Controversies in diagnosis and management of Kawasaki disease

Table 3 Salient differences between American Heart Association 2004 and 2017 criteria[1,13]

Duration of fever	In the presence of ≥ 4 principal clinical features, particularly when redness and swelling of the hands and feet are present, KD can be diagnosed even with 4 d of fever
History	Presence of one or more principal clinical manifestations of disease that can be revealed on history but have disappeared by the time of presentation, have been considered important for diagnosis
KD shock syndrome	KDSS has been given special consideration in the 2017 revised guidelines because in the presence of shock the diagnosis of KD is often not considered
KD in infants	Clinicians should have a lower threshold for diagnosis of KD in this age group
Incomplete KD	Algorithm for incomplete KD has been simplified
KD and infections	The issue of infections and KD has been detailed at length. Diagnosis of KD must not be excluded even in the presence of a documented infection when typical clinical features of KD are present
Bacterial lymphadenitis	Ultrasonography and computed tomography findings in differentiating the 2 conditions- bacterial lymphadenitis is often single and has a hypoechoic core on ultrasonography, while lymphadenopathy in KD is usually multiple and is associated with retropharyngeal edema or phlegmon
2D-echocardigraphy	The limitations of echocardiography and other diagnostic modalities have been highlighted. Z-score (by Manlihot et al) for severity classification of coronary artery abnormalities has been adapted

KD: Kawasaki disease; KDSS: Kawasaki disease shock syndrome.