Kawasaki Disease vs Scarlet Fever
Kawasaki Disease and Scarlet Fever are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Kawasaki Disease vs Scarlet Fever at a glance
- Kawasaki Disease: Self-limited medium-vessel vasculitis of young children; principal threat is coronary artery aneurysms; treated with IVIG and aspirin within 10 days of fever onset.
- Scarlet Fever: Group A strep pharyngitis with toxin-mediated sandpaper rash, strawberry tongue, and Pastia lines; preventable sequelae include rheumatic fever and post-strep glomerulonephritis.
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Side-by-side comparison
| Feature | Kawasaki Disease | Scarlet Fever |
|---|---|---|
| At a glance | Self-limited medium-vessel vasculitis of young children; principal threat is coronary artery aneurysms; treated with IVIG and aspirin within 10 days of fever onset. | Group A strep pharyngitis with toxin-mediated sandpaper rash, strawberry tongue, and Pastia lines; preventable sequelae include rheumatic fever and post-strep glomerulonephritis. |
| Classic presentation | Cracked red lips, strawberry tongue, red palms and soles, bilateral conjunctivitis, and a polymorphous rash in a febrile irritable toddler.; Fever ≥5 days, often 39-40 °C, unresponsive to antipyretics; Bilateral non-exudative conjunctival injection with limbic sparing; Lip changes: red, dry, cracked, fissured; strawberry tongue;… | Child with strep throat, sandpaper rash with circumoral pallor, and strawberry tongue.; Sudden sore throat, fever (38-40 °C), headache, abdominal pain, nausea, and vomiting; Within 12-48 hours: fine, blanchable, erythematous papular rash starting in the groin, axillae, and neck; spreads to trunk and extremities with sandpaper texture;… |
| Workup / key labs | Classic Kawasaki: fever ≥5 days plus ≥4 of 5 principal features (conjunctivitis, lip/oral changes, extremity changes, rash, cervical adenopathy). Incomplete Kawasaki: fever ≥5 days with 2-3 features plus supportive labs and/or coronary changes.; CBC: leukocytosis with left shift in week 1, thrombocytosis (>450,000) classically appears… | Compatible clinical syndrome plus positive RADT or throat culture for group A strep.; Rapid antigen detection test (RADT) on throat swab — if negative in children/adolescents, follow with throat culture; Throat culture (gold standard); Anti-streptolysin O (ASO) and anti-DNase B antibodies for retrospective confirmation if needed; CBC:… |
| Imaging | Transthoracic echocardiogram is mandatory and serial; ECG to detect arrhythmias and ischemia; Cardiac MRI or coronary CT for follow-up of aneurysms | Not required for routine diagnosis; Echocardiogram if rheumatic fever later develops |
| First-line treatment | IVIG + ASA for Kawasaki — IVIG 2 g/kg as a single infusion over 10-12 hours within 10 days of fever onset (and ideally before day 7); High-dose aspirin 30-50 mg/kg/day in 4 divided doses until afebrile for 48-72 hours, then low-dose aspirin 3-5 mg/kg/day until inflammatory markers and coronary imaging normalize; Continue low-dose… | Penicillin V 500 mg PO BID-TID for 10 days (adults) or amoxicillin 50 mg/kg/day (children, divided BID or once daily) for 10 days — drug of choice; Benzathine penicillin G IM single dose if adherence concerns; Cephalexin or cefadroxil for 10 days as alternative; Penicillin-allergic without anaphylaxis: first-generation cephalosporin… |
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