Unifying Concepts

Diagnostic Criteria for Kawasaki Disease

Presence of at least five of six conditions:

  1. Fever for five days or more

  2. Bilateral conjunctival injection without exudate

  3. Polymorphous exanthem

  4. Changes in lips and mouth:

  • Reddened, dry, or cracked lips
  • Strawberry tongue
  • Diffuse redness of oral or pharyngeal mucosa

5. Changes in extremities:

  • Reddening of palms or soles
  • Indurative oedema of hands or feet
  • Desquamation of skin of hands, feet, and groin (in convalescence)

6. Cervical lymphadenopathy:

  • More than 15 mm in diameter, usually unilateral, single, non-purulent, and painful

Exclusion of diseases with similar presentation:

  • Staphylococcal infection (such as scalded skin syndrome, toxic shock syndrome)

  • Streptococcal infection (such as scarlet fever, toxic shock-like syndrome). Throat carriage of group A streptococcus does not exclude the possibility of Kawasaki disease

  • Measles and other viral exanthems

  • Leptospirosis

  • Rickettsial disease

  • Stevens-Johnson syndrome

  • Drug reaction

  • Juvenile rheumatoid arthritis

Elevated erythrocyte sedimentation rate (ESR), anemia, and thrombocytosis are associated with Kawasaki disease and can support the diagnosis. Coronary artery aneurysms, the most serious consequence of Kawasaki disease, are seen in 20% of untreated patients, and long-term consequences include early atherosclerosis, coronary stenosis, and myocardial infarction.



  1. Taubert KA, Shulman ST. Kawasaki disease. Am Fam Physician. 1999 Jun;59(11):3093-102, 3107-8. [Medline]
  2. Stapp J, Marshall GS. Fulfillment of diagnostic criteria in Kawasaki disease. South Med J. 2000 Jan;93(1):44-7. [Medline]
  3. Curtis N. Kawasaki disease. BMJ. 1997 Aug 9;315(7104):322-3. [Medline]

Created: May 12, 2005

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