4.13 Kawaksaki

Question 1

Skipped rheumatic fever because none on exam apparently

Question 2

What is Kawasaki Disease

Answer 2

systemic syndrome involving vascular system –> including coronary arteries

Disease expresses itself mainly in mucocoutaneous and ymphatic systems but long-term sequelae affect the cardiac system in the form of coronary aneurysms, pericarditis, MIs, and myocarditis

Question 3

What age is the peak incidence of Kawasaki disease

Answer 3

1-2 years old

Question 4

Kawasaki Disease presents as an acute ___ illness and is the leading cause of ___ ____ disease

Answer 4

acute febrile illness
leading cause of acquired heart disease

Question 5

Kawasaki disease is the second most common cause of childhood ___

Answer 5

vasculitis

Question 6

How does KD start out

Answer 6

causes small and medium vessel vasculitis throughout the body

The
original criteria for KD described in 1967 are still the same and include

a persistent fever for at least 5 days plus four of the following:

bilateral conjunctival injection
changes of the lips and oral cavity
cervical lymphadenopathy
polymorphous exanthema
changes in the peripheral extremities (swelling of the hands or feet) or perineal area

Question 7

FYI

The clinical course of KD is triphasic:

Acute
Subacute
Convalescent

Question 8

In the acute phase of KD the patient may experience what

6

days 1-11

Answer 8

• fever
• conjunctival hyperemia (redness of eyes)
• rash
• swelling hands/feet
• unilateral cervical lymph node swelling (typically one single enlarged node)
• red cracked lips, strawberry tongue

Question 9

What changes in the subacute phase of KD

5

Answer 9

• fever and englarged nodes resolve
• peeling of skin starts
• joint pain
• thrombocytosis
• cardiac issues- aneurysms, myocarditis

Question 10

What happens in the convalescent phase of KD

3

Answer 10

• most clinical signs disappear
• elevated ESR/CRP can persist
• cardiac issues can persist

Question 11

In KD cardiac findings are universal and include ___ and ___

Answer 11

abnormalities of coronary vessels and myocarditis

Question 12

KD is dx’d by ___

Answer 12

exclusion of other causes

Question 13

What are the 3 main goals of treatment of KD

Answer 13

• evoke a rapid anti-inflam response
• inhibit platelet aggregation to prevent coronary thrombosis
• minimize cardiac risk - good diet, smoking prevention, exercise

Question 14

What is used to treat KD

Answer 14

IVIG
ASA

Question 15

How does ASA work with the coronary arteries

Answer 15

has antiplatelet effect on them

Question 16

What vaccination should all kids on ASA with KD receive

Answer 16

inactivated flu vaccination

Question 17

If a kid with KD were to get varicella or influenza what happens with the ASA treatment

Answer 17

stopped or 6 weeks and another antiplatelet drug subbed in to minimize risk of Reye syndrome

on exam- something about ASA and Reyes - coronary artery answer is correct

Question 18

In kids being treated with IVIG for KD how long before live vaccinations can be given

Answer 18

11 months after IVIG administration