Diferencia entre revisiones de «Kawasaki disease»
Sin resumen de edición |
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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 | ||
*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 | **LV dysfunction | ||
**Valvular dysfunction | **Valvular dysfunction | ||
**Dysrhythmias | **[[Dysrhythmias]] | ||
*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" | ||
===Evaluation=== | ===Evaluation=== | ||
Revisión del 01:05 15 sep 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
- 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
- Cardiac
- Coronary aneurysm
- Most develop during 3-4th week of illness
- May lead to MI (leading cause of death)
- Myocarditis/pericarditis
- Pericardial effusion
- LV dysfunction
- Valvular dysfunction
- Dysrhythmias
- Coronary aneurysm
- Aseptic meningitis
- Urethritis
- Anemia
- RUQ pain, large gallbladder (hydrops on US)
Differential Diagnosis
Pediatric fever
- Upper respiratory infection (URI)
- UTI
- Sepsis
- Meningitis
- Febrile seizure
- Juvenile rheumatoid arthritis
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation
Work-Up
- CBC
- Leukocytosis
- Elevated platelets
- 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