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Kawasaki Disease
Danielle Hann
ST2 GPVTS 2010
Kawasaki Disease
80% cases aged 6/12 to 5 years Acute inflammatory vasculitis of medium sized
arteries Incidence varies worldwide
– England - 8 per 100 000– Japan – 184 per 100 000
Causes
?? Probably infectious agent triggering an
inflammatory response Likely genetic predisposition
Signs/Symptoms
Fever Extreme irritability Rash Swollen hands and feet Desquamation Conjunctival injection Cervical lymphadenopathy Severe peripheral vasculitis
Investigations
Haematology WCC, anaemia, plt
Urine– Leucocytes
Biochemistry CRP/ESR
CSF ECG Echo
Diagnostic Criteria
Fever of at least 5 days duration plus 4 of the following:
1. Polymorphous exanthema
2. Bilateral non-exudative conjunctival injection
3. Changes in lips and oral cavity
4. Changes in extremities– Erythema, indurative oedema, desquamation
5. Cervical lymphadenopathy
Differential Diagnosis
Differential Diagnosis
Scarlet fever Toxic shock syndrome Measles Glandular fever Stevens-Johnson syndrome
Complications
30-50% develop mild diffuse dilatation of coronary arteries– Develops on average 10 days after onset of fever– Often regresses within 6-8 weeks
20% of coronary artery lesions become aneurysmal– Reduced to 5% with IVIG treatment
May also affect other arteries
Treatment
IV Immunoglobulin– Single dose 5-10 days after onset of fever
Aspirin– Lack of trial evidence but widely accepted use– Dose varies given in acute and sub-acute phase
Corticosteroids– Inconclusive evidence
Immunisations
Not to have live vaccines until 3 months after IVIG
Summary
Acute febrile illness mainly in under 5s Most common cause of acquired heart disease
in children Fever of at least 5 days and 4/5 criteria Clinical features appear sequentially
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