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There is no single test that can identify Kawasaki disease. Instead, the U.S. Centers for Disease Control & Prevention (CDC) has developed criteria to help physicians. If a child has a persistent, unexplained fever for five days, and at least four of the following symptoms, a diagnosis can be made. These symptoms include:
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Red tongue
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Oral-mucosal changes, including cracked, dry lips
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Pink eye (conjunctivitis)
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Enlarged lymph nodes
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Red, patchy rash over the whole body
Not all children will meet these criteria exactly. Children who have fewer than four of these symptoms may still be diagnosed with atypical Kawasaki disease. The treatment course for this form of the disease is the same as for complete Kawasaki disease.
The symptoms will be identified during a physical examination. Both children and parents will also be asked questions about the patient’s medical history and family history. If the condition is suspected, tests such as the following may be ordered:
- Echocardiogram. This test will be used to detect abnormalities in the arteries. An echocardiogram uses high-frequency sound waves to develop images of major arteries and the heart muscle. It is a safe and effective diagnostic test for assessing the size and function of the heart and blood vessels, and should identify most aneurysms that may be present. It is also used to evaluate for fluid accumulation around the heart or leakage of the heart valves.
- Electrocardiogram (EKG). This test measures the electrical activity of the heart muscle and can identify the presence of ischemia (decreased blood flow caused by the narrowing of the blood vessels) or other factors that can contribute to an increased risk of heart attack.
- Stress test. This test combines an EKG and/or echocardiogram with either exercise or, for very young patients, a drug that causes the heart to react as if the person were exercising. The goal is to detect cardiac ischemia when the heart is physically stressed. Sometimes a nuclear perfusion study may show if the coronary artery blood flow to the heart muscle is being compromised.
- Urine test. This test may reveal pus (pyuria) or proteins (proteinuria) in the urine. With Kawasaki disease there is inflammation of the urethra, the channel that leads out from the bladder and this may lead to pyuria without a bacteria being cultured.
- Computed tomography scan (CAT scan) and magnetic resonance angiogram (MRA). Painless tests that are very useful for identifying coronary aneurysms.
- Blood tests will often show an anemia or low blood red cell number. The platelets, the components that are responsible for forming clots, will be elevated. Platelet counts three or four times the normal levels are frequently seen. Non specific tests for inflammation such as a sedimentation rate (ESR) or C-reactive protein (CRP) are usually very elevated and continue to rise as the disease progresses.
If these noninvasive tests cannot confirm or rule out a diagnosis, then a more invasive test called a coronary angiogram may be ordered. This catheter-based test is an x-ray of the arteries located on the surface of the heart (the coronary arteries). It may be more helpful than less invasive tests when making a diagnosis of Kawasaki disease.
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