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.
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 → 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 → MI/thrombosis
- Acute carditis → 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 → 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 → MI/thrombosis
Rheumatic Fever
- Acute carditis → 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.
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