Kawasaki disease: Difference between revisions
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*Leading cause of acquired heart disease in children | *Leading cause of acquired heart disease in children | ||
*Coronary aneurysm more common in incomplete than in classic KD | *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 | |||
#Labs | |||
##Elevated ESR/WBC/LFTs/Plts | |||
#Aseptic meningitis | |||
#Urethritis | |||
#Anemia | |||
#RUQ pain, large GB (hydrops) | |||
==Diagnosis== | ==Diagnosis== | ||
=== Work-Up === | |||
#CBC | |||
#LFTs | |||
#ESR, CRP | |||
#Blood Cx | |||
#UA | |||
#ECG | |||
#TTE (Coronaries, LV, valves) | |||
#Red Top "Kawasaki Serum to CBR" | |||
===Criteria=== | ===Criteria=== | ||
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| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 6. Presence of pyuria | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 6. Presence of pyuria | ||
|} | |} | ||
== Treatment == | == Treatment == | ||
*IVIG 2gm/kg over 12hr | |||
*[[ASA]] 20mg/kg/dose q6h | |||
== Disposition == | == Disposition == | ||
*Admit | |||
== | == References == | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 09:52, 3 June 2015
Background
- 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)
Diagnosis
Work-Up
- CBC
- LFTs
- ESR, CRP
- Blood Cx
- UA
- ECG
- TTE (Coronaries, LV, valves)
- Red Top "Kawasaki Serum to CBR"
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 [[Image:]]3.0 milligrams/L and/or erythrocyte sedimentation rate [[Image:]]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 |
Treatment
- IVIG 2gm/kg over 12hr
- ASA 20mg/kg/dose q6h
Disposition
- Admit