142 - Kawasaki Disease Flashcards
Leading cause of acquired heart disease in children in developed nations
Kawasaki disease
Classic KD is diagnosed in a patient with prolonger fever and _____ of _____ clinical features
4
5
Other terms for KD
Mucocutaneous lymph node syndrome
Infantile periarteritis nodosa
Attack rate of KD is highest in _____ children
Asian, particularly Japanese, Korean, and Chinese
KD is predominantly an illness of young children, with 80% of cases occurring in children ages
6 months to 5 years
Y/N: Girls are more commonly affected by KD than girls at a ratio of 3:2
No - Boys are more commonly affected than girls
Peak age of KD
9 months to 11 months
Forms of generalized exanthem in KD
Morbilliform
Targetoid
Scarlatiniform (diffuse erythema)
In the acute febrile phase of KD, _____ erythema and desquamation are commonly observed
Groin
Classic periungual desquamation of the fingers and toes does not begin until
Second to third week after fever begins
In the third to sixth week after illness in KD, transverse lines across the fingernails (_____) are often apparent
Beau lines
A common finding in children with KD is erythema and swelling at the site of ______ vaccine administration
Bacille Calmette-Guerin
Stages of KD
Acute febrile phase
Subacute phase
Convalescent phase
Begins when fever resolves and continues until all clinical features have normalized
Subacute phase
Follows the subacute phase and continues until the ESR normalizes
Convalescent phase
Least commonly observed clinical feature, occurring in approximately 75% of children with classic KD
Cervical lymphadenopathy
More than 50% of KD patients have myocarditis during the acute febrile phase, manifested clinically as
Tachycardia disproportionate to fever
A complete blood count reveals either a _____ white blood cell count with a _____ predominance
Normal or elevated
Neutrophil
Thromobocyto(-sis/-penia) has been reported to be associated with a more severe outcome
-penia
Thrombocytosis, with platelet counts sometimes exceeding 1,000,000/mm3 is characteristic of the _____ phase of KD
Subacute
Once IVIG is given, the _____ cannot be used to follow clinical response, because IVIG itself transiently increases the _____
ESR
A CBC and CRP or ESR should be performed at _____, and the CRP repeated at ______
Baseline
2 to 3 weeks and 6 to 8 weeks after onset
Imaging that should be performed in all children with suspected KD
Echocardiography
Echocardiography should be performed at
Diagnosis, at 2 to 3 weeks after fever onset, and at 6 to 8 weeks after fever onset
Electrocardiogram in the acute febrile phase of illness most often shows
Prolonged PR interval and/or nonspecific ST- and T-wave changes
Diagnostic criteria for Kawasaki disease:
Fever lasting 5 or more days, high spiking and intermittent, with at least 4 of the 5 clinical features:
- Bilateral, nonexudative conjunctival injection
- Oral mucosal changes, including red, dry, cracked lips, pharyngeal erythema, and/or strawberry tongue
- Changes of the hands and feet: erythema of palms and soles and/or swelling of the hands and feet during the acute phase, and/or periungual desquamation of the fingers and toes during the subacute phase
- Rash: erythematous morbilliform, scarlatiniform, or targetoid
- Cervical lymphadenopathy at least 1.5 cm in diameter
Refers to children with prolonged fever and fewer than 4 of the other features of illness who have a laboratory profile compatible with KD
Incomplete (or atypical) KD
Y/N: Infants 6 months of age or older can have mild or subtle clinical findings with KD, but have a high risk of developing coronary artery abnormalities
No - younger
Approximately 85% of KD children treated with IVIG and aspirin within the first _____ days of illness respond with rapid resolution of fever and other clinical signs
10
Treatment of acute Kawasaki disease
2g/kg of IVIG infused over 10-12 hours
Aspirin 80-100 mg/kg/day every 6 hours orally
Regimen of IVIG and aspirin when administered to children with KD within the first 10 days of fever, was shown to reduce the prevalence of coronary artery abnormalities from _____% in untreated patients to _____% in those who receive therapy
25
5
Aspirin is given in high doses during acute KD for _____ effect
Antiinflammatory
Aspirin is generally continued at 80 to 100 mg/kd/day until
14th illness day or
Until the patient has beed afebrile for at least 2 days
Aspirin is then reduced to 3 to 5 mg/kg/day given in a single daily dose, for its _____ effect
Antithrombotic
Aspirin is discontinued at
6 to 8 weeks after onset if all echocardiograms have been normal and acute-phase reactants have normalized
Approximately _____% of acute KD patients do not respond to initial therapy
15
Most patients with “refractory” KD will respond to
Second 2 g/kg IVIG infusion
In patients who do not respond to initial therapy and are already in a high-risk category because of the presence of coronary artery dilation, _____ should be considered
Second dose of IVIG given with prednisolone in a tapering regimen over 2 to 3 weeks
