Which arteries are affected by Kawasaki disease? What is Kawasaki disease in children
Kawasaki disease (or Kawasaki syndrome) is a dangerous vascular disease and is part of the group of systemic vasculitis. With this pathology, abnormal damage to the walls of blood vessels occurs by cells of the immune system. Mostly this disease occurs in children in the first years of their life. The disease is accompanied by damage to arteries and veins of medium and small caliber, and the coronary arteries are also damaged. As a result, even a small child can develop severe cardiovascular pathologies: hemopericardium, valvulitis, mitral, aortic, etc. A number of them can cause the death of a child.
In this article we will introduce you to the suspected causes, manifestations, methods of identifying and treating Kawasaki disease in children. This information will help you understand the essence of the disease, you will be able to notice its first signs and make the right decision about the need to see a doctor.
This disease was first described in 1961 by Japanese pediatrician T. Kawasaki. He identified similar symptoms in 50 children: prolonged fever, a characteristic measles-like rash, peeling of the skin, erythematous swelling of the palms and feet, enlarged lymph nodes, cracked lips and conjunctivitis. The disease was difficult to treat, and many children died from the onset of cardiac pathology. A few years later, Kawasaki disease was described, and the whole world learned about it. In Russia, such a diagnosis was first made in 1980.
According to statistics, this disease develops tens of times more often in people of the yellow race (mainly Japanese). Typically, Kawasaki disease is detected in children under 5 years of age, the peak incidence is observed at the age of 1-2 years (according to some sources at 9-11 months, according to others at 1.5-2 years). Boys are most susceptible to this disease. In later and adulthood, the disease rarely develops.
Causes
Kawasaki disease is an autoimmune process. For a number of reasons, the body begins to produce antibodies that attack the cells of blood vessels.So far, scientists have not been able to determine the exact causes of Kawasaki disease. It is assumed that hereditary factors or bacteria and viruses that cause autoimmune reactions can provoke the disease.
It is known that Kawasaki disease is based on an autoimmune process that develops in children from the first years of life and leads to inflammation of the walls of blood vessels. It usually starts suddenly. In response to the presence of microorganisms - staphylococci, streptococci, rickettsia, herpes simplex viruses, retro- or parvoviruses - the immune system begins to produce antibodies that attack the walls of blood vessels. As a result, an inflammatory process develops, which subsequently leads to necrosis.
People at risk for developing Kawasaki disease include:
- children 1-5 years old (especially in the second year of life);
- boys;
- children with immunodeficiency;
- children in whose family there have already been cases of this disease;
- representatives of the yellow race (especially the Japanese).
In rare cases, the disease develops in children over 5 years of age and adults.
Symptoms
The first sign of Kawasaki disease is a sharp increase in temperature to 38-40 °C. The fever cannot be controlled with conventional antipyretics and lasts about 5 days. If untreated, the fever persists for 14 days, and an increase in the duration of the febrile period is considered an unfavorable prognostic symptom.
After a few days, the child begins to show other signs of Kawasaki disease.
Skin and mucous membranes
Eyes
In most children, it appears in the first 7 days. It is usually not accompanied by the eye discharge characteristic of this disease, and in some cases is accompanied by anterior uveitis.
Airways
The child develops dry mouth and bleeding cracks on the lips. The tongue becomes swollen and crimson, the pharynx turns red, and the tonsils become enlarged. In addition, swelling of the nasal mucosa occurs, manifested by nasal congestion.
Leather
One of the characteristic signs of this pathology is a rash localized on the torso, lower extremities and groin. In the first 5 weeks after the onset of the disease, various polymorphic and diffuse lesions of the skin occur:
- rash in the form of red spots of different sizes;
- blisters;
- measles-like or scarlet-like rash.
The localization of the rash is usually typical, its elements are found on:
- torso;
- lower parts of the arms and legs;
- groin area.
After some period of time, the child develops erythematous changes and thickened areas on the soles and palms. They interfere with the normal movement of the fingers and after a while they begin to peel off.
With Kawasaki disease, the reverse development of the rash begins 7 days after its appearance, and erythematous spots persist for 2-3 weeks.
The lymph nodes
In about half of children, Kawasaki disease is accompanied by enlarged lymph nodes in the neck. As a rule, it is one-sided.
Digestive system
Abnormal bowel movements (in the form of watery diarrhea), abdominal pain and vomiting may appear in the initial period of the disease. Some children may develop intussusception in the acute stage.
For 2 weeks, a child with Kawasaki disease may have symptoms of a special form, which is accompanied by vomiting, diarrhea, abdominal pain (even hepatic colic). In some cases, the disease provokes the development of pancreatitis.
Nervous system
Signs of damage to the nervous system in this disease are usually observed in children under one year of age. They may present with symptoms of serous or Guillain-Barré syndrome. As a rule, they occur in the acute period against the background of fever and can manifest as isolated paralysis, hearing impairment and fainting.
With high disease activity, children may develop neuromuscular diseases - myopathies, damage to the muscles of the diaphragm.
Joints
In approximately 35% of cases, Kawasaki disease is accompanied by joint damage - arthralgia and arthritis. Joint syndrome often lasts no more than a month. Usually the knees, ankles and small joints of the feet and hands are affected.
Urinary system
Sometimes Kawasaki disease leads to the development of urethritis or bullous cystitis.
Heart and blood vessels
Damages to the cardiovascular system in Kawasaki disease manifest themselves in the form of myocarditis, causing pain in the heart, increased heart rate and arrhythmias. Often pathological processes cause the development of acute heart failure.
Approximately 1.5-2 months after the onset of the disease, the patient may develop aneurysms of the coronary vessels, provoking myocardial infarction. Sometimes aneurysmal enlargements form on the walls of other arteries: subclavian, ulnar, femoral.
These manifestations of Kawasaki disease are the most dangerous to life and health. As a rule, the reverse development of aneurysms occurs within a month, but the high risk of death from thrombosis and myocardial infarction persists for 3 months.
In more rare cases, Kawasaki disease provokes the development of other cardiovascular pathologies:
- cardiomegaly;
- hemopericardium;
- valvulitis;
- or ;
- pericarditis.
General state
Against the background of all the symptoms described above, children with Kawasaki disease become restless, overly irritable or lethargic.
Stages of the disease
There are several periods during the course of Kawasaki disease:
- acute – lasts about 2 weeks, manifested by fever, myocarditis, general intoxication and asthenia syndrome;
- subacute – lasts from 2 to 3 weeks, manifested by an increase in the level of platelets in the blood and symptoms of cardiovascular pathologies;
- recovery - occurs by the second month of the disease, but can take several months or 1-2 years.
Diagnostics
General and biochemical blood tests will help confirm the diagnosis, in which characteristic changes will be detected. To identify this disease, there are the following diagnostic criteria-symptoms accompanying a 5-day fever:
- bilateral conjunctivitis;
- lesions of the oral mucosa;
- polymorphic rash;
- erythema and hardness of the palms and feet;
- enlarged cervical lymph nodes.
To make a diagnosis, it is enough to identify at least 4 signs, and with the additional detection of a coronary aneurysm - 3.
To confirm the diagnosis, the following laboratory blood tests are performed:
- – increased ESR, signs of anemia and leukocytosis with a shift to the left;
- biochemical and serological tests - increased levels of transaminases, immunoglobulins and seromucoid, detection of CEC.
Urine tests may show leukocytosis and the presence of protein.
To exclude an erroneous diagnosis, differential diagnosis of Kawasaki disease is carried out with the following diseases:
- childhood infections: scarlet fever, rubella;
- Stevens-Johnson syndrome;
- juvenile rheumatoid arthritis;
- mycoplasma pneumonia;
- flu;
To obtain data on the nature of changes in the blood vessels, heart, nervous system and other organs, the following studies are performed:
- chest x-ray;
- ECG (regular and Holter);
- coronary angiography;
- CT and MRI;
- Ultrasound of various organs;
- lumbar puncture followed by cerebrospinal fluid analysis.
Treatment
After Kawasaki syndrome is detected, the child is hospitalized for inpatient treatment. At the first stage, therapy is aimed at eliminating fever, stabilizing immune reactions and preventing possible complications from the cardiovascular system, which can be provoked by an increased tendency to thrombus formation.
The drug therapy plan includes the following medications:
- immunoglobulins are administered intravenously for 8-12 days to eliminate inflammatory processes in the walls of blood vessels and fever (if after the first administration the temperature does not decrease, then such drugs are used again);
- Aspirin is used to prevent blood clots and as an anti-inflammatory agent (Kawasaki disease is the only exception for refusing the use of acetylsalicylic acid in young children and after achieving the required therapeutic effect, the dosage of the drug is reduced to prophylactic).
In addition to these drugs, children with identified aneurysms are recommended to take (Clopidogrel, Warfarin, etc.).
Previously, glucocorticosteroids were used to treat this disease. However, the advisability of their use has been refuted, since taking such drugs increases the risk of coronary thrombosis. The use of antibiotics also turned out to be ineffective.
Remember! Therapy for Kawasaki disease should only be carried out under medical supervision and with regular laboratory and instrumental studies that can identify its possible complications and allow adjustments in the use of certain medications. Self-medication in such cases can lead to the development of myocardial infarction and other serious consequences of this dangerous disease (including death).
After eliminating the acute manifestations of the disease, the patient is prescribed prophylactic Aspirin and follow-up with a cardiologist is recommended.
If severe stenosis of the coronary vessels occurs, cardiac surgery is performed to bypass and catheterize or rotational ablation.
Forecasts
With modern detection and proper treatment, Kawasaki disease can be successfully cured in most cases. Aneurysms most often appear in children under one year of age.
Even with a favorable prognosis for this disease, the risk of death is present in 0.8-3% of patients. The most common causes of child death are coronary artery thrombosis and myocardial infarction. In more rare cases, death occurs due to severe myocarditis, leading to severe acute heart failure. In addition, the risk of child death increases significantly in the absence of timely diagnosis and proper treatment.
After an illness, approximately 20% of children experience changes in the walls of the coronary arteries. In the future, they may cause early atherosclerosis and calcification of the coronary vessels, leading to coronary heart disease. Subsequently, the risk of myocardial infarction in such patients also increases. Due to such long-term consequences of Kawasaki disease, persons who have had this disease should be registered with a cardiologist and undergo a complete cardiac examination at least once every 3-5 years (with mandatory echocardiography).
Kawasaki disease is an immune complex disorder that causes arterial damage. The disease usually manifests itself in children under 5 years of age; boys are affected more often than girls. Rarely, but still the disease affects adults aged 20–30 years. Characteristic manifestations of Kawasaki syndrome are redness of the skin, red discoloration of the sclera, fever and heart pain.
A little background
The disease is named after the famous Japanese pediatrician who discovered this pathology in 1961. In modern medicine, Kawasaki syndrome is considered a provocateur of cardiovascular pathologies. Typically, Eastern children are affected 10 times more often than European children.
The virus that arises against the background of Kawasaki syndrome penetrates into an unformed child’s body without any special obstacles. The infection affects the lymphatic and circulatory systems, mucous membranes, and skin.
Kawasaki disease, if you seek medical help in a timely manner, has a favorable prognosis. Therefore, at the first alarming symptoms, you must immediately contact a pediatrician, cardiac surgeon, infectious disease specialist or rheumatologist. In the future, it is necessary to undergo regular preventive examinations.
Causes
Medicine still cannot name the exact reasons for the development of Kawasaki syndrome. However, you can rely on factors that provoke pathology. These include:
- infections of viral or bacterial etiology that penetrate the body (streptococci, candida, staphylococci, herpes virus and others);
- heredity (it has been proven that 10% of cases occur in those whose relatives were affected by Kawasaki disease);
- race (most cases occur in children of the Mongoloid and Asian type);
- weak immune system.
Symptoms
The manifestation of Kawasaki disease in children and adults is expressed by the following symptoms:
- persistent fever;
- bleeding cracks appear on the lips and;
- hemorrhages of the oral mucosa;
- peeling of the skin on the fingertips;
- hyperemia of the pharynx and nasal congestion;
- diarrhea;
- exanthema on the body;
- temperature increase;
- swelling of the feet and hands;
- erythema appears on the feet and palms;
- fatigue and nervousness;
- there is an increase in lymph nodes in the neck;
- as the heart is damaged, abnormal heart rhythms may occur.
In the future, the development of the disease can cause complications in various organs and systems. The development of a myocardial infarction in the future is also possible. The danger of Kawasaki disease is that it can provoke aneurysm rupture and lead to blood entering the pericardial cavity or the development of hemopericardium.
Kawasaki syndrome, like other rare pathologies, can affect the heart valves, causing inflammation to develop in them. If the membranes of the brain are affected, aseptic meningitis develops; if the gallbladder is affected, dropsy develops. Damage to the joints is fraught with arthritis, and otitis media develops as a result of damage to the middle ear. If large arteries located in the lower extremities become clogged, it develops.
Diagnostics
Based on the patient’s complaints, he is prescribed additional examinations that will help identify this syndrome:
- a blood test that determines the level of C-reactive protein, antitrypsin and ESR. A blood test also determines the presence of anemia, transaminase or thrombocytosis.
- urine analysis to determine protein and pus in it;
- using electrocardiography, you can detect myocardial infarction at the very beginning of its development;
- A chest x-ray can reveal expansion of the cardiac boundaries;
- Computed angiography is used to calculate the patency of the coronary arteries;
- with the help of detecting cardiac dysfunction.
Stages of Kawasaki syndrome
- The acute febrile stage continues for two weeks from the onset of development. The main signs in this case will be manifestations of the inflammatory process and fever.
- The subacute stage occurs between 2 and 3 weeks. At this stage, aneurysms appear and platelet levels increase.
- Recovery. At 7–8 weeks, as a rule, the symptoms of the disease disappear completely.
Like other febrile illnesses, Kawasaki syndrome begins with a high fever. Patients become very excitable. Intense pain may be concentrated in small joints and in the abdominal area.
Treatment
Treatment for Kawasaki disease is divided into two stages. At the first stage, the patient is administered immunoglobulin intravenously or prescribed aspirin. These medications protect the coronary arteries from developing aneurysms. However, the effectiveness of such treatment will be proven only if it began no later than the 10th day from the onset of the pathology.
With timely treatment, most children recover. However, scientists have found that they may develop coronary artery abnormalities in the future.
Therefore, those who have suffered Kawasaki disease need to undergo regular examination by a cardiologist with echocardiography.
At the second stage, treatment is aimed at eliminating aneurysms that have already formed in the arteries at this stage. In this case, the patient is prescribed an additional course of aspirin. Regular visits to the doctor and undergoing the necessary examination are mandatory in this case. If the aneurysm has reached a large size, the patient is prescribed anticoagulants.
Methods such as catheterization, arterial bypass or rotational ablation are performed if it is necessary to diagnose coronary artery stenosis.
Impact of pathology on the heart
In some cases, the syndrome triggers the development of heart failure in children. Heart damage can occur both during the disease and after the crisis has subsided. If Kawasaki disease occurs in an acute form, inflammation of the myocardium develops.
As a rule, no serious consequences arise after this, only in some cases the formation is observed. The heart weakens and loses normal performance. As a result, fluid accumulates in the tissues and swelling appears.
Manifestations of the syndrome in adults
In most cases, Kawasaki disease is no longer present during life. However, not everyone manages to avoid the serious consequences of the disease. According to statistics, approximately 1 in 5 people experience heart and vascular problems after an illness.
The elasticity of the vessel walls is lost, and swelling of certain areas (aneurysms) occurs. This accelerates the development of calcification and atherosclerosis, and increases the risk of blood clots. If the nutrition of the heart muscle is disrupted, this sooner or later leads to.
Typically, aneurysms formed during Kawasaki syndrome shrink over time. Typically, the younger the patient is at the time of their formation, the greater the chance of their complete disappearance.
If aneurysms persist in adults, this increases the risk of blockage, stenosis and thrombosis, which can lead to a heart attack. This is why it is important for such patients to undergo regular examinations. Only increased attention to your health will help you avoid dangerous symptoms.
Prevention and prognosis
With timely treatment, Kawasaki syndrome disappears in 98% of cases. As for the remaining 2%, death occurs due to rupture of an aneurysm or myocardial infarction. Rapid death can occur due to severe myocardium in parallel with heart failure.
Kawasaki syndrome is also dangerous because there is a high risk of developing cardiovascular pathologies in the future. A child who is affected by the disease in early childhood may develop complications at school age. Such conditions may be:
- calcinosis;
- atherosclerosis;
- myocardial infarction.
To prevent complications after suffering from Kawasaki syndrome, the patient should be regularly examined by a cardiologist (at least once a year). The examination is complemented by a complete examination of the heart and vascular system.
As for the prevention of Kawasaki disease, it consists of the following measures:
- prevention of infections of viral and bacterial origin of the upper respiratory tract;
- proper nutrition;
- taking vitamin complexes.
Kawasaki syndrome develops in children under 5 years of age. This disease is caused by inflammation of the blood vessels and is manifested by fever, the appearance of a measles-like rash on the skin and inflammation of the lymph nodes.
Boys are most susceptible to developing pathology. Kawasaki disease is a disease that, in the absence of timely and adequate treatment, leads to dilation of the coronary vessels, development, thickening of the intima, narrowing of the lumen, and rupture of the vascular wall. An increase in incidence is observed in the spring and winter.
The syndrome and the disease of the same name were discovered by a Japanese pediatrician, 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, flaking of the skin and a characteristic rash. The disease was difficult to treat, and patients died from heart disease. 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.. Viral or bacterial infection, as well as autoimmune processes occurring in the human body are the main etiological factors of the disease.
autoimmune attack due to vasculitis
The autoimmune process underlying Kawasaki syndrome develops in children in the 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 endothelial cell antigens, antibodies are produced and an immune response is formed.
Risk factors that accelerate the development of changes in the coronary arteries are smoking, hypertension, dysproteinemia.
Symptoms
areas affected by Kawasaki syndrome
The clinical picture of the disease is nonspecific. Patients' body temperature rises to 40 degrees and does not decrease for 5 days. A measles-like rash and erythema appear on the skin, the cervical lymph nodes become enlarged, the tongue becomes crimson, the palms and soles peel and swell. The mouth is constantly dry, the red border of the lips becomes covered with cracks that bleed. Children experience nasal congestion, hyperemia of the pharynx, enlarged tonsils, bilateral conjunctivitis, etc. Against the background of fever, symptoms of intoxication appear - diarrhea, abdominal pain, arthralgia, nausea, fatigue and irritability, tachycardia. Sick children become moody, restless, lethargic, or overly excitable.
Skin manifestations of the syndrome are represented by small red spots, blisters, scarlatina-like or corepodona rash.
Its elements are found on the trunk, limbs and groin. Areas of erythema form on the hardened skin of the palms and soles, limiting the movement of the fingers.
manifestations 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
- manifests itself in the blood and symptoms of cardiac disorders - systolic murmur, muffled heart sounds,. Recovery occurs by the end of the second month of illness:
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 disappear permanently.
Patients complain of heart pain, tachycardia, arthralgia, vomiting, and diarrhea. In more rare cases, symptoms of meningitis, cholecystitis and urethritis, cardiomegaly, and hepatomegaly are noted.
Complications
Kawasaki disease has a very severe course and is often complicated by the development of serious disorders:
- Myocarditis,
- Aneurysm rupture,
- Acquired
- Hemopericardium,
- Otitis media,
- Valvulitis,
Timely diagnosis and treatment of Kawasaki syndrome have dramatically reduced 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 hyperemia of the extremities, erythema of the palms or feet, polymorphic rash on the trunk, adenopathy.
- Patients exhibit thrombocytosis, anemia, increased ESR.
- A general urine test shows protein and leukocytes.
- - signs of myocardial infarction.
- The x-ray shows changes in the boundaries of the heart.
- MRI and CT scans show signs of impaired patency of the coronary arteries.
- Additional methods include and.
Treatment
Since the etiology of the disease is not determined, etiotropic treatment is not carried out.
Kawasaki syndrome in children is a very rare and serious disease that is characterized by an inflammatory process affecting the coronary and other arteries. It develops in children, most often under the age of five, but there are known cases of the disease in adults - 20-30 year olds. This disease occurs more often in boys, and girls develop Kawasaki syndrome (pictured) much less frequently.
Description of the syndrome
This disease is also called periarteritis nodosa, as well as generalized vasculitis or mucocutaneous lymph node syndrome. Kawasaki disease is dangerous because it causes very negative complications, which can manifest themselves in the form of the formation of aneurysms and their ruptures, the occurrence of such serious diseases as myocarditis, aseptic meningitis, arthritis, etc. This pathology in European countries has exceeded the incidence of rheumatic fever, and causes in most cases complex heart defects. Treatment of Kawasaki syndrome in children should be timely.
Mechanism of development of Kawasaki disease
This disease develops as follows: the child’s body begins to form antibodies that attack its own endothelial cells, which are the main ones in the structure of the walls of blood vessels. For what reasons this happens, science is still unknown. However, as a result of such immune reactions, the following pathological processes begin in the child’s body:
- The middle wall of the vascular wall, called the media, begins to become inflamed and its cells gradually die.
- The structure of the outer and inner membranes of the vessels is destroyed, which leads to the appearance of expansions in the walls, which are aneurysms.
If Kawasaki syndrome is not treated, within two months the child begins to develop fibrosis of the vascular walls, as a result of which the lumen of the arteries begins to gradually narrow and sometimes close completely.
A favorable prognosis for Kawasaki disease occurs only in cases where therapeutic measures to eliminate this disease were started in a timely manner. However, the risk of death is very high, and the most common cause is arterial thrombosis or acute myocardial infarction. 3% of all cases of the disease end in the death of the patient.
Kawasaki syndrome is considered rheumatological, so a rheumatologist treats this disease. Depending on what complications the disease has acquired, specialists such as a heart surgeon and a cardiologist may be involved in its treatment. Let's look at the causes of Kawasaki syndrome in children.
Causes of Kawasaki disease
In the field of medicine that deals with the treatment of this disease, there is still no reliable information about the reasons for the initiation of the inflammatory process of the vascular walls. However, there are several assumptions about this. The most common of them is the suspicion that there is a certain hereditary predisposition in the body, which is aggravated by external influences - the entry of microorganisms of bacterial or viral etiology into the human body. These may include Epstein-Barr virus, rickettsia, parvovirus, spirochete, streptococcus, herpes simplex virus, retrovirus, staphylococcus, etc. Scientific medical studies have shown that 10% of people whose ancestors suffered from Kawasaki syndrome also develop it.
Prerequisites
The prerequisites for the development of this syndrome are:
Symptoms of Kawasaki disease
The disease usually develops in three periods:
- The acute phase, which usually lasts about 7-10 days.
- Subacute period, which lasts approximately 2-3 weeks.
- The convalescence phase (the period of recovery of the body), which can last several months, but not more than two years.
Kawasaki syndrome in children (photo below) usually develops very abruptly. The child’s temperature may rise to the upper levels, and persists for the first 6-7 days of the disease. If the necessary treatment is not started immediately, the high temperature may persist for 14 days. The longer such a febrile period lasts, the worse the prognosis for the recovery of the little patient.
Enlarged lymph nodes
If a child has a low-grade fever during the illness, symptoms of Kawasaki disease may include enlarged lymph nodes, most often in the neck area. This is accompanied by symptoms of severe intoxication of the body - weakness, abdominal pain, indigestion, tachycardia. The child will behave very restlessly, may cry often, have sleep disturbances and lack of appetite.
During the first 4-5 weeks from the onset of the disease, skin symptoms may appear in the form of a scattering of small blisters, as well as a rash similar to that which occurs with scarlet fever and measles. Elements of the rash are usually located in the groin and on the extremities. The skin of the feet and palms begins to thicken in certain areas, and between the toes it begins to hurt and crack. The child may experience severe swelling in the area of the feet. These skin manifestations disappear on days 6-7, but erythema can persist for up to 2-3 weeks, after which severe peeling of the skin is observed.
Conjunctivitis
Symptoms of Kawasaki syndrome in children may include acute conjunctivitis, as well as inflammation of the vascular elements in both eyes. The oral mucosa becomes dry, the tonsils become enlarged, and the color of the tongue becomes bright red.
In cases where the disease affects the heart, the child may experience arrhythmia, tachycardia, and severe shortness of breath, which is caused by acute heart failure. Sometimes inflammation of the pericardium - the pericardial sac - occurs, as a result of which the process of development of mitral and aortic insufficiency begins. The coronary vessels dilate, and aneurysms of the ulnar, subclavian and femoral arteries may also appear. In 40% of patients with the syndrome, inflammation of the joints may begin. The causes and treatment of Kawasaki syndrome in children are interrelated.
Diagnosis of the disease
The disease can be confirmed by the presence of a 5-7-day fever, and mandatory clinical diagnostic criteria include:
- Conjunctivitis of both eyes.
- Damage to the mucous membrane of the mouth and throat.
- Adenopathy (local).
- Thickening and redness of the skin of the palms and feet, accompanied by severe swelling.
- Peeling of the skin on the fingertips at 3 weeks of illness.
In cases where coronary artery aneurysms are revealed during examination of a child, then three additional signs of the disease from the above are required to establish an accurate diagnosis.
Laboratory research
Laboratory tests required for this include:
- blood chemistry;
- general blood and urine tests;
- cerebrospinal fluid examination.
Instrumental methods for identifying Kawasaki disease include:
- chest x-ray;
- Ultrasound of the heart;
- angiography of the coronary vessels.
Treatment of Kawasaki syndrome
This disease is highly treatable, but it is important to start therapeutic measures at an early stage. Cases of death cannot be excluded, since the likelihood of developing serious complications is high.
Drugs
Since the causes of this disease are unknown, treatment is not to eliminate them, but to prevent the consequences and relieve symptoms. The following medications are used for this:
- "Immunoglobulin", which is the main one in the treatment of Kawasaki disease. The drug is administered intravenously for 10-12 hours every day. If you start treatment with this medication in the first days of the disease, the effect will be most favorable. Its action reduces inflammatory processes in the walls of blood vessels.
- "Acetylsalicylic acid". This drug is prescribed in large doses in the first days, followed by a subsequent reduction in dosage. The medicine thins the blood, reduces the risk of blood clots and stops inflammatory processes.
- Anticoagulants. These medications may include Warfarin or Clopidogrel. They can be recommended to sick children who have been diagnosed with aneurysms. Prescribed for the prevention of thrombosis.
The prescription of corticosteroid drugs for the occurrence of Kawasaki syndrome in children is questionable. However, hormonal drugs are known to increase the risk factors for aneurysm formation as well as coronary thrombosis.
Conclusion
Children should be vaccinated against diseases such as measles, chickenpox, and influenza, since too long treatment with aspirin during infection with these infections causes acute liver failure and encephalopathy, the so-called Reye's syndrome.
Despite the fact that the risk of complications of the disease is extremely high, the prognosis for treatment is favorable.
Rarely diagnosed arterial damage in young children occurs due to the deposition of immune complexes. This condition is called Kawasaki disease. It is manifested by fever, skin rashes, damage to the mucous membranes of the mouth, eyes, redness of the palms and feet, and enlarged cervical lymph nodes.
Complications may include vascular aneurysms, myocarditis and myocardial infarction, and meningitis. For treatment, immunoglobulin is prescribed by intravenous injection and long-term use of Aspirin.
Read in this article
Causes of development of Kawasaki syndrome
There is no clear conclusion about the origin of the disease. The most likely theory is genetic predisposition.
- The triggering factor may be infections caused by:
- bacteria - streptococci and staphylococci;
- rickettsia;
herpes viruses, Epstein-Barr, retroviruses.
The Japanese are most often affected; they have special genes that cause the formation of an autoimmune process when microbes enter the body.
Symptoms in children
The syndrome usually occurs between the ages of one and two years, and is less commonly detected after 5 years of age. The disease progresses in stages. This is due to the fact that in the acute phase there is an active inflammatory process with temperature, the formation of vascular aneurysms and blood clots. It lasts about 2 weeks, then, even without treatment, enters a subacute phase that lasts about a month.
The outcome of inflammation is the replacement of the tissue of the lining of blood vessels with connective tissue fibers and their clogging with blood clots.
Untreated or undiagnosed disease leads to massive damage to the coronary arteries, ending in aneurysms with their rupture.
- Main clinical manifestations:
- temperature up to 38.5 - 39 degrees from 1 to 2 weeks;
- finely spotted rash, blisters, scarlet-like elements on the torso, limbs;
- swelling of the palms and feet, redness of the skin on them followed by peeling;
- conjunctivitis and;
- dry mouth, crimson tongue, cracked lips, enlarged tonsils;
- hardened, large lymph nodes in the neck;
To make a diagnosis, prolonged fever and the presence of at least 4 of the above criteria are taken into account. The insidiousness of the disease is that these signs are nonspecific, are not always present in the patient, and do not occur at the same time.
Therefore, Kawasaki syndrome often remains undetected, which leads to complications.
What is the danger of the disease
- Damage to the coronary arteries is the most severe. Untreated vasculitis causes the following consequences:
acute circulatory failure, Vascular aneurysm due to Kawasaki syndrome
Other conditions that may be accompanied by Kawasaki disease are: meningitis, inflammation of the ENT organs, indigestion, diarrhea, gangrene of the fingers or toes, and urethritis.
In addition, aneurysms occur not only in the coronary arteries, but also in the vessels of the extremities and abdominal cavity. In most cases, ruptures provoke massive internal bleeding with a fatal outcome.
Watch the video about Kawasaki disease and recommendations for patients:
Diagnostic methods
There is not a single method that could reliably determine Kawasaki syndrome, so you need to focus on a long period of fever and the presence of several criteria characteristic of the pathology.
- Additional research methods are of auxiliary value; they are used more often for differential diagnosis.
- Survey data is often the following:
- blood test - low red blood cells and hemoglobin, white blood cells above normal, accelerated ESR;
- blood biochemistry – high immunoglobulins and seromucoid, an increase in the titer of circulating antibodies in the acute stage;
- urine analysis - protein and leukocytes;
ECG – signs of ischemia;
angiography – disturbance of coronary blood flow. Despite the autoimmune nature of the disease, hormonal therapy with corticosteroids is contraindicated because it increases the process of thrombus formation in the coronary arteries of the heart.
Intravenous immunoglobulin is prescribed.
The drip is placed only in a hospital setting under the supervision of a doctor. Its duration is about 10 hours.
