Kawasaki Disease Flashcards Preview

Pediatrics > Kawasaki Disease > Flashcards

Flashcards in Kawasaki Disease Deck (30):
1

Irritability in a child may mean?

irritability may be only way child can express pain or discomfort
- meningeal irritation
- headache from intracranial irritation
- exhaustion

2

Rashes in kids with fever

Enterovirus
Erythema infectiosum
Measles
Meningococcemia
Roseola
Scarlet Fever
Varicella

3

Enterovirus

erythematous maculopapular rash (palms and soles)
- hand-foot-and-mouth
- late summer, early fall

4

Erythema infectiosum

5th disease, parvovirus B19 (slapped cheek disease)
- low grade fever with rash 7-10 days later
- can spread from cheeks to trunk
- polyarthropathy
- aplastic anemia possible

5

Measles

prodrome of low grade fever, courgh, conjunctivitis --> maculopapular rash appears on neck, ears, and hairline
- rash spreads downward
- Koplik spots on buccal mucosa

6

Meningococcemia

Neisseria meningitidis --> abrupt onset
- fever, chills, malaise, prostration
- urticarial rash petechial

7

Roseola

maculopapular rash (exanthem subitum)
- starts on trunk and spreads to extremities
- preceded by 3-4 days of high fevers ending with rash

8

Scarlet Fever

GAS --> fine papules (sand paper like)
erythematous but blanches
- starts in groin, axilla, or neck and spreads rapidly
- self limiting disease
- treat with antibiotics because of rheumatic fever

9

Varicella

rash starts on trunk and spreads to extremities
- each lesion progresses from erythematous macule to papule to vesicle to pustule
- mild fever, self-limiting disease

10

Lymphadenopathy

diffuse adenopathy is more concerning that isolated node

11

Infectious causes of lymphadenpathy

measles, mono, HIV, histoplasmosis, toxoplasmosis, mycobacterium

12

Non-infectious causes of lymphadenopathy

lymphoma, leukemia, histiocytosis, neuroblastoma, rhabdomyosarcoma

13

Unilateral cervical lymphadenopathy

Kawasaki Disease
Bacterical cervical adenitis - staph or strep pyogenes
Cat scratch disease - bartonella
Mycobacterial infection

14

Strawberry tongue

erythematous tongue with prominent papillae
- strep pharyngitis
- kawasaki disease
- toxic shock syndrome

15

Diagnostic criteria for Kawasaki Disease

High fever for >5 days
- changes in oral mucosa
- extremity changes (redness/swelling)
- unilateral cervical lymphadenopathy
- rash
- conjunctivitis
FINAL - no other cause for symptoms (diagnosis of exclusion)

16

Complications of Kawasaki Disease

CNS manifestation - irritation, lethargy, aseptic meningitis
Coronaries - aneurysms
Liver dysfunction
Arthritis
Hydrops of gallbladder
*all patients should receive echo in acute phase*

17

Derm nomenclature

Macule - flat, discolor spot
Papule - small, well-defined lump
Vesicle - small, well-defined fluid containing bump
Pusutle - small well defined purulent containing bump
Plaque - small, raise differentiated patch
Desquamation - shedding outer layer of skin

18

DDx for child with fever and rash (fully immunized)

Systemic-onset juvenile idiopathic arthritis
Kawasaki Disease
Osteomyelitis
RMSF
Scarlet Fever
SJS
Viral syndrome

19

Juvenile idiopathic arthritis

prolonged fever, rash, arthritis, visceral involvement

20

Kawasaki disease

fever >5 days, nonpurulent conjunctivitis, rash, swelling and erythema of extremities

21

Osteomyelitis

bacterial infection, low-grade fever, painful walking

22

RMSF

tick-borne infection
fever, headache, rash, myalgias

23

SJS

mucocutaneous disorder caused by hypersensitivity rxn to meds, infection or illness
- severe pruritic rash, fever, mucosal changes

24

Viral Syndrome

enterovirus
- fever (3-5 days), non-descript rash

25

DDx for erythema, pain, and extremity swelling

arthritis (joint)
cellulitis
Kawasaki

26

Evaluation of Kawasaki

1. CBC w diff - infection/inflammatory response (elevated neutrophils and platelets possible)
2. Blood culture - no growth
3. Liver enzymes - can be elevated w/ low albumin
4. Acute phase reactants - CRP and ESR elevated
5. UA - sterile pyuria

27

Diagnosis and Tx of strep pharyngitis

- Rapid strep test (highly specific but low sensitivity)
- should follow with culture if negative
Treat with amoxicillin to prevent rheumatic fever

28

Tx of KD

Aspirin - anti-inflammatory, shortens febrile course, anti-platelet (keep in mind Reye syndrome)
IVIG - decreases aneurysms incidence greatly, given over 12 hours

29

Follow-up care of KD

Echo during acute phase --> follow up echo around 3-6 weeks

30

Anticipatory guidelines for KD

Aspirin - 6-8 weeks if no aneurysm, indefinitely with aneurysm
Flu vaccine EVERY YEAR