Kawasaki disease. Kawasaki syndrome: symptoms, diagnosis and treatment
Kawasaki - a disease that usually occurs in children from one and a half to 5 years. Most often, the disease begins between 1.5 and 2 years. On top of that, Kawasaki is a disease that boys are more susceptible to than girls (1.5: 1).
How can this disease be described? Kawasaki syndrome is characterized by inflammation of the walls of blood vessels, leading to the expansion of the main coronary arteries. There is also a fever, vasculitis and a change in the lymph nodes, mucous membranes of the skin.
The disease was first described by the Japanese pediatrician T. Kawasaki in 1967. He presented it as a new childhood disease - mucous-cutaneous lympho-nodular syndrome. In total, he observed 50 cases of the disease. All children had enlarged lymph nodes, cracks in the lips, exanthema, swelling of the soles and palms, hyperemia. At first, this ailment was considered easily treatable, but after several deaths it was found that patients had serious heart damage.Subsequently, the whole world learned about the discovery of a scientist, and the disease was named after him.
Currently, medicine does not know the causes of Kawasaki disease. However, there are arguments in favor of the fact that Kawasaki is a disease that develops due to an infectious agent in genetically predisposed patients.
This ailment is 10 times more common in Japan than in America, and almost 30 times more often than in Britain and Australia. It was noted that they get sick more often in the spring and spring.
Kawasaki disease symptoms
The disease has the following symptoms:
• Fever that is observed for more than 5 days.
• Cracks appear on the lips, often they bleed. There are foci of erythema.
• There are hemorrhages in the oral mucosa.
• Kawasaki - a disease in children, which is characterized by the bright color of the tongue.
• Obstructed nasal congestion and hyperemia of the throat.
• The body temperature rises.
• Conjunctivitis appears due to increased blood vessels in the blood vessels.
• The skin begins to peel off at the fingertips (at 2-3 weeks of the disease).
• Exanthema on the skin of the body, erythema on the feet and palms.
• There are dense swelling on the hands and feet.This usually occurs 3-5 days after the onset of the disease.
• The child gets tired quickly and becomes very irritable.
• Kawasaki syndrome is also characterized by an increase in heart rate. Since the heart is damaged, the heart rhythm can be disturbed.
• Lymphatic glands become larger around the neck.
Over time, there may be various complications from many systems and organs. Perhaps the development of myocarditis, myocardial infarction with the cardiovascular system. With the disease there is a probability of rupture of the aneurysm, while blood enters the pericardial cavity, thereby developing hemopericardium. Many rare diseases, including Kawasaki disease, cause heart valve damage. They can develop an inflammatory process, which is called valvulitis. If the gallbladder is affected, then dropsy is formed, the meninges - aseptic meningitis, joints - arthritis, ear cavities - otitis media. When blockage of large arteries, which are located in the limbs, gangrene is formed.
Diagnosis of the disease
The patient is diagnosed on the basis of clinical signs and, of course, diagnostic examinations are obligatory.
• blood test - thrombocytosis, anemia, transaminases, elevated levels of C-reactive protein, ESR, antitrypsin;
• urinalysis - there is pus and protein in the urine;
• electrocardiography - used for making an early diagnosis of myocardial infarction;
• X-ray of the chest - allows you to detect changes in the boundaries of the heart;
• magnetic resonance and computed angiography - necessary in order to assess the patency of the coronary arteries;
• Echocardiography - allows you to determine if there are any abnormalities in the functioning of the heart.
Difficulty at diagnosis
Rare diseases are usually not so common for doctors. They know about them only from books. Therefore, it is more difficult to diagnose young children, such as Kawasaki syndrome, than older children. However, most often it is in young patients after a disease that there are complications in the heart. A child suffering from this disease is usually irritated and inconsolable (this may be due to aseptic meningitis), however, such signs may also be associated with other infections, such as measles.
Another symptom is the compaction and redness of the BCG injection site due to cross-reactivity between T-cells and heat shock proteins.
Changes in the oral cavity, as well as peripheral changes and rashes can occur with scarlet fever. Although an increase in lymph nodes and conjunctivitis with it are not observed.
Kawasaki is a disease that can also be confused with scalded skin syndrome, rubella, pediatric roseola, Epstein-Barr virus, infectious mononucleosis, influenza A, toxic shock syndrome, adenovirus infection, Stevenson-Johnson syndrome, systemic juvenile rheumatoid arthropic infection.
Stage of the disease
1. Acute febrile. The first two weeks continue, the main signs are fever and symptoms of acute inflammation.
2. Subacute. Lasts from 2 to 3 week, characterized by increased platelet levels, possible aneurysms.
3. Recovery. Usually at 6-8 weeks after the onset of the disease, all symptoms of the disease disappear, the stage continues to normal ESR, and lesions of blood vessels are reduced or resolved.
Kawasaki disease, like all febrile diseases, begins acutely with a sharp increase in body temperature to 40 ° C. Also characteristic is a strong excitability of patients. Patients suffer from fever, often suffer from pain in the abdomen and small joints. If you do not take any measures, the fever lasts from 1 to 2 weeks, but sometimes up to 36 days.
Usually consists of two stages. In the first stage, aspirin is used or an immunoglobulin is administered intravenously. These drugs are necessary to prevent the formation of aneurysms in the coronary arteries. The best effect of treatment is achieved if you start it in the first 10 days from the onset of the acute stage of the disease.
It is known that after undergoing this therapy, most children are cured of Kawasaki syndrome. However, recent studies have shown that in these patients, coronary artery abnormalities may occur over time. That is why people who have suffered this terrible disease need to be examined at least once every 5 years using an echocardiograph and observed by a cardiologist.
In the second stage, the treatment of aneurysms, which appeared in the coronary artery, is organized.If they are identified, an additional course of aspirin is prescribed, it is also necessary to be periodically examined (echocardiography and possibly coronary angiography). In the case when the artery aneurysm is large, then the appointment of an additional anticoagulant (clopidogrel or warfarin) is possible.
If coronary artery stenosis has developed, catheterization, rotational ablation and artery bypass surgery are prescribed.
Impact on the heart
Kawasaki is a disease that causes heart failure in children, although not in all cases. The heart is involved in the pathological process in the first few days of the disease or after the crisis. The acute form of the disease is characterized by the development of an inflammatory process in the heart muscle (myocardium). However, in most cases, after this, no serious consequences are observed, but sometimes this can be a stimulus for the development of congestive heart failure. The heart muscle weakens and cannot function normally. This is the cause of the accumulation of fluid in the tissues and the formation of edema.
Kawasaki disease in adults
Does the illness remind me of itself over time? It is known that many people who have undergone rare diseases recover, and there is no trace of the disease. In the case of Kawasaki syndrome, one in five people is suffering from serious consequences from the heart and blood vessels that feed the heart muscle. At the same time, the walls of blood vessels lose their elasticity and elasticity, and aneurysms are observed (swelling of some areas). This leads to the early onset of atherosclerosis or calcification. Sometimes all this leads to the formation of blood clots, a malfunction of the heart muscle occurs and, eventually, a myocardial infarction occurs.
Usually, over time, aneurysms that develop with the disease become smaller. It was found that the lower the age of a person at the time of the appearance of tumors, the greater the likelihood that they will completely disappear with time. Aneurysms that persist in adults can cause stenosis, blockade, thrombosis, which can lead to a heart attack. Therefore, examinations of such patients become very important in order to further exclude the likelihood of adverse symptoms.