Kawasaki disease: Difference between revisions
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== Background == | ==Background== | ||
* | *Also known as: mucocutaneous lymph node syndrome | ||
*Vasculitis of unknown etiology | *Vasculitis of unknown etiology | ||
*Peaks at 18-24 months | *Peaks at 18-24 months | ||
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**Coronary artery aneurysm development most prevalent as fever lessens | **Coronary artery aneurysm development most prevalent as fever lessens | ||
=== Associated Symptoms === | ===Associated Symptoms=== | ||
*Cardiac | *Cardiac | ||
**Coronary aneurysm | **Coronary aneurysm | ||
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==Diagnosis== | ==Diagnosis== | ||
=== Work-Up === | ===Work-Up=== | ||
*CBC | *CBC | ||
*LFTs | *LFTs | ||
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*TTE (Coronaries, LV, valves) | *TTE (Coronaries, LV, valves) | ||
*Red Top "Kawasaki Serum to CBR" | *Red Top "Kawasaki Serum to CBR" | ||
==Evaluation== | |||
*Clinical diagnosis | |||
===Criteria=== | ===Criteria=== | ||
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== | ==Management== | ||
*IVIG 2gm/kg over 12hr | *IVIG 2gm/kg over 12hr | ||
*[[ | *[[Aspirin]] 20mg/kg/dose q6h | ||
== Disposition == | ==Disposition== | ||
*Admit | *Admit | ||
== References == | ==References== | ||
<References/> | |||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 10:42, 17 August 2015
Background
- Also known as: mucocutaneous lymph node syndrome
- Vasculitis of unknown etiology
- Peaks at 18-24 months
- Rare in <4mo, >5yr
- Leading cause of acquired heart disease in children
- Coronary aneurysm more common in incomplete than in classic KD
Clinical Features
- Fever that is high, abrupt
- Rash often seen in perineum; accompanies onset of fever
- Maculopapular most common; vesicles not seen
- Cardiac complications develop early on
- Coronary artery aneurysm development most prevalent as fever lessens
Associated Symptoms
- Cardiac
- Coronary aneurysm
- Most develop during 3-4th week of illness
- May lead to MI (leading cause of death)
- Myo/pericarditis
- Pericardial effusion
- LV dysnfunction
- Valvular dysfunction
- Dysrhythmias
- Coronary aneurysm
- Labs
- Elevated ESR/WBC/LFTs/Plts
- Aseptic meningitis
- Urethritis
- Anemia
- RUQ pain, large GB (hydrops)
Differential Diagnosis
Pediatric fever
- Upper respiratory infection (URI)
- UTI
- Sepsis
- Meningitis
- Febrile seizure
- Juvenile rheumatoid arthritis
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
Diagnosis
Work-Up
- CBC
- LFTs
- ESR, CRP
- Blood culture
- UA
- ECG
- TTE (Coronaries, LV, valves)
- Red Top "Kawasaki Serum to CBR"
Evaluation
- Clinical diagnosis
Criteria
| Classic Kawasaki Disease | Incomplete Kawasaki Disease |
|---|---|
| Fever for 5 d or more plus four of the following symptoms | Fever for 5 d and two to three clinical criteria of classic Kawasaki disease |
| 1. Bilateral nonexudative conjunctivitis | plus |
| 2. Mucous membrane changes (erythema, peeling, cracking of lips, "strawberry tongue," or diffuse oropharyngeal mucosae) | C-reactive protein 3.0 milligrams/L and/or erythrocyte sedimentation rate 40 mm/h plus three or more of the following supplemental labs or positive echo |
| 3. Changes of the extremities (erythema or swelling of hands/feet, peeling of finger tips/toes in the convalescent stage) | 1. Albumin <3 grams/dL |
| 2. Anemia for age | |
| 3. Elevated alanine aminotransferase | |
| 4. Platelets >450,000/mm3 after 7 d of fever onset | |
| 4. Rash | |
| 5. Cervical adenopathy (more than one node >1.5 cm unusually unilateral anterior cervical) | 5. White blood cell count >12,000/mm3 |
| 6. Presence of pyuria |
Management
- IVIG 2gm/kg over 12hr
- Aspirin 20mg/kg/dose q6h
Disposition
- Admit