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13 Cards in this Set

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clinical
The clinical manifestations include the presence of fever for at least 5 days, no other reasonable etiology, and 4 of 5 of the following:
1.
A non exudative conjunctivitis that is usually bilateral
2.
Erythema of the lips, oral mucosa, and pharynx, including a strawberry tongue and cracking or peeling of the lips later into the disease
3.
A polymorphous rash of the face, trunk, and extremities that later can involve the perineal area and is characterized by desquamation at 5-7 days (Figure 4-2)
4.
Cervical adenopathy greater than 1.5 em in diameter that is usually unilateral
5.
Changes in the extremities, including edema and erythema of the hands and feet followed by periungual
desquamation at 11-25 days into the disease
Incomplete Kawasaki disease can be diagnosed when
Incomplete Kawasaki disease can be diagnosed when fever is present for 5 or longer days in the presence
of 2 to 3 of the preceding criteria when the CRP is 3.0 mg/dL or more and/or the ESR is 40 mm/hour or more. In this instance, certain laboratory criteria should be met including hypoalbuminemia, anemia, increased serum alanine aminotransferase, thrombocytosis,
leukocytosis, and sterile pyuria.
supportive findings of the acute phase of Kawasaki disease include
supportive findings of the acute phase of Kawasaki disease include urethritis with sterile pyuria, aseptic meningitis, abdominal pain, hydrops of the gallbladder, and arthritis that usually involves the small joints but may involve the large joints 2-3 weeks into the disease. Also, mild carditis and arrhythmias may occur.
The subacute phase occurs
The subacute phase occurs 11-25 days following the onset of fever and is characterized
by a decrease in the rash and fever with the onset of desquamation of the fingers and toes.
Thrombocytosis peaks at...
what is bacame evident in this period
Thrombocytosis peaks at 2-4 weeks into the course of the disease. It is during this phase that coronary artery aneurysms usually become evident.
the most feared complication of Kawasaki disease and occur
Coronary artery aneurysms are the most feared complication of Kawasaki disease and occur in up to 15-25% of untreated patients (Figure 4-3). They are a result of the panvasculitis resulting in aneurysmal
transformation of the coronary arteries and may be seen as early as 7 days after the onset of the fever. Their incidence peaks at 3-4 weeks and they are seldom
found after 8 weeks into the course of the disease.
Giant aneurysms
Giant aneurysms are described as having a diameter greater than 8 mm and are associated with increased mortality and morbidity
Patients with aneurysms also have a higher incidence of developing
stenoses leading to
Patients with aneurysms also have a higher incidence of developing
stenoses leading to myocardial ischemia and infarction with long-term follow-up
is the most common cause of mortality in the subacute phase;
Coronary artery rupture is the most common cause of mortality in the subacute phase;
are the most common causes of mortality in the acute phase within the first 10 days after the onset of fever.
myocarditis, heart failure, and arrhythmias are the most common causes of mortality in the acute phase within the first 10 days after the onset of fever.
Risk factors for the development
of coronary artery aneurysms include
Risk factors for the development
of coronary artery aneurysms include male gender, age younger than 1 year, hemoglobin less than 10 g/dL, white blood cell count greater than 30,OOO/mm3, ESR greater than 101 mm/hour, and prolonged fever.
is recommended for assessment of coronary artery involvement with Kawasaki disease.
Echocardiography is recommended for assessment of coronary artery involvement with Kawasaki disease. The most recent recommendations
suggest that an echocardiogram is obtained at diagnosis, and if no coronary disease is seen, then it should be repeated in 6-8 weeks. If coronary artery involvement is documented, then follow-up should be more frequent based on the extent of disease
The management of Kawasaki disease includes
The management of Kawasaki disease includes high-dose aspirin, which is given during the acute phase, followed by low-dose aspirin for 6-8 weeks.

This is given for antithrombotic effect while thrombocytosis is present. IVIG is administered within the first 10 days of the disease at a dose of 2 g/kg and may be repeated if fever persists following this therapy.
The use of IVIG decreases the incidence of coronary artery aneurysms to less than 5%.

If aneurysms persist past 2 months, then aspirin or other anticlotting agents should be continued. The use of steroids is not indicated for uncomplicated Kawasaki disease.