Infants under 6 months are the group most likely to have incomplete Kawasaki disease and the most likely to develop coronary aneurysms. They often lack the classic features.
The American Heart Association algorithm advises that an infant aged 6 months or under with fever for 7 days or more and no other explanation should have inflammatory markers checked and, if raised, an echocardiogram, even without any classic signs. Older children with 5 or more days of fever and two or three features also need evaluation for incomplete disease.
- Infant ≤6 months, fever ≥7 days, no cause: check CRP and ESR
- If raised, arrange echocardiography
- Look for supplementary lab features: anaemia, raised platelets after day 7, low albumin, raised ALT, sterile pyuria
- Do not wait for all five classic features before referring
Why it matters
The children at highest coronary risk are the ones least likely to look like textbook Kawasaki disease.
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