Kawasaki Disease Danielle Hann ST2 GPVTS 2010. Kawasaki Disease 80% cases aged 6/12 to 5 years Acute...
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Transcript of Kawasaki Disease Danielle Hann ST2 GPVTS 2010. Kawasaki Disease 80% cases aged 6/12 to 5 years Acute...
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Kawasaki Disease
Danielle Hann
ST2 GPVTS 2010
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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
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Causes
?? Probably infectious agent triggering an
inflammatory response Likely genetic predisposition
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Signs/Symptoms
Fever Extreme irritability Rash Swollen hands and feet Desquamation Conjunctival injection Cervical lymphadenopathy Severe peripheral vasculitis
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Investigations
Haematology WCC, anaemia, plt
Urine– Leucocytes
Biochemistry CRP/ESR
CSF ECG Echo
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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
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Differential Diagnosis
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Differential Diagnosis
Scarlet fever Toxic shock syndrome Measles Glandular fever Stevens-Johnson syndrome
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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
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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
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Immunisations
Not to have live vaccines until 3 months after IVIG
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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