What are the key clinical features to consider when diagnosing Kawasaki Disease in a child?

Key clinical features for diagnosing Kawasaki Disease in a child include:

• Persistent fever lasting at least 5 days, which is a hallmark and essential criterion for diagnosis ¹ (Bayers et al., 2013).
• Conjunctival injection without exudate, typically bilateral and non-purulent ¹ (Bayers et al., 2013).
• Changes in the lips and oral cavity such as erythema, cracked lips, strawberry tongue, and diffuse mucosal injection ¹ (Bayers et al., 2013; Lee et al., 2022).
• Polymorphous rash, which can vary in appearance but is usually widespread ¹ (Bayers et al., 2013).
• Extremity changes including erythema and edema of the hands and feet in the acute phase, followed by periungual desquamation in the subacute phase ¹ (Bayers et al., 2013; Luo et al., 2020).
• Cervical lymphadenopathy, typically unilateral and >1.5 cm in diameter ¹ (Bayers et al., 2013).

Additional clinical manifestations beyond the classic criteria may include irritability, arthritis or arthralgia, and gastrointestinal symptoms such as abdominal pain, vomiting, or diarrhea (Lee et al., 2022). Laboratory findings supporting the diagnosis often show elevated inflammatory markers, thrombocytosis in the subacute phase, and sterile pyuria (Lee et al., 2022).

In clinical practice, the diagnosis is primarily clinical, based on the presence of fever and at least four of the five principal features, but incomplete or atypical presentations are recognized, especially in infants and older children, requiring a high index of suspicion ¹ (Bayers et al., 2013; Luo et al., 2020).