Kawasaki virus symptoms and treatment. Kawasaki disease - what is it? Symptoms and treatment

Kawasaki syndrome develops in children under the age of 5 years. This disease is caused by inflammation of the blood vessels and is manifested by fever, morbilliform skin rash, and swollen lymph nodes. Boys are most susceptible to the development of pathology. Kawasaki disease is one that, in the absence of timely and adequate treatment, leads to the expansion of coronary vessels, development, thickening of the intima, narrowing of the lumen, and rupture of the vascular wall. An increase in the incidence is observed in the spring-winter period.

The syndrome and the disease of the same name were discovered by a pediatrician from Japan, T. Kawasaki. In 50 sick children, he found similar clinical symptoms: prolonged fever, enlarged lymph nodes, conjunctivitis, cracked lips, swelling of the soles and palms, hyperemia, dryness, peeling of the skin and a characteristic rash. The disease responded poorly to treatment, patients died from cardiac pathology. A few years later, the whole world learned about this disease.

Causes

The causes of Kawasaki syndrome are not fully understood and are not known to medicine. It is assumed that hereditary predisposition and microbes play a leading role in the development of pathology.. Viral or bacterial infection, as well as autoimmune processes occurring in the human body, are the main etiological factors of the disease.

autoimmune attack in vasculitis

The autoimmune process underlying Kawasaki syndrome develops in children in their first years of life and leads to inflammation of the blood vessels, which is detected suddenly after a series of diagnostic procedures. Staphylococci, streptococci or rickettsia stimulate the formation of T-lymphocytes. In response to antigens of endothelial cells, antibodies are produced, and an immune response is formed.

Risk factors that accelerate the development of changes in the coronary arteries - smoking, hypertension, dysproteinemia.

Symptoms

lesions in Kawasaki syndrome

The clinic of the disease is nonspecific. In patients, the body temperature rises to 40 degrees and does not decrease within 5 days. A measles-like rash, erythema appears on the skin, the cervical lymph nodes increase, the tongue becomes crimson, the palms and feet flake and swell. The mouth is constantly dry, the red border of the lips is covered with cracks that bleed. In children, nasal congestion, hyperemia of the pharynx, enlargement of the tonsils, bilateral conjunctivitis and. Against the background of fever, symptoms of intoxication appear - diarrhea, abdominal pain, arthralgia, nausea, fatigue and irritability, tachycardia. Affected children become moody, restless, lethargic or overly excitable.

Skin manifestations of the syndrome are represented by small red spots, blisters, scarlet-like or corepod rash. Its elements are found on the trunk, limbs and in the groin. Areas of erythema form on the thickened skin of the palms and soles, which limits the movement of the fingers.

symptoms of Kawasaki disease

During the pathology, three stages are distinguished, cyclically replacing each other:

• Acute stage lasts two weeks and is manifested by fever, symptoms of asthenia and intoxication. In the myocardium, it weakens and ceases to function.
• Subacute stage manifested in the blood and symptoms of cardiac disorders - systolic murmur, muffled heart tones,.
• Recovery occurs by the end of the second month of illness: all symptoms of the pathology disappear and the parameters of the general blood test return to normal.

Kawasaki syndrome in adults is characterized by inflammation of the coronary vessels, which cease to be elastic and swell in some areas. The disease leads to early, thrombosis, and heart attack. In young people, aneurysms become smaller over time and may eventually disappear.

Patients complain of pain in the heart, tachycardia, arthralgia, vomiting, diarrhea. In more rare cases, symptoms of meningitis, cholecystitis and urethritis, cardiomegaly, hepatomegaly are noted.

Complications

Kawasaki disease has a very severe course and is often complicated by the development of serious disorders:

1. myocarditis,
2. ruptured aneurysm,
3. Acquired,
4. Hemopericardium,
5. otitis media,
6. valvulitis,

Timely diagnosis and treatment of Kawasaki syndrome made it possible to drastically reduce morbidity and infant mortality.

Diagnostics

Diagnosis of the disease is based on characteristic symptoms: high fever for more than 5 days, bilateral conjunctivitis, cracked lips, swelling and redness of the extremities, erythema of the palms or feet, polymorphic rash on the trunk, adenopathy.

• patients find thrombocytosis, anemia, increased, increased ESR.
• In the general analysis of urine - protein and leukocytes.
• - signs of myocardial infarction.
• On the radiograph - a change in the boundaries of the heart.
• On MRI and CT - signs of impaired patency of the coronary arteries.
• Additional methods include and .

Treatment

Since the etiology of the disease has not been determined, etiotropic treatment is not carried out.

One possible complication of infections in children is Kawasaki syndrome. The ambiguity of the etiology makes the disease difficult to prevent, and the high incidence of infectious pathologies among infants increases the risk of development.

According to the international classification of diseases (ICD 10), this pathology is in the group of systemic lesions of the connective tissue and has a code - M30.3. Treatment is almost always effective and negative consequences can be avoided in 80% of cases, and mortality does not exceed 1%.

Kawasaki syndrome is a generalized inflammation of blood vessels with an autoimmune, i.e., arising from one's own immunity, nature. Sometimes it is also called mucocutaneous lymph node syndrome or.

The essence of the disease is damage to the arteries and veins of medium and smaller diameter, which leads to the development of aneurysms, stenosis, hemorrhages.

The disease was described in a monograph by Tomisaku Kawasaki in 1967, after whom the name was later given.

He identified a group of sick children with the same symptoms:

• skin rash;
• long fever;
• bilateral conjunctivitis;
• an increase in cervical lymph nodes;
• edema.

At first, the pathology was called "skin-mucosal-lymphatic syndrome", but in 1970, lesions of the coronary vessels were also detected.

The peak incidence of Kawasaki syndrome occurs at 12-24 months of age, but manifestations have been reported before the age of 5 years. In Russia and the CIS countries, pathology is very rare, most often found in Japan.

In adults, Kawasaki syndrome is recorded in isolated cases, because the disease belongs to pediatrics and is considered exclusively for children. In adulthood, it proceeds in a similar way, its severity depends on the primary infection.

It has been established that the main link in pathogenesis is the reaction of antibodies to endothelial cells and viruses. Antibodies affect the vessels and cause inflammation in the middle layer of the wall, causing the development of smooth muscle necrosis.

This process leads to the formation of aneurysms and ruptures, which can be accompanied by heart attacks and strokes. Most often, the cardiac, subcutaneous, renal, axillary, and periovarian arteries are affected.

Kawasaki disease is always accompanied by a fever - a temperature of about 40 degrees can last throughout the course of the disease, because the body experiences severe exhaustion. And also the arteries of the eye become very inflamed, which leads to conjunctivitis. The peculiarity of its flow is always a two-sided manifestation.

Persistent bleeding due to rupture of an aneurysm can provoke an adverse development of DIC with the formation of a large number of blood clots and subsequent massive hemorrhage. The rheumatological prognosis in this case will be disappointing.

Possible causes of pathology

The cause of Kawasaki syndrome is not fully established. The high prevalence of the disease in Japan and its rare occurrence outside the Asian region suggests a possible genetic predisposition.

The principle of inheritance of predisposition is also not fully understood. Statistically, about 10% of people whose ancestors had Kawasaki disease are also diagnosed with the disease.

Rheumatology, a branch of medicine that studies connective tissue, highlights the obligatory influence of an infection of a viral or bacterial nature.

Pathogens:

• Epstein-Barr virus.
• Parvovirus.
• Rickettsia.
• Herpes.
• Spirochetes.
• Staphylococci.
• Streptococci.

Kawasaki syndrome itself is not contagious to other people, but the bacterium or virus that caused its manifestation can be transmitted. Therefore, when communicating with a child, precautions should be used: gloves, a gauze mask.

Symptoms and signs

The disease has a complete and incomplete form. Common to them is a persistent fever, with a baby's body temperature of 39-40 degrees, which lasts more than 5 days.

To accurately determine the variety, look at the following mandatory features:

• Bilateral conjunctivitis.
• Changes in the mucous membranes of the nasopharynx, mouth and tongue (“strawberry”, pronounced color, tongue), cracked lips, redness of the throat.
• Local erythema on the palms and feet, dense swelling, exfoliation of the skin on the fingers.
• Bright red urticaria, without crusts and bubbles.
• Swelling of the glands in the neck, without discharge of pus.

In the presence of all signs, doctors diagnose the full form of the disease, in the absence of 2-3 from the list presented - incomplete.

Here is how they look in the photo:

Other symptoms may be present, but they are not necessary for an accurate diagnosis.

It can be divided into the following types:

• Skin manifestations, lesions of the musculoskeletal system.
• Mucosal manifestations.
• Damage to the heart and blood vessels.

Manifestations on the skin, in the joints

On the surface of the body, the disease is expressed by macular rash and blisters.

They appear due to the destruction of blood vessels. They are usually located on the trunk or limbs, can occur in the groin and armpits - places of greatest skin friction.

Over time, erythema forms on the surface of the skin - severe redness, which is marked by soreness. Frequent places of occurrence are the plantar surface of the hands and feet. A strong seal limits the motor activity of the fingers.

Vascular aneurysms and their destruction affect the joints. Intra-articular bleeding, arthralgia, arthritis occur in a third of cases. The articular syndrome lasts up to one month, followed by a stable remission with the restoration of motor activity.

Manifestations on the mucous membranes

The mucous membranes of the eyes and oral cavity are often damaged. Before the eyes, this is expressed by conjunctival bleeding, conjunctivitis develops. They are constantly red, streaks of blood are clearly visible.

Language undergoes special changes. Due to bursting vessels, a strawberry or crimson color of the papillary surface of the tongue may appear, which is shown in the photo below:

Bleeding is noted on the mucous membranes of the cheeks and gums, there are symptoms of inflammation in the pharynx - redness, enlargement of the tonsils, and the development of purulent tonsillitis is possible. Lips crack and bleed.

Symptoms from the cardiovascular system

Kawasaki syndrome is dangerous for heart damage: aneurysms form in the coronary arteries, blood supply worsens, and myocardial ischemia occurs.

Often manifested myocarditis with tachycardia, pain in the heart, arrhythmic disorders. In the absence of therapy, the development of acute heart failure with a high probability of death is possible.

Less common: pericarditis, aortic and mitral insufficiency. There may be a defect in the tricuspid valve, problems with the lungs due to a violation of cardiac activity.

Stages of the course of the disease

Kawasaki syndrome in children occurs in 3 stages:

• Acute, during the first 10 days.
• Subacute, within 2-3 weeks.
• The recovery period, from a month to two years.

The acute stage begins with a sharp rise in temperature (hyperthermia) to 39-40 degrees, with an intermittent character. High temperature persists throughout the acute period.

Against the background of fever, there is an increase in the cervical and thoracic lymph nodes, there are symptoms of a general intoxication syndrome - vomiting, weakness, diarrhea, pain in the liver. In the acute period, conjunctivitis occurs.

The subacute stage is characterized by the appearance of erythema, rashes. Necrosis of the medial layer leads to the formation of aneurysms, developing bleeding causes thrombosis. This stage is dangerous for the development of damage to the cardiovascular system. Rashes on the skin pass to its end, the skin begins to peel off, the manifestation of conjunctivitis subsides.

The stage of recovery is characterized by the gradual restoration of blood vessels. The duration depends on the massiveness of the lesion, the number of aneurysms. The speed of recovery depends on how quickly treatment was started.

How is the diagnosis carried out?

In addition to the usual examination, which is often enough to diagnose a pathology, tests and instrumental studies are prescribed.

Analyzes

Help in determining the pathology helps:

• Blood and urine tests.
• Study of the cerebrospinal fluid.

The disease itself does not have any specific markers on both clinical and biochemical blood tests. Kawasaki disease can be established using the summation of factors.

In the general blood test, anemia, thrombocytosis, and an increase in ESR will be observed. Biochemistry will show a large number of immunoglobulins,. Protein and leukocytes are found in the urine.

The study of cerebrospinal fluid allows you to determine the functional state of the brain, to exclude the development of meningitis. This is important because if meningitis is not diagnosed in time, there is a high risk of irreversible damage to the spinal cord and brain, followed by death.

Additionally, a coagulogram is performed, which serves as a differential examination method to exclude DIC.

Research

To determine the state of the organs, and especially the heart, carry out:

• EchoCG.
• X-ray of the chest;
• Angiography.

ECG shows tachycardia, initial signs of ischemia, arrhythmia. It is important at this stage to exclude acute heart failure. EchoCG allows you to find out the state of the pericardium and walls of the heart, the density of the valves.

Diagnosis of cardiac lesions occupies one of the main places in the treatment of this disease, since early therapy can prevent unpleasant consequences.

Angiography allows you to assess the condition of the coronary vessels, detect aneurysms and thrombosis. Additionally, an ultrasound of the kidneys may be prescribed - this is a measure to prevent kidney failure due to damage to the arteries.

Treatment Methods

Kawasaki syndrome does not imply a possible surgical treatment, as well as specific therapy.

Drug treatment is aimed at eliminating symptoms and, in some cases, suppressing autoimmune processes.

Immunoglobulins

The main method is the introduction of immunoglobulins, which prevent the process of destruction of blood vessels. The main indicator of dose sufficiency is the decrease in temperature in the first few hours after administration. If it is not noted, then a second injection is carried out until the result is obtained.

Immunoglobulins show the best result in the first 10 days of development, as they help prevent vascular damage.

Aspirin

The second drug is acetylsalicylic acid, or aspirin.

The drug belongs to the group of non-steroidal anti-inflammatory drugs and prevents platelet aggregation. A special plus is its low toxicity for children.

When the temperature drops, the dose is reduced to the prophylactic level, with the introduction of other anticoagulants.

Aspirin thins the blood, which helps prevent blood clots

In parallel, the main infectious complication is being treated - antibiotics, antiviral drugs. Bacteriophages show good efficiency at the recovery stage, but before that they are able to provoke an immune response and exacerbate the situation.

Corticosteroids can be used to suppress autoimmune processes, but their use in the treatment of Kawasaki syndrome is controversial.

Some researchers point to the possible harm of corticosteroids due to their ability to cause the development of aneurysms and a negative effect on the blood coagulation system.

Possible Complications

The main possible consequence of Kawasaki syndrome in young children is myocardial infarction. Multiple aneurysms in the coronary arteries lead to heart damage and ischemia. Prevention of these pathologies is the main task, since acute heart failure almost always leads to death.

Thrombosis can lead to disorders in the brain, kidneys.

Strokes and kidney failure are also fairly common complications. To prevent them, anticoagulant therapy is carried out.

Constant bleeding and weakened immunity can lead to. It carries complications for the heart and lungs, is a harbinger for the development of DIC. Prevention of the latter is also a separate task for doctors.

Forecast

Recovery and the presence of complications in Kawasaki disease in children depends on the timeliness of the start of treatment.

With the introduction of immunoglobulins in the first 5-6 days of the disease, the chance of recovery and rapid recovery is maximum.

And also the prognosis is extremely positive in preventing the rupture of aneurysms of the coronary vessels.

The rate of recovery also depends on the infectious agent. The worst prognosis for hospital infections, the best - for seasonal and common pathogens, such as herpes.

And also, according to doctors, the prognosis is more favorable if the child suffers the disease over the age of 3-4 years.

Kawasaki disease (Kawasaki syndrome, mucocutaneous lymphatic syndrome) belongs to a group of diseases called systemic vasculitis. Diseases of this group cause abnormal damage by cells of the immune system to vessels, most often, arteries and veins of medium and small size. In the case of Kawasaki syndrome, it can cause damage to the coronary arteries in children - the vessels that carry oxygenated blood and nutrients to the heart.

In addition to the coronary arteries, the inflammatory process can involve the pericardial sac (pericardium) that surrounds the heart, as well as endocardial tissue (the inside of the heart), and even the heart muscle itself.

Kawasaki disease most commonly affects children—usually under the age of 5 years. Rarely, older children and adults are exposed to it. The peak incidence falls on the age of 1 to 2 years, and boys are more often ill.

What it is?

Kawasaki syndrome is an acute febrile disease of childhood, characterized by damage to the coronary and other vessels with the possible formation of aneurysms, thrombosis and ruptures of the vascular wall.

Causes

Currently, rheumatology does not have unambiguous data on the causes of the development of Kawasaki disease.

The most accepted theory is the assumption that Kawasaki disease develops against the background of a hereditary predisposition under the influence of infectious agents of a bacterial (streptococcus, staphylococcus, rickettsia) or viral (Epstein-Barr virus, herpes simplex, parvoviruses, retroviruses) nature.

In favor of a hereditary predisposition to Kawasaki disease is evidenced by the relationship of the disease with race, its spread in other countries mainly among Japanese emigrants, and the development of the disease in 8-9% of the descendants of recovered persons.

Symptoms of Kawasaki disease

The most striking symptom of Kawasaki syndrome in children (see photo) is a fever that lasts longer than 5 days. Also observed in SC:

• an increase in the size of the cervical lymph node;
• swelling of the tongue;
• the acquisition of a scarlet hue by the tongue;
• redness of the lips;
• cracked lips;
• a rash of a polymorphic nature, localized on any part of the body;

Approximately 2 weeks after the onset of fever, the child may develop lumps with scaly skin on the palms or soles.

During the pathology, three stages are distinguished, cyclically replacing each other:

1. The acute stage lasts two weeks and is manifested by fever, symptoms of asthenia and intoxication. An inflammatory process develops in the myocardium, it weakens and ceases to function.
2. The subacute stage is manifested by thrombocytosis in the blood and symptoms of cardiac disorders - systolic murmur, muffled heart tones, arrhythmia.
3. Recovery occurs by the end of the second month of the disease: all the symptoms of the pathology disappear and the parameters of the general blood test return to normal.

Kawasaki syndrome in adults is characterized by inflammation of the coronary vessels, which cease to be elastic and swell in some areas. The disease leads to early atherosclerosis, calcification, thrombosis, myocardial dystrophy and infarction. In young people, aneurysms become smaller over time and may eventually disappear.

Patients complain of pain in the heart, tachycardia, arthralgia, vomiting, diarrhea. In more rare cases, symptoms of meningitis, cholecystitis and urethritis, cardiomegaly, hepatomegaly are noted.

Diagnostics

Fever for more than 5 days and any 4 of the following criteria are required for a diagnosis of Kawasaki syndrome

1. Erythema of the palms or feet;
2. Dense edema of the hands or feet on the 3-5th day of illness;
3. Peeling on the fingertips at the 2-3rd week of the disease;
4. Bilateral conjunctival injection;
5. Changes on the lips or in the oral cavity: "strawberry" tongue, erythema or cracks on the lips, infection of the oral mucosa and pharynx;
6. Any of the listed changes, localized on the limbs;
7. Polymorphic exanthema on the trunk without vesicles or crusts;
8. Acute non-purulent cervical lymphadenopathy (diameter of one lymph node> 1.5 cm).

If 2-3 of the 4 mandatory signs of the disease are absent, the diagnosis of an incomplete clinical picture of the disease is established.

Complications

Kawasaki disease has a very severe course and is often complicated by the development of serious disorders:

1. myocarditis,
2. Acquired aortic and mitral insufficiency,
3. Hemopericardium,
4. otitis media,
5. myocardial infarction,
6. ruptured aneurysm,
7. pericarditis,
8. valvulitis,
9. Acute and chronic heart failure.

Timely diagnosis and treatment of Kawasaki syndrome made it possible to drastically reduce morbidity and infant mortality.

Treatment of Kawasaki disease

The main goal of drug therapy is to protect the cardiovascular system from damage.

A good effect in Kawasaki disease is given by the following drugs:

With the development of complications from the cardiovascular system (stenosis, aneurysms, myocardial infarction), children who have had an acute and subacute stage of Kawasaki disease may be prescribed angioplasty, coronary artery bypass grafting or stenosis.

Forecast

Usually, for 2-3 months of the course of the disease, the symptoms completely disappear. After 4-8 weeks after that, transverse furrows of white color may form on the nail plates of the moment. If the disease is not treated, then in 25% of cases an aneurysm rupture develops.

At the moment, deaths are 0.1-0.5%, which suggests a positive prognosis. In rare cases, in about 3%, the disease may recur within a year after treatment.

Kawasaki is a disease that usually occurs in children from one and a half to 5 years old. Most often, the disease begins between 1.5 and 2 years. In addition, Kawasaki is a disease that affects boys more 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 dilatation of mainly the coronary arteries. There is also fever, vasculitis and changes in the lymph nodes, mucous membranes of the skin.

Story

This disease was first described by the Japanese pediatrician T. Kawasaki in 1967. He introduced it as a new childhood disease - mucocutaneous lymphnodular syndrome. In total, he observed 50 cases of the disease. All children had enlarged lymph nodes, cracks on the lips, exanthema, swelling of the soles and palms, hyperemia. At first, this disease was considered easily curable, but after several deaths, it was found that patients had serious heart damage. Subsequently, the whole world learned about the discovery of the scientist, and the disease was named after him.

Causes

Currently, medicine does not know the causes of Kawasaki disease. However, there is evidence that Kawasaki is a disease that develops due to an infectious agent in genetically predisposed patients.

This disease is 10 times more common in Japan than in America, and almost 30 times more common than in Britain and Australia. It was noted that in winter and spring they get sick more often.

Kawasaki disease symptoms

The disease is characterized by the following symptoms:

Fever that persists for more than 5 days.

Cracks appear on the lips, it often happens that they bleed. There are foci of erythema.

There are hemorrhages in the oral mucosa.

Kawasaki is a disease in children, which is characterized by a bright color of the tongue.

Nasal congestion and hyperemia of the pharynx are observed.

The body temperature rises.

Conjunctivitis appears due to increased filling of blood vessels.

The skin on the fingertips begins to peel off (at 2-3 weeks of the course of the disease).

There is 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 quickly gets tired and becomes very irritable.

Kawasaki syndrome is also characterized by an increased heart rate. Since the heart is damaged, the heart rhythm may be disturbed.

The lymph nodes usually become larger in the neck.

Over time, various complications from many systems and organs can be observed. Perhaps the development of myocarditis, myocardial infarction from the side of the cardiovascular system. With the disease, there is a possibility of rupture of the aneurysm, while blood enters the pericardial cavity, thereby developing hemopericardium. Many rare diseases, including Kawasaki disease, cause damage to the heart valves. They can develop an inflammatory process, which is called valvulitis. If the gallbladder is affected, then dropsy is formed, meninges - aseptic meningitis, joints - arthritis, ear cavities - otitis media. With blockage of large arteries that 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 mandatory.

Blood test - thrombocytosis, anemia, transaminases, elevated levels of C-reactive protein, ESR, antitrypsin are detected;

Urinalysis - there is the presence of pus and protein in the urine;

Electrocardiography - used to make 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 - are necessary in order to assess the patency of the coronary arteries;

Echocardiography - makes it possible to determine whether there are abnormalities in the work of the heart.

Difficulty in making a diagnosis

Rare diseases are usually not so common among doctors. They only know about them from books. Therefore, it is more difficult to make a diagnosis, such as Kawasaki syndrome, in young children than in older children. However, most often it is in young patients after the disease that complications occur in the heart. A child suffering from this disease is usually irritable and inconsolable (this may be due to aseptic meningitis), but such signs can also be with other infections, such as measles.

Another sign is hardening 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 a rash, can also be with scarlet fever. Although enlarged lymph nodes and conjunctivitis are not observed with it.

Kawasaki is a disease that can also be confused with scalded skin syndrome, rubella, roseola infantum, Epstein-Barr virus, infectious mononucleosis, influenza A, toxic shock syndrome, adenovirus infection, Stevenson-Johnson syndrome, systemic juvenile rheumatoid arthritis.

Stages of the disease

1. Acute febrile. It lasts the first two weeks, the main signs are fever and symptoms of acute inflammation.

2. Subacute. It lasts from 2 to 3 weeks, is characterized by an increase in the level of platelets, the appearance of aneurysms is possible.

3. Recovery. Usually at 6-8 weeks after the onset of the disease, while all the symptoms of the disease disappear, the stage continues to normal ESR and the lesions of blood vessels decrease or resolve.

Kawasaki disease, like all febrile diseases, begins acutely with a sharp increase in body temperature up to 40 ° C. Also characteristic is the strong excitability of patients. Patients suffer from fever, often suffer from pain in the abdomen and small joints. If no measures are taken, then the fever lasts from 1 to 2 weeks, but sometimes up to 36 days.

Treatment

Usually consists of two stages. At the first stage, aspirin is used or intravenous immunoglobulin is administered. These drugs are needed 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 show that these patients may develop coronary artery abnormalities over time. That is why people who have suffered this terrible disease need to be examined with an echocardiograph and observed by a cardiologist at least once every 5 years.

At the second stage, the treatment of aneurysms that have appeared in the coronary artery is organized. If they are detected, an additional course of aspirin is prescribed, it is also necessary to periodically undergo an examination (echocardiography and possibly angiography of the coronary vessels). In the case when the aneurysm of the artery is large, then it is possible to prescribe an additional anticoagulant (clopidogrel or warfarin).

If coronary artery stenosis has developed, catheterization, rotational ablation and artery bypass 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 illness 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 there are no serious consequences, but sometimes it can be an incentive for the development of congestive heart failure. The heart muscle is weakened and cannot function normally. This causes the accumulation of fluid in the tissues and the formation of edema.

Kawasaki disease in adults

Does the ailment remind of itself over time? It is known that many people who have had rare diseases recover, and there is no trace of the disease. In the case of Kawasaki syndrome, one person in five experiences severe consequences from the heart and blood vessels that feed the heart muscle. In this case, the walls of the vessels lose their elasticity and elasticity, and aneurysms are also observed (swelling of some areas). This leads to early onset of atherosclerosis or calcification. Sometimes all this leads to the formation of blood clots, malnutrition of the heart muscle occurs and, in the end, myocardial infarction occurs.

Usually, over time, the aneurysms that develop with the disease become smaller. It has been found that the younger the age of a person at the time of the appearance of neoplasms, the more likely it is that they will finally disappear over time. Aneurysms that persist in adults can cause stenosis, blockage, thrombosis, which can lead to a heart attack. Therefore, examinations of such patients become very important in order to exclude the possibility of adverse symptoms in the future.

One of the main causes of pathologies of the heart and blood vessels in children is Kawasaki syndrome. This anomaly is considered rare and poorly understood. It can lead to sad consequences, including death. Therefore, it is important to recognize the signs of the disease in time and provide assistance to the child.

Causes of the development of Kawasaki syndrome

The disease was first discovered in the middle of the twentieth century by an Asian doctor. According to Wikipedia, the anomaly is an acute fever in children. Kawasaki disease is also called mucocutaneous lymphonodular syndrome. Pathology is characterized by the development of proliferative-destructive vasculitis, arteritis.

It is quite rare in Russia, more often Kawasaki disease is diagnosed in Asian countries. Out of a hundred thousand children, about ten percent of babies are sick with it. In medical practice, there are cases when pathology was detected in adult patients.

The exact causes of Kawasaki syndrome in children have not been identified. It is known that heredity plays a certain role in the development of the disease, because it is often passed down from generation to generation and is observed in relatives.

The disease has an infectious nature. This was revealed during the examination of patients. Particles of some viruses were found in their blood. The following microorganisms are considered as suspected agents:

• staphylococcus;
• streptococcus;
• Epstein-Barr virus;
• parvovirus;
• spirochetes.

There is a pathology and seasonal variability. The peak is in spring and winter. There is a hypothesis that Kawasaki disease is an immune response to exposure to toxins.

In the development of pathology, a person's belonging to a particular ethnic community plays an important role. This is evidenced by the increased sensitivity to this syndrome of people living in China, Japan and Korea.

Characteristic features

The disease is accompanied by damage to the coronary and other vessels, the formation of aneurysms, thrombosis. It usually develops two months after birth. In most cases, the pathology occurs in the fourth year of a baby's life. It is noted that boys suffer from it twice as often as the opposite sex.

Kawasaki disease in children has symptoms that appear suddenly. Initially, the child has a fever that can last for a whole month. Sometimes it reaches 40 degrees. The patient is disturbed by a fever that lasts at least five days. At the same time, he feels drowsiness, abdominal cramps, becomes irritable. There are other symptoms of Kawasaki syndrome:

• dry lips;
• enlargement of the lymph nodes of the neck;
• redness of the inner oral membrane and the connective membrane of the eyes.

A few days later, skin exanthema, polymph formations, swelling of the palms and soles are added to the unpleasant symptoms, rashes appear on the mucous membrane in the mouth and on the genitals. In some cases, the syndrome is accompanied by the following manifestations:

• joint pain;
• disorder of the gastrointestinal tract;
• arrhythmia;
• tachycardia;
• protrusion of the wall of the arteries;
• cardiomegaly.

After about three weeks, some signs disappear, peeling appears on the palms and soles, and the tongue becomes crimson. You can see patients with Kawasaki symptoms in the photo (presented below). As for the respiratory organs, the patient may experience rhinorrhea, cough. In some cases, convulsions, paralysis of the facial nerve and limbs appear.

In infants, there is increased excitability, poor sleep, itching due to a rash on the skin. Swelling and pain in the tongue can cause food refusal.

A characteristic clinical sign in girls and boys is thickening and redness of the area at the injection site of BCG. This symptom is not detected in some countries, since such mass vaccination is not provided for in certain states.

Diagnosis of pathology

The complexity of diagnosing the disease lies in the rarity of the anomaly. Not every specialist is able to distinguish it from other ailments. Sometimes the syndrome is confused with chickenpox, scarlet fever, measles. Manifestations of Kawasaki disease are similar to toxic shock, Stevens-Johnson syndrome, as well as signs of other exanthemic infections. Often, along with this pathology, tonsillitis, pneumonia, and urinary tract infections are diagnosed.

The reason for going to the doctor is fever, skin rash and mucosal lesions, swelling of the hands and feet, fever that does not stop for more than five days. At least four out of five symptoms must be present in the patient to make sure that the disease is present. If a child develops coronary artery aneurysms, three signs are sufficient.

In most cases, consultation with an infectious disease specialist, cardiologist, dermatologist is required. Laboratory studies include:

1. Biochemical and general blood tests. Patients have an increase in leukocytes, thrombocytosis, transaminase activity, elevated levels of bilirubin and urobilinogen.
2. Immunological analysis. Shows the content of C-reactive protein.
3. Analysis of urine. Detects the presence of small microhematuria, proteinuria.
4. To diagnose Kawasaki, the following measures are used:
5. Electrocardiogram. Shows the work of the heart, violations of its functions.
6. Echocardiography. Detects lesions of the coronary arteries, aneurysms and stenoses of various departments.
7. Angiography. Assesses the condition of the vessels, shows the thinning and expansion of the arteries.

In some cases, a chest x-ray, CSF analysis, and lumbar puncture may be required. Based on the results of the diagnosis and questioning of parents, appropriate treatment is prescribed.

Treatment

Usually the patient is placed in a hospital, where they are treated under the supervision of a doctor. Radical therapeutic methods of pathology do not exist. Kawasaki syndrome includes treatment in children using conservative methods, and advanced cases of damage to the heart and blood vessels are eliminated surgically. The main goal of therapy is to protect the cardiovascular system.

The following drugs are usually prescribed:

1. Anticoagulants. Used to prevent the formation of blood clots. Often prescribed "Clopidogrel", "Warfarin".
2. Aspirin. Reduces the risk of thrombosis, lowers body temperature, eliminates fever.
3. Immunoglobulin. Stops inflammatory processes in the vessels, preventing the formation of aneurysms, helps to reduce temperature, reduce inflammatory processes. Intravenous administration of "Immunoglobulin" is carried out in the hospital for the first 12 hours.

These drugs have an antipyretic effect and reduce the risk of platelet aggregation. They are used at the first therapeutic stage. All drugs must be prescribed by the attending physician.

Self-therapy is unacceptable.

The second stage involves the elimination of vascular aneurysms. The patient is prescribed an additional course of "Aspirin" and anticoagulants with regular examination by a cardiologist.

Children who have undergone an acute stage of the disease undergo stenting, angioplasty, and coronary artery bypass grafting. Corticosteroid therapy should be used with caution as it increases the risk of blood clots.

Possible Complications

The main danger of pathologists is that small and large arteries are involved in the infectious process. This is fraught with vasodilation, leading to serious heart disease. The syndrome can cause the following complications:

• arthritis;
• otitis media;
• valvulitis;
• myocarditis;
• hemopericardium;
• blockage of the bile duct;
• peripheral gangrene;
• soft tissue inflammation.

Sometimes Kawasaki disease in adults makes itself felt after a while. So, one person out of five faces tragic consequences from the vascular system. The walls of the arteries become less elastic, lose elasticity. A person develops early onset of calcification and atherosclerosis. As a result, thrombosis is formed, the nutrition of the heart muscle is disturbed.

Survival prognosis

The disease has a conditionally favorable prognosis. If you start intensive use of drugs during the first few days, then recovery will come in a couple of months. Without adequate treatment, the risk of aneurysms of the coronary arteries is high.