommend that pregnancy be super- vised by a multidisciplinary team including a cardiologist, and to alter thromboprophylaxis management during pregnancy and delivery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Regression to Medium Aneurysms=====
 
{| class="wikitable" style="width:80%"
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess the patient every 6 to 12 months.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myocardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every year or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Further imaging with angiography (CT, MRI, invasive) may be considered for periodic surveillance every 2 to 5 years.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' It is reasonable to assess blood pressure, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking every year; this may be performed by the primary care provider. It is reason- able to obtain a follow-up fasting lipid profile.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, ACEI, statin)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Empirical treatment with β-blockers may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients should be treated with low-dose ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intolerant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Discontinuation of anticoagulation (warfarin/ LMWH) and substitution with an additional antiplatelet agent (eg, a thienopyridine such as clopidogrel) is reasonable.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Additional patient and coronary artery characteristics may be considered in decision making regarding adjustments to strategy for thromboprophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Use of anticoagulation (warfarin, LMWH) is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Activities involving a risk of bodily contact, trauma, or injury should be restricted or modified for patients on dual-antiplatelet or anticoagulation therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit without restrictions or precautions. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to discourage use of oral contraceptive drugs that increase thrombosis risk, to recommend that pregnancy be super- vised by a multidisciplinary team including a cardiologist, and to alter thromboprophylaxis management during pregnancy and delivery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Regression to Small Aneurysms=====
 
{| class="wikitable" style="width:80%"
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess the patient every 6 to 12 months.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myocardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every 1 to 2 years or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Further imaging with angiography (CT, MRI, invasive) may be considered for periodic surveillance every 2 to 5 years.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' It is reasonable to assess blood pressure, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking every year; this may be performed by the primary care provider. It is reason- able to obtain a follow-up fasting lipid profile.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, ACEI, statin)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Empirical treatment with β-blockers may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"3.''' Discontinuation of additional medical therapy may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients should be treated with low-dose ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intolerant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Additional patient and coronary artery char- acteristics may be considered in decision making regarding adjustments to strategy for thromboprophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Anticoagulation or dual-antiplatelet therapy is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' For patients on anticoagulation or dual-antiplatelet therapy, activities involving a risk of bodily contact, trauma, or injury should be restricted or modified.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit without restrictions or precautions. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide age-appropriate counseling regarding contraception. It is reasonable to recommend that pregnancy be supervised by a multidisciplinary team including a cardiologist and to alter thromboprophylaxis management during pregnancy and delivery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Regression to Normal Z Score or Dilation Only=====
 
{| class="wikitable" style="width:80%"
|-
| '''Frequency of cardiology assessment (to include history and physical examination, echocardiography, electrocardiography)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess the patient every 1 to 2 years. Not performing routine 2D echocardiography may be considered unless there is evidence for inducible myocardial ischemia or the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Type and frequency of additional cardiology assessment (other cardiology testing)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to assess for inducible myocardial ischemia (stress echocardiography, stress with MRI, stress NM perfusion imaging, PET) every 2 to 5 years or if the patient has symptoms suggestive of ischemia or signs suggestive of ventricular dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''Cardiovascular risk factor assessment and management'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide general counseling regarding healthy lifestyle and activity promotion at every visit; this may additionally be provided by the primary care provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' It is reasonable to assess blood pressure, body mass index (and plot), waist circumference, dietary and activity assessment, and smoking every 2 years; this may be performed by the primary care provider. It is reasonable to obtain a follow-up fasting lipid profile as per the Expert Panel guidelines.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Medical therapy (β-blockers, ACEI, statin)'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Empirical statin therapy for non–lipid-lowering (pleiotropic) effects may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Empirical treatment with β-blockers is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Thromboprophylaxis'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to continue treatment with low-dose ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |'''"2.''' Use of an alternative antiplatelet agent (eg, a thienopyridine such as clopidogrel) instead of ASA is reasonable if the patient is intol- erant or resistant to ASA.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Additional patient and coronary artery characteristics may be considered in decision making regarding intensification or discontinuation of thromboprophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Use of anticoagulation (warfarin/LMWH) or dual-antiplatelet therapy is not indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Physical activity'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' For patients on anticoagulation or dual-anti- platelet therapy, activities involving a risk of bodily contact, trauma, or injury should be restricted or modified.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide physical activity counseling at every visit without restrictions or precautions. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''Reproductive counselling'''
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to provide age-appropriate counseling regarding contraception. It is reasonable to recommend that pregnancy be supervised by a multidisciplinary team including a cardiologist and to alter thrombo- prophylaxis management during pregnancy and delivery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Recommendations for Testing for Inducible Ischemia=====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to use stress echocardiography or CMRI, NM MPI, or PET for assessment of inducible myocardial ischemia.
'''Note:''' The general principle is to minimize risk to the patient, particularly cumulative radiation dose, and this should guide selection of testing modality based on patient and institutional characteristics''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Exercise treadmill electrocardiographic testing alone should not be used for assessment for inducible myocardial ischemia.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
=====Recommendation for Assessment of Patients With Inducible Myocardial Ischemia=====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients with evidence of inducible myocardial ischemia on testing should undergo invasive coronary angiography.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
=====Recommendations for Indications for Mechanical Revascularization=====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Adult patients with remote history of KD presenting with STEMI should be referred emergently for coronary angiography for determination of best means of flow restoration in the culprit artery.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Revascularization should be performed in KD patients with stable angina and high-risk coronary anatomy including left main CAD, multi- vessel coronary disease with reduction in LV function, multivessel coronary disease with diabetes mellitus, or high-risk noninvasive ischemia testing.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' Revascularization should be performed for patients with non–ST-segment elevation and coronary anatomy amenable to revascularization on coronary angiography.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Revascularization for patients with stable angina and symptoms refractory to maximal medical therapy is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Revascularization for KD patients with silent ischemia and ischemia involving >10% of LV mass may be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Revascularization should be avoided in KD patients in the acute/subacute phase of the illness with STEMI attributable to acute thrombotic occlusion of an aneurysm.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
=====Recommendations for Modes of Revascularization=====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' CABG is preferred to PCI in KD patients with left main CAD, multivessel CAD with reduced LV function, multivessel CAD with lesions not amenable to PCI, and multivessel CAD in diabetic patients.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' CABG is preferred to PCI in older children and adults with KD and multivessel involvement .''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |'''<nowiki>"</nowiki>3.''' CABG should be performed with bilateral internal thoracic arterial grafts where possible.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''4.''' PCI is preferred in patients with single-vessel or focal multivessel disease amenable to PCI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''5.''' RA and stents should be used in PCI of calcified lesions.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' The use of multivessel PCI is reasonable for KD patients with focal lesions amenable to PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' The use of DESs during PCI is reasonable for KD patients who do not require long- term anticoagulation. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' The use of IVUS is reasonably indicated during PCI in KD patients to ensure adequate stent sizing and deployment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Multivessel PCI may be considered for patients who are acceptable CABG candidates but prefer to avoid CABG, provided the risks and benefits of both approaches are discussed with and understood by the patient. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' The use of DESs during PCI may be considered for KD patients who require anti- coagulation, provided the bleeding risk of the patient is acceptable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Stand-alone balloon angioplasty should not be used for PCI in KD patients with coronary obstructions.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
=====Recommendation for Cardiac Transplantation=====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' The use of multivessel PCI is reasonable for KD patients with focal lesions amenable to PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
===Surgery===
 
==Prevention==
 
===AHA Scientific Statement on Kawasaki Disease===
 
====Recommendations for Prevention of Thrombosis During the Acute Illness====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Low-dose ASA (3–5 mg·kg−¹·d−¹) should be administered to patients without evidence of coronary artery changes until 4 to 6 weeks after onset of illness.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' For patients with rapidly expanding coronary artery aneurysms or a maximum Z score of ≥10, systemic anticoagulation with LMWH or warfarin (international normalized ratio target 2.0–3.0) in addition to low dose ASA is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' For patients at increased risk of thrombosis, for example, with large or giant aneurysms (≥8 mm or Z score ≥10) and a recent history of coronary artery thrombosis, “triple therapy” with ASA, a second antiplatelet agent, and anticoagulation with warfarin or LMWH may be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Ibuprofen and other non steroidal anti-inflammatory drugs with known or potential involvement of cyclooxygenase pathway may be harmful in patients taking ASA for its antiplatelet effects. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
====Recommendations for Risk Stratification of Coronary Artery Abnormalities====
 
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to use echocardiographic coronary artery luminal dimensions converted to BSA-adjusted Z scores to determine risk stratification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' It is reasonable to incorporate both maximal and current coronary artery involvement in risk stratification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' It is reasonable to incorporate the presence of additional features other than coronary artery luminal dimensions into decisions regarding risk stratification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}


==References==
==Case Studies==
{{Reflist|2}}
[[Kawasaki disease case study one|Case #1]]


[[Category: (name of the system)]]
==External links==
==External links==
*[http://www.kdfoundation.org/ Kawasaki Disease Foundation]
*[http://www.kdfoundation.org/ Kawasaki Disease Foundation]

Latest revision as of 14:35, 24 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2], Arzu Kalayci, M.D. [3]

Synonyms and keywords: Mucocutaneous lymph node syndrome; Lymph node syndrome; Acute febrile vasculitic syndrome

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