Kawasaki syndrome in children is a very rare and serious disease, which is characterized by an inflammatory process that affects the coronary and other arteries. It develops in children, most often, under the age of five years, however, cases of the disease of adults - 20-30-year-old people are known. This disease is more common in boys, and girls get Kawasaki syndrome (pictured) much less often.
Syndrome Description
This disease is also called periarteritis nodosa, as well as generalized vasculitis or mucocutaneous lymph node syndrome. Kawasaki’s disease is dangerous because it causes very negative complications, which can manifest as the formation of aneurysms and their ruptures, the occurrence of such serious diseases as myocarditis, aseptic meningitis, arthritis, etc. This pathology in European countries exceeded the incidence of rheumatic fever, and causes in most cases, complex heart defects. Treatment for Kawasaki syndrome in children should be timely.
The mechanism of development of Kawasaki disease
This disease develops as follows: in the child's body, the formation of antibodies begins, which affect their own endothelial cells, which are the main in the structure of the walls of blood vessels. For what reasons this happens, science is still unknown. Nevertheless, due to such immune reactions, the following pathological processes begin in the child's body:
- The middle wall of the membrane of the vascular wall, which is called "media", begins to become inflamed and its cells gradually die off.
- The structure of the outer and inner membranes of the vessels is destroyed, which leads to the appearance of extensions in the walls, which are aneurysms.
If Kawasaki syndrome is not treated, within two months the child begins to develop fibrosis of the vessel walls, as a result of which the lumen of the arteries begins to gradually narrow, and sometimes completely close.
A favorable prognosis of Kawasaki disease occurs only in those cases when therapeutic measures to eliminate this disease were started in a timely manner. Nevertheless, the risk of death is very high, and the most common reason for this is arterial thrombosis or acute myocardial infarction. 3% of all cases of the disease result in the death of the patient.
Kawasaki syndrome is considered rheumatologic, therefore a rheumatologist is involved in the treatment of this disease. Depending on what complications the disease has acquired, specialists such as a cardiac surgeon and cardiologist can be involved in its treatment. Consider the causes of Kawasaki syndrome in children.
Causes of Kawasaki Disease
In the field of medicine that treats this disease, there is still no reliable information on why the nucleation of the inflammatory process of the vascular walls occurs. However, there are several suggestions about this. The most common of them is the suspicion that there is a certain hereditary predisposition in the body, which is exacerbated by external influences - bacterial or viral etiology of microorganisms entering the human body. These may include Epstein-Barr virus, rickettsia, parvovirus, spirochaete, streptococcus, herpes simplex virus, retrovirus, staphylococcus, etc. Scientific medical studies have shown that 10% of people whose ancestors suffered from Kawasaki syndrome also get it.
Background
Prerequisites for the development of this syndrome are:
- Racial affiliation, as a high propensity for this disease to be seen in Asians.
- Decreased immune defense of the body.
Symptoms of Kawasaki Disease
The disease develops, as a rule, in three periods:
- The acute phase, which usually lasts about 7-10 days.
- A subacute period that lasts approximately 2-3 weeks.
- The phase of convalescence (the period of recovery of the body), which can last several months, but not more than two years.
Kawasaki syndrome in children (photo below) develops, as a rule, very sharply. The temperature in the child can rise to the upper marks, and the first 6-7 days of the disease remain. If you do not immediately begin the necessary treatment, the fever can last for 14 days. The longer this febrile period lasts, the worse the prognosis for recovery of a small patient.
Swollen lymph nodes
If the child has a low-grade fever during the period of the disease, the symptoms of Kawasaki disease may be an increase in lymph nodes, most often in the neck. Symptoms of severe intoxication of the body are added to this - weakness, abdominal pain, indigestion, tachycardia. At the same time, the child will behave very restlessly, can often cry, he has a sleep disturbance and lack of appetite.
During the first 4-5 weeks from the onset of the disease, skin symptoms may appear in the form of a scattering of small blisters, as well as a rash similar to the one that occurs with scarlet fever and measles. Elements of rashes are usually located in the groin and on the extremities. The skin of the feet and palms begins to thicken in separate areas, between the fingers begins to hurt and crack. In this case, the child may experience severe swelling in the area of the feet. These skin manifestations disappear on the 6-7th day, however, erythema can persist for up to 2-3 weeks, after which severe peeling of the skin is observed.
Conjunctivitis
Symptoms of Kawasaki syndrome in children can be acute conjunctivitis, as well as inflammation of the vascular elements in both eyes. The mucous membrane of the oral cavity becomes dry, tonsils enlarge, the color of the tongue becomes bright red.
In cases where the disease affects the heart, the child may experience arrhythmia, tachycardia, severe shortness of breath due to acute heart failure. Sometimes inflammation of the pericardium, the pericardial sac, occurs, as a result of which the development of mitral and aortic insufficiency begins. The coronary vessels expand, and aneurysms of the ulnar, subclavian, and femoral arteries may also appear. In 40% of patients with the syndrome, joint inflammation can begin. The causes and treatment of Kawasaki syndrome in children are interrelated.
Diagnosis of the disease
The disease can be confirmed by the presence of a 5-7-day fever, and the mandatory clinical diagnostic criteria include:
- Conjunctivitis of both eyes.
- Damage to the mucous membrane of the mouth and throat.
- Adenopathy (local in nature).
- Sealing and redness of the skin of the hands and feet, accompanied by severe swelling.
- Peeling of the skin on the fingertips at 3 weeks of illness.
In cases when, during the examination of the child, aneurysms of the coronary arteries are revealed, then three additional signs of the disease from the above are required to establish an accurate diagnosis.
Laboratory research
Laboratory studies necessary for this include:
- blood chemistry;
- general blood and urine tests;
- cerebrospinal fluid examination.
Instrumental methods for establishing Kawasaki disease include:
- ECG;
- chest x-ray;
- Ultrasound of the heart;
- angiography of coronary vessels.
Kawasaki Syndrome Treatment
This disease responds well to treatment, but it is important to start therapeutic measures at an early stage. Cases of death are not excluded, since the likelihood of developing serious complications is high.
Preparations
Since the causes of this disease are unknown, the treatment is not to eliminate them, but to prevent the consequences and relieve symptoms. For this, the following medications are used:
- "Immunoglobulin", which is the main in the treatment of Kawasaki disease. The drug is administered intravenously for 10-12 hours every day. If you start treatment with this medication in the early days of the disease, the effect will be most favorable. Its action reduces inflammatory processes in the walls of blood vessels.
- "Acetylsalicylic acid". This drug is prescribed in large doses in the early days, followed by a reduction in dosage. The drug dilutes the blood, reduces the risk of thrombosis and relieves inflammation.
- Anticoagulants. These medicines may be Warfarin or Clopidogrel. They can be recommended for sick children who have been diagnosed with aneurysms. They are prescribed for the prevention of thrombosis.
The appointment of corticosteroid drugs in the event of Kawasaki syndrome in children is in question. However, it is known that hormonal drugs increase the formation of aneurysms, as well as coronary thrombosis.
Conclusion
Children should be vaccinated against diseases such as measles, chickenpox, and flu, because too long treatment with aspirin when infected with these infections causes acute liver failure and encephalopathy, the so-called Reye's syndrome.
Despite the fact that the risk of complications of the disease is extremely high, the prognosis of treatment is favorable.