Kawasaki Dis SemV

8/13/2019 Kawasaki Dis SemV

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INTRO

Pertama kali ditemukan oleh Tomisaku Kawasaki

tahun 1967 di Jepang

Insidensi tertinngi di Jepang

Laki : perempuan 1.5 : 1

Komplikkasi: aneurisma arteri koronaria (20-40%)

Etiologi: tak diketahui


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EPIDEMIOLOGI

* Asia khususnya Jepang dan Korea : 50-100/ tahun

per 100,000 anak berusia 100 kasus, kebanyakan ras Cina

* 80 % berusia 8 tahun


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Other associated findings

Sterile pyuria (60 %)

Liver dysfunction (40%)

Arthritis of large joints (30%)

Aseptic meningitis (25%)

Abdominal pain with diarrhea

Hydrops of gallbladder with jaundice

CNS symptoms (irritable, lethargic, semicoma)


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BCG scar : redness and crust

Cardiovascular findings during acute phase

Tachycardia

Cardiomegaly

Pericardial effusion

LV dysfunctionECG changes : PR int >, low QRS voltage

ST depression/elevation


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Subacute phase (day 11-25)

* Desquamation: tips of fingers and toes

* Rash, fever, lymphadenopathy disappear

Significant cardiovascular changes : coronary

aneurysm,pericardial eff, myocard infarct

* Thrombocytosis, peaking at 2 weeks />


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Convalescent phase

Lasts till ESR and platelet count return to normal.Deep transverse grooves (Beaus line) : finger nails

and toenails


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DIAGNOSTIC CRITERIA FOR KD

1. Remittent fever for 5 days/more

2. Bilateral conjunctival injection (no exudate)

3. Changes in the mouth and lips :strawberry tongue,diffuse reddening of oral cavity, erythema andcracking of lips

4. Changes in the hands and feet : erythema andedema

5. Polymorphous exanthem

6. Unilateral cervical lymphadenopathy (1.5 cm)


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Fever + more of remaining five criteria are present :

KD is probable.

Presence of coronary artery pathology may bediagnostic even when < 4 criteria are present


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DIFFERENTIAL DIAGNOSIS

Measles

Stevens Johnson syndrome

Staphylococcal scalded skin syndrome

Drug reaction

Scarlet feverHand Foot and Mouth Disease


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Laboratory test not pathognomonicLeucocytosis with a shift to the left

CRP, ESR, alpha1 antitrypsin : increase

during acute phase

* Thrombocytosis : subacute phase may

> 1,000,000

* Pyuria (due to urethritis)

Liver enzyme increase

Elevated CPK : myocard infarction


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ECG

Low voltage QRS

ST elevation/depression

QTc >

Wide and deep Q wave : myocard infarct


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Echocardiography

Most important

Detect coronary artery aneurysm and cardiac

dysfunction

May reveal coronary artery changes, depressed LV

function, regurgitation tricuspid, mitral, aortic and

pericardial effusion

N coronary size : baby 2 mm, toddler


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Catheterization

Selective

Large or multiple aneurysm

Sign of ischemia clinically or in ECG

Suggest stenosis


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Treatment

Hospital admission with bed rest

IVIG 2 g/kg BW in 10-12 hours

Acetosal 80-100 mg/kgBW po 14 days or 2-3 days

after fever subsides, -> 3-10 mg/kgBW once daily for

6-8 wks if echo N


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Kawasaki Dis SemV

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