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  1. 2. Causes <ul><li>interaction of genetic and environmental factors, possibly including an infection . The specific cause is unknown but current theories center primarily on immunological causes for the disease. Evidence increasingly points to an infectious etiology Like all autoimmune diseases, the cause of Kawasaki disease is presumably the but debate continues on whether the cause is a conventional antigenic substance </li></ul>
  2. 3. Symtoms <ul><li>High-grade fever (greater than 39 °C or 102 °F; often as high as 40 °C or 104 °F) that normally lasts for more than 5 days if left untreated. </li></ul><ul><li>Red eyes ( conjunctivitis ) without pus or drainage, also known as &quot;conjunctival injection&quot; </li></ul><ul><li>Bright red, chapped, or cracked lips </li></ul><ul><li>Red mucous membrame in the mouth .Strawberry tongue, white coating on the tongue or prominent red bumps ( papillae ) on the back of the tongue </li></ul><ul><li>Red palms of the hands and the soles of the feet </li></ul>
  3. 4. <ul><li>Rash which may take many forms, but not vesicular (blister-like), on the trunk </li></ul><ul><li>Swollen lymph nodes (frequently only one lymph node is swollen), particularly in the neck area </li></ul><ul><li>Joint pain ( arthralgia ) and swelling, frequently symmetrical </li></ul><ul><li>Beau's lines (transverse grooves on nails) </li></ul>
  4. 6. Differential diagnosis <ul><li>Many other serious illnesses can cause similar symptoms, and must be considered in the </li></ul><ul><li>- Measles </li></ul><ul><li>- Scarlet fever </li></ul><ul><li>- Toxic shock </li></ul><ul><li>- Stevens - Johnson syndrome </li></ul><ul><li>- Leptospirosis </li></ul><ul><li>- Juvenile rheumatoid arthritis </li></ul>
  5. 7. Investigate <ul><li>A physical examination will demonstrate many of the features listed above. </li></ul><ul><li>Blood tests </li></ul><ul><li>Complete blood count (CBC) may reveal normocytic anemia and eventually thrombocytosis </li></ul><ul><li>Erythrocyte sedimentation rate (ESR) will be elevated </li></ul><ul><li>C-reactive protein (CRP) will be elevated </li></ul><ul><li>Liver function tests may show evidence of hepatic inflammation and low serum albumin </li></ul><ul><li>Other tests (may or may not be performed) </li></ul><ul><li>Electrocardiogram may show evidence of ventricular dysfunction or, occasionally, arrhythmia due to myocarditis </li></ul><ul><li>  </li></ul>
  6. 8. <ul><li>Echocardiogram may show subtle coronary artery changes or, later, true aneurysms. </li></ul><ul><li>Urinalysis may show white blood cells and protein in the urine ( pyuria and proteinuria ) without evidence of bacterial growth </li></ul><ul><li>  </li></ul>
  7. 9. Diagnosis <ul><li>five days of fever </li></ul><ul><li>plus four of five diagnostic criteria must be met in order to establish the diagnosis </li></ul><ul><li>2.1 red eyes (conjunctival injection) </li></ul><ul><li>2.2 erythema of the lips or oral cavity or cracking of the lips<strawberry tongue> </li></ul><ul><li>2.3 swelling or erythema of the hands or feet </li></ul><ul><li>2.4 swollen lymph node in the neck </li></ul><ul><li>2.5 rash on the trunk </li></ul>
  8. 10. Treatment <ul><li>Children with Kawasaki disease should be hospitalized and cared for by a physician who has experience with this disease. When in an academic medical center, care is often shared between pediatric cardiology and pediatric infectious disease </li></ul><ul><li>Antipyletic </li></ul><ul><li>Salicylate therapy, particularly aspirin , remains an important part of the treatment . Aspirin therapy is started at high doses until the fever subsides, and then is continued at a low dose when the patient returns home, usually for 2 months to prevent blood clots from forming. Except for Kawasaki disease and a few other indications </li></ul>
  9. 11. <ul><li>3. Intravenous immunoglobulin( IVIG ) is the standard treatment for Kawasaki disease and is administered in high doses with marked improvement usually noted within 24 hours. If the fever does not respond, an additional dose may have to be considered. IVIG by itself is most useful within the first 7 days of onset of fever, in terms of preventing coronary artery aneurysm. </li></ul>