Kawasaki Disease Flashcards
Define Kawasaki Disease.
Acute childhood febrile illness with small + medium vessel vasculitis.
Explain the aetiology of Kawasaki Disease.
Infectious agent may trigger in immuno-genetically disposed
5 risk factors for Kawasaki Disease?
Asian (esp. Japanese)
< 5y
Winter-spring peak
1% +ve FH
Siblings of KD case
What are differential diagnoses for KD?
Streptococcal disease (scarlet fever)
Viral infections (measles, EBV, enterovirus)
Staphylococcal scalded skin syndrome
Summarise the epidemiology of KD.
Most common acquired heart disease in children
Much more common in Japanese children
M > F
What criteria guide dx of KD?
Fever >5 days + 4 of:
- Conjunctivitis
- Oral mucous membrane changes- cracked lips/ strawberry tongue
- Peripheral extremity changes: hand/ feet erythema, oedema, desquamation
- Polymorphous rash
- Cervical lymphadenopathy
How is Kawasaki disease diagnosed?
Clinical dx
What is the management for KD?
IVIG: High-dose (2 g/kg) IV
Most effective if < 10d since onset
Aspirin: High-dose (80-100 mg/kg/ day in 4 doses) until day 24-72hr post fever cessation (up to 14d) followed by low-dose (3–5 mg/kg OD) for 6–8w
Steroids (Methylpred/ Pred): If 2 IVIG infusions have been ineffective.
What are complications associated with KD?
Coronary artery aneurysms develop in 15-25% of untreated children and may lead to myocardial infarction, sudden death or IHD (2%).
What are the classic signs and Sx of Kawasaki disease?
Conjunctivitis: bilateral
Rash: Polymorphous, extremities to trunk
Adenopathy: Cervical lymphadenopathy
Strawberry tongue + cracked lips
Hands + feet swollen (+desquamate)
Burn: Fever >38.5, >5d (no response to antipyretics)
What bloods may be seen in KD?
Mild-moderate anaemia
High WCC
High CRP/ESR
High platelets (subacute phase).
What imaging test is used in KD, why, and when is this repeated?
Echo
Detect coronary artery aneurysm
Repeat at 1-2w + 4-6w post tx
May be normal in 1st week of illness, does not exclude KD
Why is IVIG used in KD?
Reduces risk of coronary artery aneurysm.
Reduces duration of fever
Why is Aspirin used in KD?
High dose for anti-inflammatory effect until fever subsided
Continued at lower dose for anti platelet effect until ESR normalised (1-2m)
Why is KD the only disease in which aspirin is prescribed to children? Describe what can happen.
Aspirin SE in kids = Reye’s syndrome
Encephalopathy + hepatic dysfunction
Vomiting, confusion, seizures, coma
