Laboratory and radiology findings

KAWASAKI DISEASE …2​:point_down::point_down:

:maple_leaf:LABORATORY AND RADIOLOGY FINDINGS…:maple_leaf:

:lollipop:There is no diagnostic test for KD
patients usually have characteristic laboratory findings.
:zap:The TLC :arrow_right:elevated, with a predominance of neutrophils and immature forms.
:zap:Normocytic, normochromic anemia
:zap:The platelet count normal in the 1st wk of illness and rapidly increases :arrow_up::arrow_up:by the 2nd to 3rd wk of illness, sometimes exceeding 1,000,000/mm3.

:zap:An elevated :arrow_up::arrow_up:ESR and/or C-reactive protein The ESR may remain elevated for weeks, in part from the effect of IVIG.

:fire::fire:Two-dimensional echocardiography is the most useful test to monitor for development of CAA (coronary artery aneurysms)
:point_right: Echocardiography should be performed at
*diagnosis
*2-3 wk of illness.
*6-8 wk after onset of illness.

:maple_leaf:DIAGNOSIS​:maple_leaf:

:hole:classic KD,
the diagnostic criteria require the presence of fever for at least 4 days and at least 4 of 5 of In atypical or incomplete KD patients have persistent fever but fewer than 4 of the 5 characteristics.
In these patients, laboratory and echocardiographic data can assist in the diagnosis .

:hole: Ambiguous cases should be referred to a center with experience in the diagnosis of KD.

:maple_leaf:TREATMENT​:maple_leaf:

:lollipop::lollipop:Patients with acute KD should be treated with 2 g/kg of( IVIG and high-dose aspirin) (80-100 mg/kg/day divided q6h) within 10 days of disease onset

:lollipop::lollipop:The mechanism of action of IVIG in KD is unknown, but treatment results in resolution of clinical signs of illness in approximately 85% of patients

:lollipop::lollipop:Aspirin is continued for its anti-thrombotic effect until(( 6-8 wk after illness onset ))and is then discontinued in patients who have had normal echocardiography findings throughout the course of their illness.

:lollipop::lollipop:Patients with CAA continue with aspirin therapy and may require anticoagulation, depending on the degree of coronary dilation

:lollipop::lollipop:Corticosteroids have been trialed as primary therapy with the first dose of IVIG in hopes of improving coronary outcomes.
a single pulse dose of intravenous methylpred-nisolone (30 mg/kg) with IVIG as primary therapy did not improve
coronary outcomes

:lollipop::lollipop:IVIG-resistant KD occurs in 15% of patients and :arrow_right::arrow_right: persistent or recurrent fever 36 hr after completion of the initial IVIG infusion.

:bell::bell: Patients with IVIG resistance are at increased risk for CAA.
Treated by another dose of IVIG at 2 g/kg Corticosteroids have also been used as secondary or “rescue” therapy when fever persists after the first IVIG.

:hotsprings:Tumor necrosis factor inhibitors, including ((infliximab and etanercept)), given for the treatment of IVIG-resistant disease.

See PHOTO below :point_down::point_down:

:maple_leaf:COMPLICATIONS​:maple_leaf:

:broken_heart:a small solitary aneurysm Patients with larger or numerous aneurysms require antiplatelet agents or anticoagulation
:broken_heart:Acute thrombosis may occasionally occur in an aneurysmal or stenotic coronary artery;

Patients undergoing long-term aspirin therapy should receive annual influenza vaccination to reduce the risk of :arrow_right::arrow_right:Reye syndrome. A different antiplatelet agent can be substituted for aspirin during the 6 wk after varicella vaccination.

:maple_leaf:PROGNOSIS​:maple_leaf:

:zap:The majority of patients with KD return to normal health, as treatment reduces the risk of coronary aneurysms to less than
5%.
:zap:Acute KD recurs in 1-3% of cases.
The prognosis for patients with coronary abnormalities depends on the severity of coronary disease…