Kawasaki Disease Flashcards
What is Kawasaki disease (KD)?
It is defined as an acute systemic, medium-sized vessel vasculitis, which tends to affect the coronary arteries
What four risk factors are associated with Kawasaki disease?
Children < 5 Years Old
Male Gender
Asian Ethnicity
Family History
What are the seven clinical features of Kawasaki disease?
High Fever > 39C For > 5 Days
Erythematous Maculopapular Rash
Palm & Sole Desquamation
Strawberry Tongue
Bright Red Cracked Lips
Bilateral Conjunctivitis
Cervical Lymphadenopathy
What is palm & sole desquamation?
It is defined as peeling of the skin
What is a strawberry tongue?
It is defined as a red tongue, with large papillae
What are the three phases of Kawasaki disease?
Acute Phase
Subacute Phase
Convalescent Phase
When does the acute phase of Kawasaki disease?
It occurs within 1 -2 weeks of fever onset
What is the acute phase of Kawasaki disease?
It results in the presentation of high fever, irritability, rash, mucositis, peripheral erythema and oedema
When does the subacute phase of Kawasaki disease occur?
It occurs within 2 - 4 weeks of fever onset
What is the subacute phase of Kawasaki disease?
In this phase, individuals are afebrile and most clinical features begin to resolve
However, there is development of hand/feet desquamation and polyarthralgia
When does the convalescent phase of Kawasaki disease occur?
It occurs within 4 - 8 weeks of fever onset
What is the convalescent phase of Kawasaki disease?
This is an asymptomatic period, in which most clinical features have resolved
In which phase of Kawasaki disease, is the risk of developing cardiac complications highest?
Subacute Phase
What three investigations are used to diagnose Kawasaki disease?
Blood Tests
Urinalysis
ECHO Scans
What nine bood test results indicate Kawasaki disease?
Decreased Haemoglobin Levels
Increased Platelet Levels
Increased White Cell Levels
Increased ALP Levels
Increased ALT Levels
Increased AST Levels
Decreased Albumin Levels
Increased CRP Levels
Increased ESR Levels
What is the feature of Kawasaki disease on urinalysis?
There is increased white blood cells without infection
What is the gold standard investigation used to diagnose Kawasaki disease?
ECHO Scans
When should ECHO scans be used to diagnose Kawasaki disease?
It should be conducted in all suspected patients without delay
Following diagnosis, it is used to monitor disease progression and complication development
What are the five features of Kawasaki disease on ECHO scans?
Coronary Artery Aneurysms
Coronary Artery Thrombosis
Valvular Disease
Pericardial Effusion
Decreased Ventricular Function
What is important to note about the use of ECHO scans when diagnosing Kawasaki disease?
In early disease, there may be normal ECHO results
What does the ‘American Heart Association’ criteria state for a diagnosis of Kawasaki disease to be obtained?
A diagnosis can be obtained in cases where individuals have a high fever > 39C for at least five days, plus at least four out of five key clinical features…
- Mucositis: Erythema & Cracking of Lips, Strawberry Tongue, Oral Erythema
- Conjunctivitis: Bilateral Conjunctivitis Without Exudate
- Rash: Maculopapular, Erythroderma, Erythema Multiforme
- Peripheral Changes: Erythema, Oedema, Desquamation
- Cervical Lymphadenopathy
What is the most appropriate management step in suspected Kawasaki disease?
There should be urgent secondary care admission
What are the two pharmacological management options of Kawasaki disease?
Oral High Dose Aspirin
IV Immunoglobulins
What is the gold standard management option of Kawasaki disease?
Oral high dose aspirin + single dose of IV immunoglobulin
How is aspirin used to manage Kawasaki disease?
It is used to reduce the risk of coronary artery aneurysms/thrombosis
What aspirin regime should be administered to manage Kawasaki disease?
A high dose aspirin is administered until the fever has resolved for a period of 48 hours
Following this, low dose aspirin should be administered for approximately 6 weeks
Why is aspirin usually contraindicated in children < 16 years old?
Reye’s Syndrome
What is Reye’s syndrome?
It is a rare acute encephalopathy associated with liver failure
How is IV immunoglobulin used to manage Kawasaki disease?
It is used to reduce the risk of coronary artery aneurysms
What IV immunoglobulin regime should be administered to manage Kawasaki disease?
A single dose is administered within the first 10 days of illness
However, if there is no clinical feature improvement within 36 hours, a second dose can be administered
What are the seven complications are associated with Kawasaki disease?
Coronary Artery Aneurysms
Coronary Artery Thrombosis
Myocardial Infarction
Valvular Heart Disease
Myocarditis
Pericarditis
Arrhythmias
