Children with<unk>  should be hospitalized and cared for by a physician who has experience with this<unk> . In an academic medical center, care is often shared between pediatric cardiology, pediatric rheumatology, and pediatric infectious<unk>  specialists (although no specific infectious agent has yet been identified). To prevent damage to coronary arteries, treatment should be started immediately following the diagnosis. Intravenous immunoglobulin (IVIG) is the standard treatment for<unk>  and is administered in high doses with marked improvement usually noted within 24 hours. If the fever does not respond, an additional dose may be considered. In rare cases, a third dose may be given. IVIG is most useful within the first seven days of fever onset, to prevent coronary artery aneurysm. IVIG given within the first 10 days of the<unk>  reduces the risk of damage to the coronary arteries in children, without serious adverse effects. Salicylate therapy, particularly aspirin, remains an important part of the treatment (though questioned by some) but salicylates alone are not as effective as IVIG. There is limited evidence to indicate whether children should continue to receive salicylate as part of their treatment. Aspirin therapy is started at high doses until the fever subsides, and then is continued at a low dose when the patient returns home, usually for two months to prevent blood clots from forming. Except for<unk>  and a few other indications, aspirin is otherwise normally not recommended for children due to its association with Reye syndrome. Because children with<unk>  will be taking aspirin for up to several months, vaccination against varicella and influenza is required, as these infections are most likely to cause Reye syndrome. High-dose aspirin is associated with anemia and does not confer benefit to<unk>  outcomes. About 15-20% of children following the initial IVIG infusion show persistent or recurrent fever and are classified as IVIG-resistant. While the use of TNF alpha blockers (TNF-α) may reduce treatment resistance and the infusion reaction after treatment initiation, further research is needed. Due to the potential involvement of the upregulated calcium-nuclear factor of activated T cells pathway in the development of the<unk> , a 2019 study found that the combination of ciclosporin and IVIG infusion can suppress coronary artery abnormalities. Further research is needed to determine which patients would respond best to this treatment. Corticosteroids have also been used, especially when other treatments fail or symptoms recur, but in a randomized controlled trial, the addition of corticosteroid to immune globulin and aspirin did not improve outcome. Additionally, corticosteroid use in the setting of<unk>  is associated with increased risk of coronary artery aneurysm, so its use is generally contraindicated in this setting. In cases of<unk>  refractory to IVIG, cyclophosphamide and plasma exchange have been investigated as possible treatments, with variable outcomes. However, a Cochrane review published in 2017 found that, in children, the use of corticosteroids in the acute phase of<unk>  was associated with improved coronary artery abnormalities, shorter hospital stays, a decreased duration of clinical symptoms, and reduced inflammatory marker levels. Patient populations based in Asia, people with higher risk scores, and those receiving longer steroid treatment may have greater benefit from steroid use.
Kawasaki disease
Scarlet fever
Juvenile idiopathic arthritis
Quartan fever
Multisystem inflammatory syndrome in children
Cotton fever
Toxic shock syndrome
Haverhill fever