The need for changes in diagnostic criteria for kawasaki disease in infants

Background: Infants with Kawasaki disease commonly have atypical presentations and a higher complication rate, likely related to delayed diagnosis and treatment. Methods: A total of 81 cases with Kawasaki disease who were treated at our hospital from 1988 to 1996 were analyzed retrospectively. Among them, 21 (25%) had atypical presentations of Kawasaki disease. Of the 21 patients who presented with atypical presentation of Kawasaki disease, 9 (45%) were infants and 12 were children older than one year. Results: Infants had a higher incidence of atypical Kawasaki disease [9 (45%) versus 12 (19%); P = 0.02] and also a higher incidence of coronary artery complications than the patients older than one year did [9(45%) versus 11 (18%); P < 0.05]. Cervical lymphadenopathy was less common in infants younger than 1 year [0 (0%) versus 40 (65%)]. Other manifestations and laboratory changes were not different despite patient age. Coronary artery complications did not develop in any infants who received early intravenous immunoglobulin (IVIG) therapy. Conclusion: From this study, we found that the diagnostic criteria for Kawasaki disease are too restrictive to allow early diagnosis for infants with atypical presentation. It is suggested that the diagnostic criteria for infants with Kawasaki disease may be revised for early diagnosis.