Abstract
Kawasaki disease (KD) is a vasculitis with predilection for coronary arteries. Due to a lack of reliable confirmatory laboratory tests, the diagnosis of KD is based on a characteristic pattern of clinical findings that appear in a typical temporal sequence. The diagnostic criteria have been periodically modified and the American Heart Association has proposed the most recent guidelines for its diagnosis. However, patients may have incomplete or atypical forms of KD and diagnosis can often be difficult. Because oropharyngeal manifestations are a common and important feature for diagnosing KD and recent studies have hypothesized a possible association between KD and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in this review we highlight the importance of dentists in the diagnosis of KD and its potential association with SARS-CoV-2.
Highlights
Kawasaki disease (KD, OMIM #611775), a medium-sized vasculitis with coronary artery predilection, shows a variable incidence rate ranging from 4 to 300 per 100,000 children.[1,2] It is more frequently diagnosed in boys and the diagnosis is based on clinical features, including recurrent fever, polymorphic rash, characteristic changes in the extremities, bilateral conjunctivitis, cervical lymphadenopathy, oropharyngeal changes, such as a ‘strawberry’ tongue, dry, erythematous or split-lips, and oropharyngeal mucosal erythema,[3] because there is no gold standard laboratory test.[4]
Because oropharyngeal manifestations are a common and important feature for diagnosing KD and recent studies have hypothesized a possible association between KD and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in this review we highlight the importance of dentists in the diagnosis of KD and its potential association with SARS-CoV-2
There is an increase in the erythrocyte sedimentation rate, C-reactive protein, blood cell count, serum transaminase levels associated with hypoalbuminemia, thrombocytosis, and anemia
Summary
Kawasaki disease (KD, OMIM #611775), a medium-sized vasculitis with coronary artery predilection, shows a variable incidence rate ranging from 4 to 300 per 100,000 children.[1,2] It is more frequently diagnosed in boys and the diagnosis is based on clinical features, including recurrent fever, polymorphic rash, characteristic changes in the extremities (erythema of the hands and feet accompanied by desquamation of the fingers and toes), bilateral conjunctivitis, cervical lymphadenopathy, oropharyngeal changes, such as a ‘strawberry’ tongue (prominent lingual papillae), dry, erythematous or split-lips, and oropharyngeal mucosal erythema,[3] because there is no gold standard laboratory test.[4]. The association of KD and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was noticed after the first case of KD was diagnosed in a patient infected with the coronavirus disease 2019 (COVID-19) by Jones et al.[7] a cluster. Of SARS-CoV-2-infected children presenting with KD-like symptoms has been reported, as well as, multisystem inflammatory syndrome (MIS), KD shock syndrome, and toxic shock syndrome.[8,9,10,11,12]. This association has worried the scientific community, since the COVID-19 pandemic has reached more of 19.4 million cases and 721,000 deaths (https://who.sprinklr.com, accessed on Aug 9th, 2020). As orofacial manifestations are common and essential for diagnosing KD and a potential association with COVID-19 was reported, we highlight, in this critical review, the clinical and laboratory features of KD and its association with SARS-CoV-2
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