Difference between revisions of "Kawasaki disease"

(Disposition)
 
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==Background==
 
==Background==
 
*Also known as: mucocutaneous lymph node syndrome
 
*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
 
**Rare in <4mo, >5yr
 
**Rare in <4mo, >5yr
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[[File:1200px-Kawasaki.png|thumb|Kawasaki disease signs]]
 
[[File:1200px-Kawasaki.png|thumb|Kawasaki disease signs]]
 
*[[Fever]] that is high, abrupt. Anyone with a fever >5 days should get considered for a Kawasaki workup.
 
*[[Fever]] that is high, abrupt. Anyone with a fever >5 days should get considered for a Kawasaki workup.
*Rash often seen in perineum; accompanies onset of fever
+
*[[Rash]] often seen in perineum; accompanies onset of fever
**[[Maculopapular]] most common; vesicles not seen
+
**Maculopapular most common; vesicles not seen
 
*Cardiac complications develop early on
 
*Cardiac complications develop early on
 
**Coronary artery aneurysm development most prevalent as fever lessens
 
**Coronary artery aneurysm development most prevalent as fever lessens
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***May lead to MI (leading cause of death)
 
***May lead to MI (leading cause of death)
 
**[[Myocarditis]]/[[pericarditis]]
 
**[[Myocarditis]]/[[pericarditis]]
**Pericardial effusion
+
**[[Pericardial effusion]]
**LV dysnfunction
+
**LV dysfunction
 
**Valvular dysfunction
 
**Valvular dysfunction
**Dysrhythmias
+
**[[Dysrhythmias]]
*Labs
 
**Elevated ESR/WBC/LFTs/Plts
 
 
*Aseptic [[meningitis]]
 
*Aseptic [[meningitis]]
*Urethritis
+
*[[Urethritis]]
 
*[[Anemia]]
 
*[[Anemia]]
 
*[[RUQ pain]], large gallbladder (hydrops on US)
 
*[[RUQ pain]], large gallbladder (hydrops on US)
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===Work-Up===
 
===Work-Up===
 
*CBC
 
*CBC
*LFTs
+
**[[Leukocytosis]]
*ESR, CRP
+
**Elevated platelets
 +
*Labs
 +
*[[LFTs]]- elevated
 +
*ESR, CRP- elevated
 
*[[Blood culture]]
 
*[[Blood culture]]
 
*[[Urinalysis]]
 
*[[Urinalysis]]
 
*[[ECG]]
 
*[[ECG]]
*TTE (Coronaries, LV, valves)
+
*[[Echocardiography|TTE]] (Coronaries, LV, valves)
 +
**Consider if f ESR≥ 40, CRP≥ 3, or if desquamation occurs
 
*Red Top "Kawasaki Serum to CBR"
 
*Red Top "Kawasaki Serum to CBR"
*Consider echocardiogram
 
**If ESR≥ 40, CRP≥ 3, or if desquamation occurs
 
  
 
===Evaluation===
 
===Evaluation===

Latest revision as of 01:05, 15 September 2019

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

Kawasaki disease signs
  • Fever that is high, abrupt. Anyone with a fever >5 days should get considered for a Kawasaki workup.
  • 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

Differential Diagnosis

Pediatric fever

Erythematous rash

Evaluation

Work-Up

  • CBC
  • Labs
  • LFTs- elevated
  • ESR, CRP- elevated
  • Blood culture
  • Urinalysis
  • ECG
  • TTE (Coronaries, LV, valves)
    • Consider if f ESR≥ 40, CRP≥ 3, or if desquamation occurs
  • Red Top "Kawasaki Serum to CBR"

Evaluation

  • Clinical diagnosis
Classic Kawasaki Disease Fever for 5 days or more plus four of the following symptoms
1. Bilateral nonexudative conjunctivitis
2. Mucous membrane changes (erythema, peeling, cracking of lips, "strawberry tongue," or diffuse oropharyngeal mucosae)
3. Changes of the extremities (erythema or swelling of hands/feet, peeling of finger tips/toes in the convalescent stage)
4. Rash
5. Cervical adenopathy (more than one node >1.5 cm unusually unilateral anterior cervical)
Incomplete Kawasaki Disease Fever for 5 days and two to three clinical criteria of classic Kawasaki disease plus
C-reactive protein 3.0 milligrams/L and/or erythrocyte sedimentation rate 40 mm/h plus positive echocardiogram or three or more of the following:
1. Albumin <3 grams/dL
2. Anemia
3. Elevated alanine aminotransferase (ALT)
4. Platelets >450,000/mm3 7d after fever onset
5. White blood cell count >12,000/mm3
6. Pyuria

Management

Disposition

  • Admit
  • Follow-up cardiac evaluation for coronary aneurysm screening

References