Tuesday, November 8, 2016

Kawasaki's disease And Its Management.

A 6-year-old female presents with 6 days of fever. On physical examination, she has a temperature of 102°F, a heart rate of 120 beats per minute, conjunctival erythema, an indistinct maculopapular rash, digital desquamation, pharyngeal erythema, and cervical lymphadenopathy. A rapid strep screen and throat culture are negative. The next step in evaluating and treating this patient includes which of the following?
A. Await repeat throat culture to determine therapy
B. Empiric penicillin for streptococcal coverage
C. Empiric vancomycin for staphylococcal and streptococcal coverage
D. Intravenous immunoglobulin
E. Oral corticosteroids

Answer:  D. Intravenous immunoglobulin 

Discussion: Kawasaki's disease is the most common cause of acquired heart disease in children in the United States. Diagnosis is based on clinical findings and this disease should be suspected in children who have a fever for 5 days or longer. 
Four of the following findings along with fever support the diagnosis of Kawasaki's disease: 
  • rash, 
  • conjunctivitis, 
  • lymphadenopathy, 
  • strawberry tongue, 
  • oropharyngeal erythema, and 
  • digital desquamation. 
Laboratory findings consistent with Kawasaki's disease include elevated white blood cell count, sedimentation rate, and C-reactive protein. 

The primary concern with Kawasaki's is prevention and detection of cardiac complications, which develop in more than 50% of patients. 
- Myocarditis occurs most commonly—in up to one-half of patients. 
- Coronary aneurysms, which are associated with coronary thrombosis or rupture, and 
- myocardial infarction develop in an additional 20% of patients. 

Prompt therapy with intravenous immunoglobulin and aspirin lessen the risk for developing these cardiac complications. 

Included in the differential diagnosis for Kawasaki's disease are 
  • scarlet fever, 
  • toxic shock syndrome, 
  • drug reactions, 
  • measles, 
  • Stevens-Johnson syndrome, and 
  • juvenile rheumatoid arthritis.

1 comment:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.