side by side comparison
Kawasaki Disease vs Rheumatic Fever: Two Post-Infectious Cardiac Inflammations in Children
Both diseases inflame a child's heart after an infection, but one destroys coronary arteries and the other destroys heart valves. Mixing up the diagnostic criteria — or choosing IVIG when the child needs penicillin — is a classic NCLEX trap that changes the entire treatment plan.
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Side-by-side2 compared
Focus
Dimension
Kawasaki Disease
Rheumatic Fever
Pathophysiology & risk
- Idiopathic medium-vessel vasculitis
- Age < 5 yr (peak 18–24 mo)
- No identified pathogen
- Autoimmune reaction to GAS pharyngitis
- Age 5–15 yr
- 2–6 wk after strep
Signs & symptoms
- ★Fever ≥ 5 days despite antipyretics
- Strawberry tongue, cracked lips
- Peeling fingertips/toes (late)
- ★Sydenham chorea
- Migratory polyarthritis
- Erythema marginatum, SC nodules
Diagnostics & labs
- Clinical: fever ≥ 5 d + 4 of 5 features
- ↑ ESR/CRP
- Echo for coronary aneurysms
- ↑ Platelets (thrombocytosis, wk 2–3)
- ★Jones: 2 major, or 1 major + 2 minor
- ↑ ASO titer
- Positive throat culture/rapid strep
- ↑ ESR/CRP
Nursing priorities
- ★IVIG within 10 days of fever onset
- Monitor cardiac status
- Mouth care for cracked lips
- Penicillin to eradicate strep
- Bed rest during acute carditis
- Monitor cardiac status
Treatment & meds
- IVIG single dose
- High-dose ASA, then low-dose ASA
- Penicillin (eradicate GAS)
- ASA/NSAIDs for migratory arthritis
- Steroids for severe carditis
Patient teaching
- On ASA: report flu/varicella (Reye)
- Serial echos to watch coronaries
- Delay live vaccines 11 mo after IVIG
- Monthly IM penicillin for years
- Treat strep throat promptly
- On ASA: report flu/varicella (Reye)
Red flags — escalate
- Coronary aneurysm → MI/thrombosis
- New murmur, tachycardia (carditis)
Complications
- Coronary aneurysm
- Myocardial infarction
- Rheumatic heart disease (mitral stenosis)
- Recurrence with new strep infection
Pathophysiology & risk
Kawasaki Disease
- Idiopathic medium-vessel vasculitis
- Age < 5 yr (peak 18–24 mo)
- No identified pathogen
Rheumatic Fever
- Autoimmune reaction to GAS pharyngitis
- Age 5–15 yr
- 2–6 wk after strep
Signs & symptoms
Kawasaki Disease
- ★Fever ≥ 5 days despite antipyretics
- Strawberry tongue, cracked lips
- Peeling fingertips/toes (late)
Rheumatic Fever
- ★Sydenham chorea
- Migratory polyarthritis
- Erythema marginatum, SC nodules
Diagnostics & labs
Kawasaki Disease
- Clinical: fever ≥ 5 d + 4 of 5 features
- ↑ ESR/CRP
- Echo for coronary aneurysms
- ↑ Platelets (thrombocytosis, wk 2–3)
Rheumatic Fever
- ★Jones: 2 major, or 1 major + 2 minor
- ↑ ASO titer
- Positive throat culture/rapid strep
- ↑ ESR/CRP
Nursing priorities
Kawasaki Disease
- ★IVIG within 10 days of fever onset
- Monitor cardiac status
- Mouth care for cracked lips
Rheumatic Fever
- Penicillin to eradicate strep
- Bed rest during acute carditis
- Monitor cardiac status
Treatment & meds
Kawasaki Disease
- IVIG single dose
- High-dose ASA, then low-dose ASA
Rheumatic Fever
- Penicillin (eradicate GAS)
- ASA/NSAIDs for migratory arthritis
- Steroids for severe carditis
Patient teaching
Kawasaki Disease
- On ASA: report flu/varicella (Reye)
- Serial echos to watch coronaries
- Delay live vaccines 11 mo after IVIG
Rheumatic Fever
- Monthly IM penicillin for years
- Treat strep throat promptly
- On ASA: report flu/varicella (Reye)
Red flags — escalate
Kawasaki Disease
- Coronary aneurysm → MI/thrombosis
Rheumatic Fever
- New murmur, tachycardia (carditis)
Complications
Kawasaki Disease
- Coronary aneurysm
- Myocardial infarction
Rheumatic Fever
- Rheumatic heart disease (mitral stenosis)
- Recurrence with new strep infection
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Clinical Pearl
Strawberry tongue + coronary aneurysm = Kawasaki + IVIG; post-strep + valve damage = rheumatic + penicillin prophylaxis.
Component Topics
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Go further
- TopicKawasaki DiseaseA toddler with a fever that will not break for five days, cracked red lips, and a strawberry tongue — and the real problem is the coronary arteries.
- TopicRheumatic FeverA strep throat nobody finished the antibiotics for, and weeks later the child's joints hurt and a new heart murmur has appeared.
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