KAWASAKI DISEASE …2:point_down:
LABORATORY AND RADIOLOGY FINDINGS…
There is no diagnostic test for KD
patients usually have characteristic laboratory findings.
The TLC elevated, with a predominance of neutrophils and immature forms.
Normocytic, normochromic anemia
The platelet count normal in the 1st wk of illness and rapidly increases by the 2nd to 3rd wk of illness, sometimes exceeding 1,000,000/mm3.
An elevated ESR and/or C-reactive protein The ESR may remain elevated for weeks, in part from the effect of IVIG.
Two-dimensional echocardiography is the most useful test to monitor for development of CAA (coronary artery aneurysms)
Echocardiography should be performed at
*2-3 wk of illness.
*6-8 wk after onset of illness.
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 .
Ambiguous cases should be referred to a center with experience in the diagnosis of KD.
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
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
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.
Patients with CAA continue with aspirin therapy and may require anticoagulation, depending on the degree of coronary dilation
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
IVIG-resistant KD occurs in 15% of patients and persistent or recurrent fever 36 hr after completion of the initial IVIG infusion.
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.
Tumor necrosis factor inhibitors, including ((infliximab and etanercept)), given for the treatment of IVIG-resistant disease.
See PHOTO below
a small solitary aneurysm Patients with larger or numerous aneurysms require antiplatelet agents or anticoagulation
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 Reye syndrome. A different antiplatelet agent can be substituted for aspirin during the 6 wk after varicella vaccination.
The majority of patients with KD return to normal health, as treatment reduces the risk of coronary aneurysms to less than
Acute KD recurs in 1-3% of cases.
The prognosis for patients with coronary abnormalities depends on the severity of coronary disease…