kawasaki

Kawasaki disease (also known as mucocutaneous lymph node syndrome) is a systemic febrile condition affecting children usually less than 5 years old. It is one of the most common vasculitides of childhood. Aetiology remains unknown. Possible bacterial toxins or viral agents. Leading cause of acquired heart disease in the developed world.

Diagnostic Criteria

1. Fever lasting at least 5 days.
2. Presence of 4 out of the following 5 signs:

• Bilateral non-purulent conjunctivitis
• Mucosal changes of the oropharynx (injected pharynx, red lips or dry fissured lips, strawberry tongue).
• Changes in extremities (oedema and/or erythema of the hands or feet, desquamation, usually beginning periungually)
• Rash (usually truncal), polymorphous but non vesicular.
• Cervical lymphadenopathy.

1. Illness not explained by other known disease process.

Other signs may be present including irritability, altered mental state, transient arthritis, diarrhoea, vomiting, abdominal pain, aseptic meningitis, hepatosplenomegaly. Most important complication is coronary vasculitis occurring usually within 2 weeks of illness. Occurs in up to 35% of untreated children. Manifest as myocardial ischaemia, infarction, pericarditis, myocarditis, endocarditis, heart failure and arrhythmias.

Treatment

1) IV Gammaglobulins. 2 g/kg single infusion over 10 - 12 hours. Fever and systemic complaints resolve within 24-48 hours. Therapy within 10 days of onset of fever is effective in preventing coronary vascular damage.

2) Salicylate. 30 mg/kg/24 hours for 2 weeks or until patient is afebrile for 2-3 days. Then low dose 3-5 mg/kg OD for 6 - 8 weeks from onset or until ESR and platelet count returns to normal if no coronary artery abnormalities are observed on echocardiogram. If there is coronary aneurysm, low dose aspirin is continued until it resolves. Dipyridamole 3 - 5 mg/kg OD in place of aspirin especially in epidemics of influenza or varicella to avoid risk of Reyes syndrome.

3) Corticosteriods. Earlier concerns of possible detrimental effects of steroids are under increasing scrutiny. One recent (Prednisolone 2 mg/kg for 1 week then tail off over 2 weeks) study showed some benefit but will require more randomized controlled trials.

Reference : malaysian paediatrics protocol 2005

hurmm.. kesian kan.. kecik-kecik dah sakit. tapi, best la peds ward. jumpa budak-budak yang comel-comel. geram je tengok.. =D

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aman : kak cik nak beli hadiah wak balik ko aman. (sebab prestasi dia meningkat). kak nak bagi gapo?

kak : laa, kak cik bagi doh kea. kak tok keno buwi doh la..

aman : kedekut!

kak : hahaha.

aman.. aman..