Kawasaki disease is an auto-immune disorder. It is an acute febrile vasculitis syndrome that occurs in early childhood.
The child is presented with-
• Cervical lymphadenitis
• Erythema of hands and feet
• Inflammation of lips and oral cavity.
There are characteristic changes in mucous membranes of lips and mouth and lymph nodes becomes enlarged and tender.
In early stage of disease, edema of vascular media and endothelial cells occurs.
After 7-9 days of onset of fever, neutrophil influx occurs, that is followed by proliferation of cytotoxic lymphocytes and immunoglobulin A–producing plasma cells.
Cytokines, interleukins and matrix metalloproteinases are secreted by inflammatory cells and they target the endothelial cells.
Inflammation in affected vessels occurs with necrosis of smooth muscle cells. The internal and external elastic laminae splits and results in aneurysms.
In few weeks or months, fibroblasts and monocytes replace the inflammatory cells and fibrous connective tissue starts forming within vessel wall. The vessel becomes narrow resulting in stenosis or thrombus. Due to this myocardial infarction occurs and causes cardiovascular death.
Kawasaki Disease Common In?
Kawasaki disease is more common in males than females. Death and complications from Kawasaki disease are more common in boys than in girls. Up-to 90% cases of Kawasaki disease occur in children under 5 yeas of age. 95% cases occur in children under 10 years of age.
It is rarely reported in adults. People who are affected with HIV are reported with Kawasaki disease.
The etiology of Kawasaki disease is not known. Certain genes are known to increase child’s susceptibility towards the Kawasaki disease.
The disease has genetic tendency. Siblings of affected children have high risk of developing Kawasaki disease as compared to general population.
• Boys are at more risk.
• Children under 5 years of age are at more risk.
• Child of Asian descent is at greater risk of having Kawasaki disease.
• Red inflamed tongue called as “strawberry tongue”
• Joint pains
• Swollen lymph nodes in the neck
• Cough and runny nose
• Rashes on the palms and soles.
There is no diagnostic test for Kawasaki disease.Evaluation of symptoms and ruling out other possible conditions (scarlet fever, measles, juvenile RA, allergic drug reaction, etc.) is necessary.
There is presence of fever that lasts for 5 or more days with four of the following symptoms:
• Redness in both eyes.
• Changes in lips, tongue and mouth.
• Swelling, discoloration or peeling in fingers and toes.
• Rashes in trunk or genital area.
• Swollen lymph nodes in the neck.
• Redness and swelling in palms and soles.
• Patient is hospitalized.
• High doses of aspirin reduce inflammation and it acts as a blood thinner.
• Administration of gamma-globulin through vein.
• Anti-inflammatory drugs e.g. ibuprofen or naproxen relieves joint pains.
• Plasmapheresis also helps in giving relief to patient. Plasmapheresis is a procedure in which plasma is removed from the blood protein containing fluid is replaced with it. In this procedure the antibodies and proteins are responsible for causing immune reaction are removed.
• With early treatment patient recovers in four to eight weeks.
• Prognosis is poor in case if complications set in. Patient dies from formation of blood clots in coronary arteries.
• Heart attack at younger age or later in life due to aneurysms and inflammation of vessels.
• It acts best in plethoric, dark haired people of rigid muscles, with a nervous, sanguine nature.
• It acts feebly in debilitated people with impoverished blood.
• Limbs and body ache as if beaten; joints as if sprained.
• Bed feels too hard.
• There is sore lame bruised feeling.
• Rheumatism of muscles and tendons especially of back and shoulders.
• Its characteristic symptoms are debility, exhaustion and restlessness with nocturnal aggravation.
• There are burning pains, burning is relieved by heat.
• Unquenchable thirst.
• Periodicity marked in fever with great exhaustion.
• It affects glandular structures.
• It is also useful in degenerative changes especially in coats of arteries, aneurism and senility.
• Its characteristic symptoms are ebullitions of heat, dislikes of water, dry and hard hair and skin, red orifices, sinking feeling in the stomach around 11 a.m. and catnap sleep.
• There is heat and burning with itching that is worse by heat of bed.
• It acts upon the coats of veins causing relaxation with consequent engorgement.
• Tongue feels burnt, blisters on the sides.
• Sore muscles and joints.
• It is indicated in inflammation of veins with great swelling.
• Lips and tongue swollen, livid, protruded.
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