Symptoms Kawasaki disease

Definition

Kawasaki disease is a vasculitis, which is an inflammation of the blood vessels, which tends to occur in infants and children (from the first months of life until 5-6 years of age).

The inflammatory process affects, particularly, the arteries of medium caliber and, in about 20% of the untreated patients, can involve the coronaries.

Even today, the etiology of Kawasaki disease is unknown, but clinical manifestations suggest the intervention of infectious agents or an abnormal immunological response in genetically predisposed children.

Kawasaki disease is present throughout the world and cases occur throughout the year, but more often in spring or winter.

Most common symptoms and signs *

Arrhythmia
Asthenia
Increase in the ESR
Bubbles on the Tongue
Conjunctivitis
Diarrhea
Dyspnoea
Abdominal pain
Neck pain
Chest pain
Jaw pain
Articolar pains
Edema
Hepatitis
Rash
Temperature
Hearing loss
Lethargy
leukonychia
Swollen lymph nodes
Red tongue
macules
Meningitis
Nervousness
Eyes reddened
Pallor
thrombocytopenia
Proteinuria
Red Dots on the Tongue
Scarlet red skin rash
Drowsiness
Scales on the skin
Cardiac tamponade
thrombocytosis
He retched

Further indications

The early manifestations of Kawasaki disease include high and persistent fever (lasts at least 5 days and, generally, is above 39 ° C), irritability, occasional lethargy and abdominal colic pain.

Within 5 days of onset, a maculo-papular exanthe appears that initially affects the trunk and the perineal region, thus extending to the face and limbs. This erythematous rash may be urticarial, morbilliform or scarlet-like and generally disappears after a week.

In most cases, the rash of Kawasaki disease is accompanied by congestion of the conjunctival mucous membranes, with strongly reddened eyes.

In addition, there are pharyngeal hyperemia (reddened throat), strawberry-like tongue (with the papillae detected), dryness and painful fissure of the lips.

See More Photos Kawasaki Syndrome

During the first week, a pallor may appear at the level of the proximal part of the nails (partial leukonychia), while the palms of the hands and the soles of the feet may show a redness and an edema "a glove" and "a sock", often tense, hard and without sign of the fovea. Towards the tenth day after the onset, a desquamation of the skin of the fingers and the perineal region begins; sometimes, the more superficial skin layer detaches to large layers, bringing to light a new normal skin.

During the entire course of Kawasaki disease, in about 50% of patients, there is an enlargement of the latero-cervical or angular-mandibular lymph nodes, painful and non-suppurative (? 1 lymph node, ? 1.5 cm in diameter).

In most cases, the course of the disease is self-limiting and tends to heal spontaneously over a period of time ranging from 2 to 12 weeks. However, incomplete or atypical cases may occur, especially in young children, who have the highest risk of developing coronary artery disease.

Possible cardiac complications usually begin in the subacute phase of the syndrome, at about 1-4 weeks from onset, when fever, eruption and other early acute symptoms begin to regress.

Kawasaki disease can cause myocarditis, arrhythmias, endocarditis, pericarditis and heart failure. Furthermore, coronary artery aneurysms may develop which may cause cardiac tamponade, thrombosis or myocardial infarction.

Less frequent manifestations indicate the involvement of many other apparatuses and include: arthritis or arthralgias (especially the large joints are affected), urethritis, aseptic meningitis, hepatitis, ear infections and symptoms of the upper respiratory tract.

The diagnosis is based on clinical criteria; laboratory tests (blood counts, ANA, FR, VES, and pharyngeal and blood culture tests) are not diagnostic, but are performed to exclude other diseases, including scarlet fever, rubella, leptospirosis, pharmacological reactions and juvenile idiopathic arthritis. Once the presence of the disease is ascertained, the electrocardiogram (ECG) is performed to highlight the presence of cardiac complications.

Treatment involves the administration of intravenous immunoglobulins and aspirin under the close supervision of an experienced pediatric cardiologist. This approach can reduce acute symptoms and, more significantly, the incidence of coronary aneurysms. Thrombosis may require, instead, fibrinolysis or percutaneous interventions. In the absence of coronary heart disease, the prognosis for complete recovery is excellent.