Kawasaki Disease Flashcards
Irritability in a child may mean?
irritability may be only way child can express pain or discomfort
- meningeal irritation
- headache from intracranial irritation
- exhaustion
Rashes in kids with fever
Enterovirus Erythema infectiosum Measles Meningococcemia Roseola Scarlet Fever Varicella
Enterovirus
erythematous maculopapular rash (palms and soles)
- hand-foot-and-mouth
- late summer, early fall
Erythema infectiosum
5th disease, parvovirus B19 (slapped cheek disease)
- low grade fever with rash 7-10 days later
- can spread from cheeks to trunk
- polyarthropathy
- aplastic anemia possible
Measles
prodrome of low grade fever, courgh, conjunctivitis –> maculopapular rash appears on neck, ears, and hairline
- rash spreads downward
- Koplik spots on buccal mucosa
Meningococcemia
Neisseria meningitidis –> abrupt onset
- fever, chills, malaise, prostration
- urticarial rash petechial
Roseola
maculopapular rash (exanthem subitum)
- starts on trunk and spreads to extremities
- preceded by 3-4 days of high fevers ending with rash
Scarlet Fever
GAS –> fine papules (sand paper like)
erythematous but blanches
- starts in groin, axilla, or neck and spreads rapidly
- self limiting disease
- treat with antibiotics because of rheumatic fever
Varicella
rash starts on trunk and spreads to extremities
- each lesion progresses from erythematous macule to papule to vesicle to pustule
- mild fever, self-limiting disease
Lymphadenopathy
diffuse adenopathy is more concerning that isolated node
Infectious causes of lymphadenpathy
measles, mono, HIV, histoplasmosis, toxoplasmosis, mycobacterium
Non-infectious causes of lymphadenopathy
lymphoma, leukemia, histiocytosis, neuroblastoma, rhabdomyosarcoma
Unilateral cervical lymphadenopathy
Kawasaki Disease
Bacterical cervical adenitis - staph or strep pyogenes
Cat scratch disease - bartonella
Mycobacterial infection
Strawberry tongue
erythematous tongue with prominent papillae
- strep pharyngitis
- kawasaki disease
- toxic shock syndrome
Diagnostic criteria for Kawasaki Disease
High fever for >5 days - changes in oral mucosa - extremity changes (redness/swelling) - unilateral cervical lymphadenopathy - rash - conjunctivitis FINAL - no other cause for symptoms (diagnosis of exclusion)
Complications of Kawasaki Disease
CNS manifestation - irritation, lethargy, aseptic meningitis
Coronaries - aneurysms
Liver dysfunction
Arthritis
Hydrops of gallbladder
all patients should receive echo in acute phase
Derm nomenclature
Macule - flat, discolor spot
Papule - small, well-defined lump
Vesicle - small, well-defined fluid containing bump
Pusutle - small well defined purulent containing bump
Plaque - small, raise differentiated patch
Desquamation - shedding outer layer of skin
DDx for child with fever and rash (fully immunized)
Systemic-onset juvenile idiopathic arthritis Kawasaki Disease Osteomyelitis RMSF Scarlet Fever SJS Viral syndrome
Juvenile idiopathic arthritis
prolonged fever, rash, arthritis, visceral involvement
Kawasaki disease
fever >5 days, nonpurulent conjunctivitis, rash, swelling and erythema of extremities
Osteomyelitis
bacterial infection, low-grade fever, painful walking
RMSF
tick-borne infection
fever, headache, rash, myalgias
SJS
mucocutaneous disorder caused by hypersensitivity rxn to meds, infection or illness
- severe pruritic rash, fever, mucosal changes
Viral Syndrome
enterovirus
- fever (3-5 days), non-descript rash
DDx for erythema, pain, and extremity swelling
arthritis (joint)
cellulitis
Kawasaki
Evaluation of Kawasaki
- CBC w diff - infection/inflammatory response (elevated neutrophils and platelets possible)
- Blood culture - no growth
- Liver enzymes - can be elevated w/ low albumin
- Acute phase reactants - CRP and ESR elevated
- UA - sterile pyuria
Diagnosis and Tx of strep pharyngitis
- Rapid strep test (highly specific but low sensitivity)
- should follow with culture if negative
Treat with amoxicillin to prevent rheumatic fever
Tx of KD
Aspirin - anti-inflammatory, shortens febrile course, anti-platelet (keep in mind Reye syndrome)
IVIG - decreases aneurysms incidence greatly, given over 12 hours
Follow-up care of KD
Echo during acute phase –> follow up echo around 3-6 weeks
Anticipatory guidelines for KD
Aspirin - 6-8 weeks if no aneurysm, indefinitely with aneurysm
Flu vaccine EVERY YEAR
