Infants under six months are the group most likely to form aneurysms and least likely to show the full criteria. A baby with five or more days of fever, irritability out of proportion, and raised inflammatory markers without a source deserves an echocardiogram even with only one or two classic features.
Supportive laboratory clues include low albumin, raised ALT, sterile pyuria, anaemia for age and, after day seven, a rising platelet count. Redness or crusting at a BCG scar is a useful sign in countries that give BCG, India among them.
- Fever ≥5 days in an infant with no source: consider Kawasaki.
- Check CRP, ESR, albumin, ALT, urine and full blood count.
- Look for erythema at the BCG scar.
- Arrange echocardiography early; do not wait for full criteria.
Why it matters
The infants at highest aneurysm risk are the ones most often missed.
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