paediatrics Flashcards
explain the pathophysiology of Kawasaki disease (KD)
- KD is an acute, self-limiting systemic vasculitis of unknown etiology
- likely immune-mediated (possibly post-infectious)
- predominantly affecting medium-sized arteries, especially the coronary arteries.
explain the incidence of Kawasaki disease (KD)
It’s most common in children <5 years, with a peak incidence at 6-24 months.
explain the diagnostic criteria for complete Kawasaki disease
Complete KD requires fever ≥5 days plus ≥4/5 of:
- Cervical lymphadenopathy
- Bilateral non-exudative conjunctivitis
- Oral changes (strawberry tongue, fissured lips, pharyngeal erythema)
- Extremity changes (acute erythema/oedema, later desquamation)
- Polymorphous rash (non-vesicular)
what is this disease?
Kawasaki disease
List 2 infective and 2 non-infective differential diagnoses you would also consider for a child with ?Kawasaki Disease
Infective: Scarlet fever, Measles, Sepsis
Non-Infective: drug reactions (Steven-Johnson), Juvenile idiopathic arthritis
how would you define incomplete Kawasaki Disease?
Fever ≥5 days with 2-3 features, plus supportive evidence (e.g., coronary artery dilation on echo, or lab markers like CRP >30 mg/L, ESR >40 mm/h).
what are complications of Kawasaki Disease?
Coronary artery aneurysms in 20-25% of untreated cases, risking thrombosis or rupture.
Other features include myocarditis, pericarditis, or valve dysfunction.
discuss investigations in ED for suspected Kawasaki Disease and justification
- echo: rule out coronary artery aneurysm
- troponin: elevated with myocarditis
- ECG: changes with myo/pericarditis (prolonged PR, non-specific ST changes, T wave changes, arrhythmia, 2 to 3rd degree HB.
- ESR>40/CRP>30: indication to commence treatment
discuss management in ED for Kawasaki Disease
- aspirin (high-dose 80-100 mg/kg/day initially, then low-dose 3-5 mg/kg/day
- IVIG (2 g/kg over 10-12 hours)
- steroids
- cyclosporin
