Clinical and Laboratory Characteristics Distinguishing Node-First Kawasaki Disease from Bacterial Cervical Lymphadenitis: A Systematic Review.

Node-first Kawasaki disease (NFKD) presents with fever and cervical lymphadenopathy as the sole initial manifestations, mimicking bacterial cervical lymphadenitis (BCL). Delayed diagnosis may increase coronary artery lesion risk. This review synthesizes evidence differentiating NFKD from BCL. We conducted a PRISMA 2020-compliant systematic review registered with OSF. PubMed, Web of Science Core Collection, and Cochrane CENTRAL were searched, supplemented by handsearching and citation tracking. Eligible studies compared clinical and laboratory findings between children with NFKD and BCL. Two reviewers independently screened studies and assessed bias. One reviewer extracted data, verified by a second. Evidence was synthesized narratively. Six studies were included (NFKD, n = 285; BCL, n = 375). CRP concentrations were higher in NFKD in all six studies, with significant differences in five. WBC counts showed no consistent trend; neutrophil counts and ESR were higher in NFKD in some studies. ALT concentrations were higher in NFKD in five of six studies. Only one study, in which the corresponding author was a co-investigator, quantitatively assessed clinical findings; bilateral conjunctival injection and oral mucosal changes were more frequent in NFKD, but these findings should be regarded as hypothesis-generating pending independent replication. CRP concentrations, and to a lesser extent other laboratory markers such as ALT, were higher in NFKD, although substantial overlap limits their value as individual-level discriminators. Clinical features may serve as adjunctive findings, although evidence remains limited. No single laboratory or clinical parameter reliably distinguished NFKD from BCL. Prospective multicenter studies using standardized methods are needed.