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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Comparison

Side-by-side2 compared
Dimension
Kawasaki Disease
Rheumatic Fever
Pathophysiology & risk
  • Idiopathic medium-vessel vasculitis
  • Age < 5 yr (peak 18–24 mo)
  • no pathogen
  • Immune reaction to Group A strep pharyngitis
  • Age 5–15 yr
  • 2–6 wk after strep
Signs & symptoms
  • ★Fever ≥ 5 days, unresponsive to antipyretics
  • Strawberry tongue, cracked lips
  • peeling hands/feet
  • ★Sydenham chorea
  • Migratory polyarthritis
  • erythema marginatum, nodules
Diagnostics & labs
  • Clinical: fever ≥ 5 d + 4 of 5 features
  • ↑ ESR/CRP, ↑ platelets
  • echo coronaries
  • ★Jones criteria: 2 major or 1 major + 2 minor
  • ↑ ASO titer
  • + throat culture
Nursing priorities
  • ★IVIG within 10 days of fever onset
  • Monitor cardiac status
  • daily temp
  • Penicillin to eradicate strep
  • Bed rest
  • monitor for carditis
Treatment & meds
  • IVIG single dose
  • High-dose ASA then low-dose antiplatelet
  • Penicillin (eradicate GAS)
  • ASA/steroids for carditis & joints
Patient teaching
  • Aspirin used despite peds — an exception
  • Serial echos
  • IVIG delays live vaccines
  • Monthly IM penicillin prophylaxis for years
  • Treat strep throat promptly to prevent
Red flags — escalate
  • Coronary artery aneurysm then MI/thrombosis
  • Acute carditis then mitral regurgitation
Complications
  • Coronary aneurysm
  • myocardial infarction
  • Chronic mitral stenosis
  • recurrence
Pathophysiology & risk

Kawasaki Disease

  • Idiopathic medium-vessel vasculitis
  • Age < 5 yr (peak 18–24 mo)
  • no pathogen

Rheumatic Fever

  • Immune reaction to Group A strep pharyngitis
  • Age 5–15 yr
  • 2–6 wk after strep
Signs & symptoms

Kawasaki Disease

  • ★Fever ≥ 5 days, unresponsive to antipyretics
  • Strawberry tongue, cracked lips
  • peeling hands/feet

Rheumatic Fever

  • ★Sydenham chorea
  • Migratory polyarthritis
  • erythema marginatum, nodules
Diagnostics & labs

Kawasaki Disease

  • Clinical: fever ≥ 5 d + 4 of 5 features
  • ↑ ESR/CRP, ↑ platelets
  • echo coronaries

Rheumatic Fever

  • ★Jones criteria: 2 major or 1 major + 2 minor
  • ↑ ASO titer
  • + throat culture
Nursing priorities

Kawasaki Disease

  • ★IVIG within 10 days of fever onset
  • Monitor cardiac status
  • daily temp

Rheumatic Fever

  • Penicillin to eradicate strep
  • Bed rest
  • monitor for carditis
Treatment & meds

Kawasaki Disease

  • IVIG single dose
  • High-dose ASA then low-dose antiplatelet

Rheumatic Fever

  • Penicillin (eradicate GAS)
  • ASA/steroids for carditis & joints
Patient teaching

Kawasaki Disease

  • Aspirin used despite peds — an exception
  • Serial echos
  • IVIG delays live vaccines

Rheumatic Fever

  • Monthly IM penicillin prophylaxis for years
  • Treat strep throat promptly to prevent
Red flags — escalate

Kawasaki Disease

  • Coronary artery aneurysm then MI/thrombosis

Rheumatic Fever

  • Acute carditis then mitral regurgitation
Complications

Kawasaki Disease

  • Coronary aneurysm
  • myocardial infarction

Rheumatic Fever

  • Chronic mitral stenosis
  • recurrence

★ marks the fact that sets a column apart.

Clinical Pearl

Strawberry tongue + coronary aneurysm = Kawasaki + IVIG; post-strep + valve damage = rheumatic + penicillin prophylaxis.

Component Topics

Kawasaki DiseaseRheumatic Fever

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