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. 2022 Mar 16;65:101516. doi: 10.1016/j.ppedcard.2022.101516

Table 1.

Diagnostic criteria for typical and atypical Kawasaki Disease and MIS-C.

Kawasaki Disease 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 conjunctival injection

  • Oral mucosal changes

  • Peripheral extremity changes

Atypical Kawasaki Disease Patients whose illness does not meet the above KD case definition but who have fever and coronary artery abnormalities are classified as having atypical or incomplete KD:
Criteria is as follows:
  • Fever for 5 days or more meeting 2 to 3 diagnostic criteria or infants with fever for 7 or more days with no other explanation:
    • -
      If the C-reactive protein (CRP) is <3 mg/dl and erythrocyte sedimentation rate (ESR) < 40 mm/h, conduct serial clinical and laboratory assessments if fevers persist. If peeling begins an echocardiogram is then indicated.
    • -
      If the CRP is 3 mg/dl or more and ESR is 40 mm/h or more, and there are 3 or more of the following laboratory findings:
      • 1)
        Anemia for age
      • 2)
        Platelet count of 450,000 or more after the 7th day of fever
      • 3)
        Albumin of 3 g/dl or less
      • 4)
        Elevated Alanine Aminotransferase (ALT)
      • 5)
        White Blood Cell count of 15,000 mm3 or more
      • 6)
        Urine White Blood Cells of 10/hpf or more
      or
    • -
      Positive echocardiogram
Treatment is then indicated [3]
Multi-inflammatory syndrome in children related to COVID-19 An individual aged <21 years presenting with fever*, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization, with multisystem (≥2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurological); AND:
  • No alternative plausible diagnoses; AND

  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms.

*Fever ≥38.0 °C for ≥24 h, or report of subjective fever lasting ≥24 h
**Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin
Additional information:
  • Some individuals may fulfill full or partial criteria for Kawasaki disease should be reported if they meet the case definition for MIS-C.

  • Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection [13]

Information for MIS-C and Kawasaki disease in this table was obtained from the center for disease control website.

Information on atypical Kawasaki disease algorithm is from: McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927-e999. doi:https://doi.org/10.1161/CIR.0000000000000484.