Patient handout

Kawasaki disease

PRODUCTION

1. Your condition

This handout is for kawasaki disease. Your care team identified this based on: fever >=5 days in a child (aha 2017 mccrindle).

Other reasons your team may use this plan: conjunctivitis + rash + lip/oral changes + extremity changes + lymphadenopathy (aha 2017 principal criteria); markedly elevated crp/esr with normocytic anemia + thrombocytosis (aha 2017 supplementary); echocardiographic coronary artery dilation / aneurysm (aha 2017).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
IVIG	2 g/kg single dose IV over 10–12 hours	IV	single dose	AHA 2017 — primary intervention; reduces coronary aneurysm risk from ~25% to ~4% if given <10 days; still indicated after day 10 if persistent fever or evidence of inflammation
aspirin	High-dose 80–100 mg/kg/day PO divided q6h (US/AHA) OR 30–50 mg/kg/day (Japan/Europe)	PO	q6h	AHA 2017 — anti-inflammatory dose acutely; controversial whether high vs moderate is better; both effective when paired with IVIG

Plan: Kawasaki disease — IVIG + ASA → escalation for IVIG-resistance → long-term cardiac surveillance

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Recovering well — no aneurysm or small aneurysm regressing

If you have:

Afebrile x 1 week (AHA 2017)
Normal/mild coronary changes (z-score <2.5) (AHA 2017)
Normal CBC + CRP/ESR trending normal (AHA 2017)
Tolerating low-dose ASA (AHA 2017)
No new symptoms (AHA 2017)

Do this:

Continue low-dose ASA 3-5 mg/kg/day until 6-8 weeks afebrile + normal echo (AHA 2017)
Cardiology follow-up at 1-2 weeks + 6-8 weeks (AHA 2017)
Avoid live vaccines for 11 months after IVIG (consult vaccine schedule; AAP 2024)
Avoid contact with VZV/influenza while on ASA (Reye risk) — switch to clopidogrel if exposed (AHA 2017)
Daily activity as tolerated (AHA 2017)
Inform pediatrician + cardiologist of any new symptoms (AHA 2017)

YELLOW — Caution — coronary aneurysm OR fever recurrence OR medication reaction

If you have:

New coronary aneurysm (z-score 2.5-10) (AHA 2017)
Recurrent fever after discharge (AHA 2017)
Persistent inflammation (CRP/ESR not normalizing) (AHA 2017)
Medication side effects (GI bleed on ASA, easy bruising) (AHA 2017)
Suspected adverse reaction to IVIG (delayed hemolysis) (AHA 2017)

Do this:

Contact pediatric cardiology within 24h (AHA 2017)
May need additional anti-thrombotic (clopidogrel if medium aneurysm) (AHA 2017)
Recurrent fever then re-evaluate for IVIG resistance OR alternative diagnosis (AHA 2017)
Adverse reaction then contact provider for medication change (AHA 2017)
Bring child to ED if signs of bleeding or coronary ischemia (chest pain, syncope) (AHA 2017)

Call your provider if:

Any aneurysm progression or new aneurysm (AHA 2017)
Fever recurrence (AHA 2017)
Medication side effects (AHA 2017)

RED — Emergency — coronary thrombosis, MI, severe bleeding, KDSS recurrence

If you have:

Chest pain in child with prior KD (AHA 2017)
Syncope, sudden collapse (AHA 2017)
Severe bleeding on antiplatelet/anticoagulant (AHA 2017)
New shock syndrome with rash + perfusion changes (AHA 2017)
Stroke symptoms (focal neuro deficit) (AHA 2017)

Do this:

Call 911 immediately (AHA 2017)
Bring all medications + KD records (AHA 2017)
Identify as Kawasaki disease patient with coronary aneurysm if applicable (AHA 2017)
Pediatric cardiac center transfer if available (AHA 2017)

Call your provider if:

Any red zone trigger — go to ED, do not wait (AHA 2017)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Fever ≥5 days + ≥4 of 5 principal criteria
Fever ≥5 days + 2–3 principal criteria + supportive labs (CRP ≥3, ESR ≥40, ≥3 supplementary)
Persistent fever ≥36 hours after end of first IVIG
Kobayashi score ≥5 (or Egami ≥3 / Sano ≥2) at diagnosis (Asian cohort)
KD with hypotension, poor perfusion, ventricular dysfunction, or vasoactive requirement(life-threatening)
Coronary z-score ≥2.5 at first echo
Coronary z-score ≥10 OR absolute diameter ≥8 mm(life-threatening)
Suspected MIS-C with KD-like features (post-SARS-CoV-2 exposure 2–6 wk prior)

5. Follow-up

Pediatric cardiology follow-up at 6-8 wk + lifetime if aneurysm per AHA 2017; influenza/VZV vaccination timing relative to IVIG (delay live vaccines 11 months per AAP 2024); discontinue ASA at 6-8 wk if no aneurysm; family counseling on recurrence (~2%)

6. Sources

Guideline: 2017 AHA Scientific Statement on Diagnosis, Treatment, and Long-term Management of Kawasaki Disease + RAISE trial (steroid for high-risk) + Egami/Kobayashi/Sano IVIG-resistance scores