Kawasaki disease in adults symptoms. Autoimmune pathology in childhood - Kawasaki syndrome in children

Kawasaki disease, also known as Kawasaki syndrome, mucocutaneous lymph node syndrome, and mucocutaneous lymph node syndrome, is an autoimmune disease in which medium-sized blood vessels throughout the body become inflamed. It is often seen in children under five years of age. It affects many organ systems, mainly which include blood vessels, skin, mucous membranes and lymph nodes. It has less frequent but more serious effects on the heart, where it can cause fatal coronary artery aneurysms in untreated children. Without treatment, mortality can be as high as 1%, usually within six weeks of onset. When treated, the mortality rate is 0.17% in the United States. Often, a previous viral infection may play a role in the pathogenesis of the disease. Skin, conjunctiva and mucous membranes oral cavity become red and inflamed. Swelling of the hands and feet is common, and the lymph nodes in the neck are often enlarged. Intermittent fever, often 37.8 °C (100.0 °F) or higher, is a characteristic feature of the acute phase of the disease. In untreated children, the fever lasts about 10 days, but can last anywhere from five to 25 days. The disease was first described in 1967 by Tomisaku Kawasaki in Japan.

Classification

Systemic vasculitis is inflammatory disease, affecting arteries and veins throughout the body, which is usually caused by the proliferation of cells associated with an immune response to a pathogen or an autoimmune reaction. Systemic vasculitis can be classified according to the type of cells involved in proliferation, as well as the specific type of tissue damage observed in the walls of arteries and veins. According to this classification scheme for systemic vasculitis, Kawasaki disease is considered a necrotizing vasculitis (also called necrotizing angiitis), which can be defined histologically by the appearance of necrosis (tissue death), fibrosis, and cell proliferation associated with inflammation of the inner layer of the vascular wall. (Other diseases suggestive of necrotizing vasculitis include polyarteritis nodosa, granulomatosis with polyangiitis, Henoch-Schönlein purpura, and Churg-Strauss syndrome.) Kawasaki disease can be further classified as a medium-sized vascular vasculitis, affecting medium-sized and small blood vessels such as as the small cutaneous vasculature (veins and arteries in the skin), which range in diameter from 50 to 100 microns. Kawasaki disease is also considered primary childhood vasculitis, a vasculitis-related disease that mainly affects children under 18 years of age. IN lately The consensus assessment of vasculitis, which occurs predominantly in children, has led to a classification scheme for these diseases to differentiate them, which provides a more precise set of diagnostic criteria for each. According to this classification of childhood vasculitis, Kawasaki disease is, again, a vasculitis of predominantly medium-sized vessels. The disease is also an autoimmune form of vasculitis that does not bind to antineutrophil cytoplasmic antibodies, unlike other associated vasculitic diseases (such as granulomatosis with polyangiitis, microscopic polyangiitis, and Churg-Strauss syndrome). This categorization is considered indispensable for appropriate treatment.

Signs and symptoms

Kawasaki disease often begins with a high, persistent fever that does not respond to usual treatment (acetaminophen) or ibuprofen. This is the most predominant symptom in Kawasaki disease, characteristic feature acute phase of the disease, usually high (above 39-40 °C), remitting and accompanied by excessive irritability. Recently, patients have been reported to have atypical or partial Kawasaki disease; however, this is not observed in 100% of cases. The first day of fever is considered the first day of illness; the duration of the fever averages from one to two weeks; if left untreated, it can last three to four weeks. Prolonged fever is associated with a higher incidence of heart damage. It partially responds to antipyretic drugs and does not stop when antibiotics are started. However, when appropriate therapy is started—intravenous immunoglobulin and aspirin—the fever resolves within two days. Bilateral conjunctival inflammation has been reported to be the most common symptom after fever. Usually it covers the conjunctiva of the eyeball, is not accompanied by suppuration and is painless. It usually begins immediately after the onset of fever during the acute phase of the disease. Anterior uveitis can be detected by examining the eye with a target lamp. Iritis may also occur. Corneal deposits are another ocular manifestation (detectable by slit lamp, but usually too small to be detectable by the naked eye). Kawasaki disease manifests itself as a complex of intraoral symptoms, the most characteristic changes being bright red (erythema), swollen lips (edema) with vertical cracking (fissures) and bleeding. The mucous membrane of the oropharynx may be bright red, and the tongue may have a typical external view“raspberry tongue” (pronounced erythema with a predominance on the taste buds). These intraoral symptoms are caused by a typical necrotizing microvasculitis with fibrinoid necrosis. Involvement of the cervical lymph nodes is observed in 50% to 75% of patients, while other characteristic features are estimated to be observed in 90% of patients, but sometimes it can be the dominant symptom. According to the definition of the diagnostic criterion, at least one abnormal lymph node ≥ 1.5 cm in diameter must be included. Affected lymph nodes are painless or minimally painful, non-fluctuating and non-purulent; Erythema of the adjacent skin may be observed. Children with fever and cervical adenitis who do not respond to antibiotics have Kawasaki disease considered part of the differential diagnoses.

Less common symptoms:

Gastrointestinal tract: diarrhea, abdominal pain, vomiting, liver dysfunction, pancreatitis, hydrocele, mumps, cholangitis, intussusception, pseudo-obstruction, ascites, splenic infarction

Musculoskeletal system: polyarthritis and arthralgia

Cardiovascular system: myocarditis, pericarditis, tachycardia, heart disease

Genitourinary system: urethritis, prostatitis, cystitis, priapism, interstitial nephritis, orchitis, nephrotic syndrome

Central nervous system: lethargy, subcoma, aseptic meningitis and sensorineural deafness

Respiratory system: lack of air, influenza-like illness, pleural effusion, atelectasis

Skin: erythema and local induration BCG vaccination, Bo furrows and gangrene of the finger

During the acute phase of the disease, changes in the peripheral extremities may include erythema of the palms and soles, which are often affected by acute demarcation and are often accompanied by painful, firm swelling of the dorsum of the hands and feet. This is the reason why children with the condition often refuse to hold objects in their hands and bear weight on their feet. Later, during the convalescent or subacute phase, peeling of the fingers and toes usually begins in the periungual area within two to three weeks after the onset of the fever and may spread to the palms and soles. In about 11% of affected children, peeling skin may continue for many years. One to two months after the onset of fever, deep transverse grooves on the nails (Bo's grooves) may develop, and sometimes the nails come off. The most common skin symptom is a diffuse maculopapular erythematous rash, which is quite nonspecific. The rash changes over time and is characteristically located on the torso; may subsequently spread to the face, limbs and perineum. Many other forms have been reported skin lesions; they may include scarlatiniform, papular, urticaria-like lesions, erythema multiforme, and purpuric lesions; even micropustules have been reported. They can be polymorphic, non-pruritic and are usually observed until the fifth day of fever. However, they are never bullous or vesicular. In the acute stage of Kawasaki disease, systemic inflammatory changes visible on many organs. Joint pain (arthralgia) and swelling, often symmetrical, and arthritis may also occur. Myocarditis, diarrhea, pericarditis, valvutitis, aseptic meningitis, pneumonia, lymphadenitis and hepatitis may present and manifest through the presence of inflammatory cells in affected tissues. If left untreated, some symptoms will eventually subside, but coronary artery aneurysms will not improve, resulting in a significant risk of death and disability due to myocardial infarction. If treatment is started quickly, in most cases this risk can be avoided and the course of the disease will be shorter. Others reported nonspecific symptoms include cough, runny nose, sputum, vomiting, headache and paroxysm.

The course of the disease can be divided into three clinical phases:

Clinical manifestations differ between adults and children, with cervical adults being more susceptible to lymph node involvement (93% of adults vs. 15% of children), hepatitis (65% vs. 10%), and arthralgia (61% vs. 24- 38%). Some patients have atypical presentations and may not suffer from the usual symptoms. This is observed, in particular, in infants; These patients are at increased risk of cardiac aneurysms.

Complications

Heartfelt

Cardiac complications are the most important aspect Kawasaki disease. This is the main reason cardiovascular diseases purchased during childhood in the United States and Japan. In developed countries, it is being replaced by acute rheumatic fever as the most common cause of childhood-acquired cardiovascular disease. Coronary artery aneurysms occur as a complication of vasculitis in 20-25% of untreated children. They are first detected after an average of 10 days of illness, and the peak incidence of coronary artery dilation or aneurysms occurs within four weeks of illness onset. Aneurysms are classified into small ones (internal diameter of the vascular wall<5 мм), средние (диаметр в диапазоне 5–8 мм) и крупные (диаметр >8 mm). Saccular and fusiform aneurysms usually develop between 18 and 25 days after onset. Even when treated with high-dose IVIG during the first 10 days of illness, 5% of children with Kawasaki disease develop at least temporary dilatation of the coronary arteries, and 1% develop large aneurysms. Death can occur due to either myocardial infarction due to the formation of blood clots in the aneurysm coronary artery, or due to the rupture of a large coronary artery aneurysm. Death is most often observed from the second to the 12th week after the onset of the disease. Many risk factors that precede coronary artery aneurysms can be identified, including persistent fever after IVIG therapy, low hemoglobin concentration, low albumin concentration, large number white blood cells, high number of band neutrophils, high concentration C-reactive protein, male gender and age less than one year. Coronary artery damage resulting from Kawasaki disease changes dynamically over time. Resorption one to two weeks after the onset of the disease is observed in half of the vessels with aneurysms. Narrowing of the coronary artery, which occurs as a result of the healing process of the vessel wall, often leads to significant obstruction of the blood vessel and results in the heart not receiving sufficient quantity blood and oxygen. This can ultimately lead to death of heart muscle tissue (myocardial infarction). Myocardial infarction caused by thrombotic occlusion in an aneurysmal, stenotic, or aneurysmal and stenotic coronary artery is the leading cause of death from Kawasaki disease. The highest risk of myocardial infarction occurs in the first year of the disease. Myocardial infarction in children presents with symptoms that differ from those in adults. The main symptoms are shock, anxiety, vomiting and abdominal pain; Chest pain is common in older children. In most of these children, exacerbations occur during sleep or rest, and about one third of exacerbations are asymptomatic. Valvular insufficiency, particularly the mitral or tricuspid valves, is often observed in the acute stage of Kawasaki disease due to inflammation heart valve or myocardial dysfunction caused by inflammation of the heart muscle, regardless of the involvement of the coronary arteries. These lesions mostly disappear with the cessation of the acute phase of the disease, but a small group of lesions persist and progress. Aortic or mitral regurgitation late-onset, caused by thinning or deformation of fibrous valves, with a time interval ranging from several months to years after the onset of Kawasaki disease. Some of this damage causes the valve to need to be replaced.

Other

Other complications of Kawasaki disease have been described, such as aneurysms of other arteries: aortic aneurysm, with a large number of cases including abdominal aorta, aneurysm axillary artery, aneurysm of the brachycephalic artery, aneurysm of the iliac and femoral arteries and aneurysm renal artery. Other vascular complications may occur, such as increased wall thinning and decreased distension of the carotid arteries, aorta, and brachioradial artery. This change in vascular tone occurs due to endothelial dysfunction. In addition, children with Kawasaki disease, with or without coronary artery complications, may have a more unfavorable cardiovascular risk profile, such as increased blood pressure, obesity and abnormal serum lipid profile. Gastrointestinal complications of Kawasaki disease are similar to those seen in Henoch-Schönlein purpura, such as intestinal obstruction, colonic edema, intestinal ischemia, pseudo-obstruction, and acute abdomen. Eye changes associated with the disease have been described since the 1980s and include uveitis, iridocyclitis, conjunctival hemorrhage, neuritis optic nerve, amaurosis and blockage of the optic artery. Necrotizing vasculitis may also be found, progressing to peripheral gangrene. Neurological complications due to damage to the central nervous system are reported significantly frequently. Neurological complications found include meningoencephalitis, subdural effusion, cerebral hypoperfusion, cerebral ischemia and infarction, cerebellar infarction manifesting through paroxysms, chorea, hemiplegia, confusion, lethargy and coma, or even cerebral infarction without neurological manifestations. Other neurological complications resulting from cranial nerve involvement include ataxia, prosopoplegia and sensorineural hair loss. Behavioral changes thought to be caused by local cerebral hypoperfusion may include attention deficits, cognitive deficits, emotional disturbances(emotional instability, fear of the dark and nightmares) and internalizing problems (anxiety, depressive or aggressive behavior).

Reasons

Because the cause(s) of Kawasaki disease remain unknown, the disease is more accurately described as Kawasaki syndrome. Like all autoimmune diseases, its cause is believed to be an interaction genetic factors and environmental factors, possibly including infection. Specific reason unknown, but current theories focus primarily on immunological causes. The evidence largely points to an infectious etiology, but there is ongoing debate as to whether the cause is a common antigenic substance or a superantigen. Researchers at Boston Children's Hospital reported that “some studies have found an association between the occurrence of Kawasaki disease and recent exposure to carpet cleaning or living near standing water; however, cause and effect have not been determined." Other data demonstrate a clear link between Kawasaki disease and tropospheric wind patterns; Winds blowing from Central Asia have been linked to cases of Kawasaki disease in Japan, Hawaii and San Diego. This relationship with tropospheric winds is modulated on the seasonal and interannual time scale of the El Niño Southern Oscillation phenomenon, further suggesting that the agent responsible for the disease is a windborne pathogen. The activities are presented by the process of identifying a suspected pathogen in air purification facilities installed at altitude above Japan. An association was made with a single nucleotide polymorphism in the ITPKC gene, which encodes an enzyme that negatively regulates T cell activation. Regardless of location, Japanese children are more likely to have the disease than other children, suggesting a genetic predisposition. The HLA-B51 serotype is associated with endemic cases of the disease.

Diagnostics

Kawasaki disease can only be diagnosed clinically (that is, by clinical signs and symptoms). There are no specific laboratory tests for this disease. Diagnosis is difficult, especially early in the disease course, and children are often not diagnosed until they have been seen by multiple health care professionals. Many other serious illnesses can cause similar symptoms and should be taken into account differential diagnosis, including scarlet fever, toxic shock, juvenile idiopathic arthritis and childhood poisoning mercury (infantile acrodynia). Typically, a five-day fever and four of the five diagnostic criteria are sufficient to make a diagnosis.

Criteria include:

Erythema of the lips or mouth, or chapping of the lips

Rash on the torso

Swelling or erythema of the hands and feet

Red eyes (conjunctival infection)

A swollen lymph node in the neck, at least 15 mm in size

Many children, especially infants, end up being diagnosed with Kawasaki disease without demonstrating all of the above criteria. In fact, many experts now recommend treatment for Kawasaki disease if only three days of fever have passed and at least three diagnostic criteria are present, especially if other tests have found abnormalities consistent with Kawasaki disease. In addition, the diagnosis can be made accurately by detecting coronary artery aneurysms under appropriate clinical conditions.

Interventions

A physical examination will reveal many of the features listed above.

Blood tests:

A complete blood count may detect normocytic anemia and eventually thrombocytosis.

The erythrocyte sedimentation rate will be increased.

C-reactive protein will be elevated.

Liver function tests can show the presence of liver inflammation and low level serum albumin.

Other tests performed under the agreement include:

An electrocardiogram may show the presence of ventricular dysfunction or, rarely, arrhythmia due to myocarditis.

An echocardiogram may show subtle changes in the coronary arteries or, later, true aneurysms.

An ultrasound or computed tomography scan may show hydrops (enlargements) of the gallbladder.

A urine test can show levels of white blood cells and protein in the urine (pyuria and proteinuria) without obvious bacterial growth.

Lumbar puncture may reveal the presence of aseptic meningitis.

X-ray angiography has historically been used to detect coronary artery aneurysms and remains the gold standard for their detection, but is rarely used today if coronary artery aneurysms have already been detected on electrocardiography.

Temporal artery biopsy

Treatment

Children with Kawasaki disease should be hospitalized and seen by a doctor who has experience with the disease. At an academic medical center, patient care is often divided between pediatric cardiology, pediatric rheumatology, and pediatric infectious disease specialists (although the specific causative agent of the infection is still uncertain). Treatment should begin immediately after diagnosis to avoid damage to the coronary arteries. Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease and is given in high doses, with significant improvements usually observed within 24 hours. If the fever does not respond to treatment, an additional dose may be used. In rare cases, the child may receive a third dose. IVIG itself is most beneficial during the first seven days after the onset of fever in preventing coronary artery aneurysms. Therapy salicylic acid, particularly aspirin, remains an important part of treatment (although questioned by some), but salicylates alone are not as effective as IVIG. Aspirin therapy is started at high doses and continued until the fever subsides, and then continued at low doses when the patient returns home, usually for two months, to prevent blood clots. With the exception of Kawasaki disease and small quantity For other indications, aspirin is generally not recommended for use in children due to its association with Reye's syndrome. Because children with Kawasaki disease take aspirin for up to several months, vaccination against chickenpox and influenza, since these infections most often cause Reye's syndrome. Corticosteroids are also used, especially when other treatments have failed or symptoms have returned, but in a randomized controlled trial, adding a corticosteroid to immunoglobulin and aspirin did not improve outcomes. In addition, the use of corticosteroids in the setting of Kawasaki disease has been associated with increased risk coronary artery aneurysm, thus the use of corticosteroids is generally contraindicated in these circumstances. In cases of Kawasaki disease that are difficult to treat with IVIG, cyclophosphamide and plasmapheresis have been studied as possible means treatments with variable results. An IL-1 receptor antagonist (anakinra) can prevent coronary injury in a mouse model of knee disarticulation. This prevention was found even after a three-day treatment delay in mice. There are ways to treat iritis and other eye symptoms. Another treatment option may include the use of infliximab. Infliximab works by binding to tumor necrosis factor alpha.

Forecast

With early treatment, acute symptoms can be expected to resolve quickly and the risk of coronary artery aneurysms is significantly reduced. Without treatment acute symptoms Kawasaki disease is self-limiting (meaning the patient eventually recovers), but the risk of coronary artery involvement is much higher. Overall, about 2% of patients die from complications of coronary vasculitis. Patients with Kawasaki disease should have an echocardiogram initially every few weeks and then every one or two years to monitor the progression of the cardiac complication. Laboratory evidence of increased inflammation, combined with demographic characteristics (male sex, age less than six months or more than eight years) and poor response to IVIG therapy, creates a profile of patients at increased risk of Kawasaki disease. It is likely that an aneurysm is largely characterized by its initial size, with smaller aneurysms having a greater likelihood of regression. Other factors positively associated with regression of aneurysms include age less than one year at onset of Kawasaki disease, fusiform rather than saccular aneurysm morphology, and location of the aneurysm in the distal coronary segment. An increased rate of progression to stenosis is observed among those who develop large aneurysms. Worst prognosis expects children with large aneurysms. This serious result may require such further treatment, such as percutaneous transluminal angioplasty, coronary artery stenting, implantation of a heart-lung machine, and even heart transplantation. Return of symptoms may occur soon after initial IVIG treatment. This usually requires readmission and treatment. Treatment with IVIG may cause allergic and non-allergic acute reactions, aseptic meningitis, hypervolemia and, in rare cases, other serious reactions. In general, life-threatening complications resulting from treatment for Kawasaki disease are quite rare, especially compared to the risks associated with no treatment. In addition, there is evidence that Kawasaki disease alters fat metabolism, which persists after clinical regression of the disease.

Epidemiology

Kawasaki disease affects boys more than girls, with people of Asian ethnicity, particularly Japanese and Korean populations, being most susceptible, as well as people of Afro-Caribbean ethnicity. The disease was rare in Caucasians until the last few decades, with incidence varying from country to country. Today, Kawasaki disease is the most commonly diagnosed pediatric vasculitis in the world. By far the highest incidence of Kawasaki disease is in Japan, with a more recent study estimating the incidence at 218.6 per 100,000 children under five years of age (approximately one in 450 children). According to this incidence rate, more than one in 150 children in Japan will develop Kawasaki disease during their lifetime. However, occurrence in the United States is increasing. Kawasaki disease is predominantly a disease of young children, with 80% of patients under five years of age. About 2,000 to 4,000 cases are diagnosed in the United States each year (9 to 19 per 100,000 children under five years of age). In the UK, incidence estimates vary due to the rarity of Kawasaki disease. However, the disease is said to affect less than one in 25,000 people. The incidence of the disease doubled from 1991 to 2000, with four cases per 100,000 children in 1991 compared with eight cases per 100,000 in 2000.

Story

The disease was first reported by Tomisaku Kawasaki in a four-year-old child with a rash and fever at the Red Cross Hospital in Tokyo in January 1961, and later published a report of 50 similar cases. Kawasaki et al were later convinced of some cardiac involvement when they examined and reported 23 cases, of which 11 (48%) patients showed abnormalities detected by electrocardiogram. In 1974, the first description of this disease was published in the English literature. In 1976, Melish et al described a similar condition in 16 children in Hawaii. Melish and Kawasaki independently developed similar diagnostic criteria for the disease, which are used today to make a diagnosis. classical disease Kawasaki. The question was raised whether the disease appeared during the period from 1960 to 1970, but later the preserved heart of a seven-year-old boy who died in 1870 was examined, resulting in the discovery of three coronary artery aneurysms with blood clots, as well as pathological changes, corresponding Kawasaki diseases. Kawasaki disease is now diagnosed throughout the world. In the United States and other developed countries, it is being replaced by acute rheumatic fever as the most common cause of childhood-onset cardiovascular disease.

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Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1232–4. ISBN 1-4160-2999-0.

Okano M, Luka J, Thiele GM, Sakiyama Y, Matsumoto S, Purtilo DT (October 1989). "Human herpesvirus 6 infection and Kawasaki disease." Journal of Clinical Microbiology 27(10): 2379–80. PMC 267029. PMID 2555393.

Kim DS (December 2006). "Kawasaki disease". Yonsei Medical Journal 47(6):759–72. doi:10.3349/ymj.2006.47.6.759. PMC 2687814. PMID 17191303.

Kawasaki T (1967). "". Arerugi 16(3):178–222. PMID 6062087.

Rigante D (2006). "Clinical overview of vasculitic syndromes in the pediatric age." European Review for Medical and Pharmacological Sciences 10 (6): 337–45. PMID 17274537.

Kawasaki syndrome in children is very rare and serious illness, which is characterized by an inflammatory process affecting the coronary and other arteries. It develops in children, most often under the age of five, but there are known cases of the disease in adults - 20-30 year olds. This disease occurs more often in boys, and girls develop Kawasaki syndrome (pictured) much less frequently.

Description of the syndrome

This disease is also called periarteritis nodosa, as well as generalized vasculitis or mucocutaneous lymph node syndrome. Kawasaki disease is dangerous because it causes very negative complications, which can manifest themselves in the form of the formation of aneurysms and their ruptures, the occurrence of such serious diseases as myocarditis, aseptic meningitis, arthritis, etc. This pathology V European countries exceeded the incidence rheumatic fever, and in most cases causes complex heart defects. Treatment of Kawasaki syndrome in children should be timely.

Mechanism of development of Kawasaki disease

This disease develops as follows: children's body the formation of antibodies begins, which attack their own endothelial cells, which are the main ones in the structure of the walls of blood vessels. For what reasons this happens, science is still unknown. However, due to such immune reactions in the child's body the following begin: pathological processes:

• Middle wall The membrane of the vascular wall, which is called “media,” begins to become inflamed and its cells gradually die.
• The structure of the outer and inner membranes vessels are destroyed, which leads to expansions in the walls, which are aneurysms.

If Kawasaki syndrome is not treated, within two months the child begins to develop fibrosis of the vascular walls, as a result of which the lumen of the arteries begins to gradually narrow and sometimes close completely.

A favorable prognosis for Kawasaki disease occurs only in cases where treatment was started in a timely manner. therapeutic measures to eliminate this disease. However, the risk of death is very high, and the most common cause is arterial thrombosis or acute heart attack myocardium. 3% of all cases of the disease end in the death of the patient.

Kawasaki syndrome is considered rheumatological, so a rheumatologist treats this disease. Depending on what complications the disease has acquired, specialists such as a heart surgeon and a cardiologist may be involved in its treatment. Let's look at 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 about the reasons for the initiation of the inflammatory process. vascular walls. However, there are several assumptions about this. The most common of these is the suspicion that there is some kind of hereditary predisposition, which is aggravated by external influences - getting inside human body microorganisms, bacterial or viral etiology. These may include Epstein-Barr virus, rickettsia, parvovirus, spirochete, streptococcus, herpes simplex virus, retrovirus, staphylococcus, etc. Scientific medical research showed that 10% of people whose ancestors suffered from Kawasaki syndrome also develop it.

Prerequisites

Prerequisites for development of this syndrome are:

Symptoms of Kawasaki disease

The disease usually develops in three periods:

1. Acute phase, which usually lasts about 7-10 days.
2. Subacute period, which lasts approximately 2-3 weeks.
3. The convalescence phase (the period of recovery of the body), which can last several months, but no more than two years.

Kawasaki syndrome in children (photo below) usually develops very abruptly. The child’s temperature may rise to the upper levels, and persists for the first 6-7 days of the disease. If the necessary treatment is not started immediately, high temperature can last for 14 days. The longer such a febrile period lasts, the worse the prognosis for the recovery of the little patient.

Enlarged lymph nodes

If a child has a low-grade fever during the illness, symptoms of Kawasaki disease may include enlarged lymph nodes, most often in the neck area. This is accompanied by symptoms of severe intoxication of the body - weakness, abdominal pain, indigestion, tachycardia. The child will behave very restlessly, may cry often, have sleep disturbances 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 that which occurs with scarlet fever and measles. Elements of the rash are usually located in the groin and on the extremities. The skin of the feet and palms begins to thicken in certain areas, and between the toes it begins to hurt and crack. The child may experience severe swelling in the area of ​​the feet. Data skin manifestations disappear on days 6-7, but 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 may include: acute conjunctivitis, as well as inflammation of the vascular elements in both eyes. The oral mucosa becomes dry, the tonsils become enlarged, and the color of the tongue becomes bright red.

In cases where the disease affects the heart, the child may experience arrhythmia, tachycardia, and severe shortness of breath, which is caused by acute heart failure. Sometimes inflammation of the pericardium - the pericardial sac - occurs, as a result of which the process of development of the mitral and aortic insufficiency. The coronary vessels dilate, and aneurysms of the ulnar, subclavian and femoral arteries. In 40% of patients with the syndrome, inflammation of the joints may 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 mandatory clinical diagnostic criteria include:

1. Conjunctivitis of both eyes.
2. Damage to the mucous membrane of the mouth and throat.
3. Adenopathy (local).
4. Thickening and redness of the skin of the palms and feet, accompanied by severe swelling.
5. Peeling of the skin on the fingertips at 3 weeks of illness.

In cases where coronary artery aneurysms are revealed during examination of a child, then three additional signs of the disease from the above are required to establish an accurate diagnosis.

Laboratory research

Laboratory tests required for this include:

• biochemical blood test;
• general blood and urine tests;
• cerebrospinal fluid examination.

TO instrumental methods Establishments of Kawasaki disease include:

• x-ray chest;
• Ultrasound of the heart;
• angiography of the coronary vessels.

Treatment of Kawasaki syndrome

This disease responds well to treatment, but it is important to start therapeutic measures at early stage. Cases of death cannot be excluded, since the likelihood of developing serious complications.

Drugs

Since the causes of this disease are unknown, treatment is not to eliminate them, but to prevent the consequences and relieve symptoms. The following medications are used for this:

1. "Immunoglobulin", which is the main one 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 first days of the disease, the effect will be most favorable. Its action reduces inflammatory processes in the walls of blood vessels.
2. "Acetylsalicylic acid." This drug is prescribed in large doses in the first days, followed by a subsequent reduction in dosage. The medicine thins the blood, reduces the risk of blood clots and stops inflammatory processes.
3. Anticoagulants. These medications may include Warfarin or Clopidogrel. They can be recommended to sick children who have been diagnosed with aneurysms. Prescribed for the prevention of thrombosis.

The prescription of corticosteroid drugs for the occurrence of Kawasaki syndrome in children is questionable. However, hormonal drugs are known to increase the risk factors for aneurysm formation as well as coronary thrombosis.

Conclusion

Children should be vaccinated against diseases such as measles, chickenpox, and influenza, since 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 for treatment is favorable.

Kawasaki syndrome is an acute autoimmune disease (one of the types of vasculitis) in which the walls of the coronary vessels are damaged. The disease develops in children under 8 years of age, more often in boys. The occurrence of Kawasaki disease in adults is very rare. Coronary vessels are vessels that carry blood to the heart muscle, and their damage poses a danger to the child's life. Possible consequences of the pathology: aneurysm and vascular thrombosis, myocardial infarction. Kawasaki disease is a rather rare disease for the CIS countries and Europe; it is common mainly in Asian countries and among people from there. Because of this, there may be cases of misdiagnosis and improper treatment Kawasaki disease in children.

Currently, there are no effective treatments for the pathology. Taking acetylsalicylic acid, which is found in many fresh vegetables and fruits, will help reduce the manifestations of the disease and reduce the risk of complications.

Causes of the disease

Currently, the exact causes of the disease are unknown. It is believed that an acute bacterial or viral infection can trigger the onset of the disease. But not every child’s infectious process is complicated by an autoimmune disease, in particular Kawasaki syndrome. It is believed that hereditary predisposition plays an important role in the development of the disease.

In most cases, Kawasaki disease develops against the background of the following infections:

• coccal: staphylococci and;
• viral: retrovirus, parvovirus, herpevirus, ;
• rickettsia.

Kawasaki syndrome is more often diagnosed in children preschool age, although older children may also suffer from this disease. Kawasaki disease primarily affects boys. First of all, very young children aged one to two years are at risk. Their disease is especially severe.

This syndrome occurs more often in people originating from the Asian region, particularly Japan. The development of the disease in several relatives within the same family is also often observed. All this indicates that Kawasaki syndrome is hereditary.

Pathogenesis

To fight infection, the child’s immune system produces special immune cells and complexes. Due to a malfunction of the immune system, these cells recognize the body's own cells as foreign agents and attack them. The immune system produces antibodies against vascular endothelial cells. Most often, arteries of medium diameter, in particular the coronary arteries, are affected. As the disease progresses, the walls slowly deteriorate blood vessels, which leads to the development of aneurysm and thrombosis.

With this disease, the inflammatory process develops in the skin and mucous membranes. A bacterial infection also often occurs, which can cause misdiagnosis.

The disease lasts, on average, 2.5 months, after which, in most cases, recovery occurs. However, there is a possibility of sudden death. Death occurs from myocardial infarction or coronary aneurysm.

Symptoms of Kawasaki disease

The child develops following symptoms diseases:

• damage to the mucous membrane of the oral cavity and lips: hyperemia, cracks in the lips,
• addition of a bacterial infection;
• damage to the mucous membranes of the eyes, development;
• swelling of the limbs;
• hyperemia of the skin of the palms and feet;
• rash on the surface of the entire body;
• peeling of the skin on the fingertips, which develops in the second or third week
• pathological process;
• enlarged cervical lymph nodes.

Except external manifestations The sick child experiences a general deterioration in health. His temperature rises sharply to 38–40 °C, the fever lasts from several days to 2–3 months.

The course of the pathological process:

1. At the initial stage, the child’s temperature rises sharply, abruptly, up to 40°C.
   In this case, hyperemia of the mucous membranes of the conjunctiva of the eye and oral cavity occurs.
2. The patient's cervical lymph nodes are enlarged; the enlargement can be symmetrical or unilateral.
3. Then hyperemia develops on the skin of the fingers and toes, and swelling of the extremities occurs.
4. A rash forms on the body.
5. The fingertips begin to peel.
6. If the joints are damaged, pain occurs in them.
7. Some patients are diagnosed with an increase in the size of the heart muscle and disruption of the heart.
8. In some cases, indigestion occurs and the stool becomes liquid.
9. There is also an increase in the size of the liver.

Treatment of Kawasaki syndrome

Unfortunately, there are currently no effective treatments for this syndrome. To prevent the development of coronary artery aneurysm, prophylactic vascular support agents are used. However, such therapy does not guarantee the absence of pathologies of the heart and blood vessels.

In this case, acetylsalicylic acid is indispensable. This acid is found in many foods, primarily in fruits and berries: apples, raspberries, apricots, cherries, strawberries, black currants, plums, grapes. This acid is found in fresh vegetables: cucumbers, tomatoes, bell peppers. The introduction of these products into a child’s diet can reduce the risk of developing aneurysm and coronary thrombosis.

Prognosis and prevention

The duration of the disease most often does not exceed 2.5 months. Most patients recover, although it is possible death. The mortality rate for this syndrome does not exceed 0.5% of affected children. Most often, children under 1 year of age die.

However, the disease does not go away without leaving a trace. Kawasaki disease can cause the following complications:
Diseases of the cardiovascular system:

• myocardial infarction;
• inflammation of the heart muscle or lining of the heart;
• inflammation of the heart valves;
• damage to the coronary vessels and cardiac malnutrition;
• coronary aneurysm and hemorrhage into the heart sac.

Other systemic disorders:

• arthritis;
• non-infectious inflammation of the meninges;
• non-infectious otitis media;
• obstruction bile ducts;
• peripheral tissue necrosis (gangrene).

It is believed that most of the secondary disorders of the heart muscle in people who suffered from this disease in childhood are associated with Kawasaki disease.

There is a small chance of relapse of the syndrome within one year after the illness. Most often, relapses develop in children under 3 years of age.

Unfortunately no effective measures prevention of Kawasaki syndrome, since the mechanisms that trigger this process are not clearly understood. To prevent the development of the disease, it is important to protect children from infectious diseases.

For this purpose, it is necessary to introduce into the child’s diet fresh vegetables and fruits, dried fruits, nuts, natural fruit and vegetable juices, honey. Hardening is also extremely useful for strengthening the immune system. To begin with, at a certain age, you can start dousing a child with cold water. Walking in the fresh air is useful for strengthening the body, active games, sports

Strengthening the immune system will prevent the development of infectious diseases and reduce the likelihood of an autoimmune process. However, the syndrome is believed to be genetic in nature, and there are no effective treatments that can definitely prevent it.

It is important to follow a number of recommendations even after an illness. Children who have suffered this syndrome need to strengthen the heart muscle and blood vessels, healthy image life, avoid infections and systemic diseases. A healthy diet rich in vitamins and exercise will help reduce the likelihood of developing secondary disorders of the cardiovascular system.

Kawasaki disease (or Kawasaki syndrome) refers to dangerous vascular diseases and is included in the group systemic vasculitis. With this pathology, abnormal damage to the walls of blood vessels occurs by cells of the immune system. Mostly this disease occurs in children in the first years of their life. The disease is accompanied by damage to arteries and veins of medium and small caliber, and the coronary arteries are also damaged. As a result, even small child Severe cardiovascular pathologies may develop: hemopericardium, valvulitis, mitral, aortic, etc. A number of them can cause the death of a child.

In this article we will introduce you to the suspected causes, manifestations, methods of identifying and treating Kawasaki disease in children. This information will help you understand the essence of the disease, you will be able to notice its first signs and make the right decision about the need to see a doctor.

This disease was first described in 1961 by Japanese pediatrician T. Kawasaki. He found similar symptoms in 50 children: prolonged fever, a characteristic measles-like rash, peeling of the skin, erythematous swelling of the palms and feet, enlarged lymph nodes, cracked lips and conjunctivitis. The disease was difficult to treat, and many children died from the onset of cardiac pathology. A few years later, Kawasaki disease was described, and the whole world learned about it. In Russia, such a diagnosis was first made in 1980.

According to statistics, this disease develops tens of times more often in people of the yellow race (mainly Japanese). Typically, Kawasaki disease is detected in children under 5 years of age, the peak incidence is observed at the age of 1-2 years (according to some sources at 9-11 months, according to others at 1.5-2 years). Boys are most susceptible to this disease. In later and adulthood, the disease rarely develops.

Reasons

Kawasaki disease - autoimmune process. For a number of reasons, the body begins to produce antibodies that attack the cells of blood vessels.

So far, scientists have not been able to determine the exact causes of Kawasaki disease. It is assumed that hereditary factors or bacteria and viruses that cause autoimmune reactions can provoke the disease.

It is known that Kawasaki disease is based on an autoimmune process that develops in children from the first years of life and leads to inflammation of the walls of blood vessels. It usually starts suddenly. In response to the presence of microorganisms - staphylococci, streptococci, rickettsia, herpes simplex viruses, retro- or parvoviruses - the immune system begins to produce antibodies that attack the walls of blood vessels. As a result, an inflammatory process develops, which subsequently leads to necrosis.

People at risk for developing Kawasaki disease include:

• children 1-5 years old (especially in the second year of life);
• boys;
• children with immunodeficiency;
• children in whose family there have already been cases of this disease;
• representatives of the yellow race (especially the Japanese).

In rare cases, the disease develops in children over 5 years of age and adults.

Symptoms

The first sign of Kawasaki disease is sharp increase temperatures up to 38-40 °C. The fever cannot be controlled with conventional antipyretics and lasts about 5 days. If untreated, the fever persists for 14 days, and an increase in the duration of the febrile period is considered an unfavorable prognostic symptom.

After a few days, the child begins to show other signs of Kawasaki disease.

Skin and mucous membranes

Eyes

Most children appear in the first 7 days. It is usually not accompanied by the eye discharge characteristic of this disease, and in some cases is accompanied by anterior uveitis.

Airways

The child develops dry mouth and bleeding cracks on the lips. The tongue becomes swollen and crimson, the pharynx turns red, and the tonsils become enlarged. In addition, swelling of the nasal mucosa occurs, manifested by nasal congestion.

Leather

One of characteristic features This pathology is a rash localized on the torso, lower extremities and groin.

In the first 5 weeks after the onset of the disease, various polymorphic and diffuse lesions of the skin occur:

• rash in the form of red spots of different sizes;
• blisters;
• measles-like or scarlet-like rash.

The localization of the rash is usually typical, its elements are found on:

• torso;
• lower parts of the arms and legs;
• groin area.

After some period of time, the child develops erythematous changes and thickened areas on the soles and palms. They interfere with the normal movement of the fingers and after a while they begin to peel off.

With Kawasaki disease, the reverse development of the rash begins 7 days after its appearance, and erythematous spots persist for 2-3 weeks.

Lymph nodes

In about half of children, Kawasaki disease is accompanied by enlarged lymph nodes in the neck. As a rule, it is one-sided.

Digestive system

Abnormal bowel movements (in the form of watery diarrhea), abdominal pain and vomiting may appear in initial period diseases. Some children may develop intussusception in the acute stage.

For 2 weeks, a child with Kawasaki disease may have symptoms of a special form, which is accompanied by vomiting, diarrhea, abdominal pain (even hepatic colic). In some cases, the disease provokes the development of pancreatitis.

Nervous system

Signs of damage to the nervous system in this disease are usually observed in children under one year of age. They may present with symptoms of serous or Guillain-Barré syndrome. As a rule, they occur in acute period against the background of fever and can manifest as isolated paralysis, hearing impairment and fainting.

At high activity diseases in children may develop neuromuscular diseases - myopathies, damage to the muscles of the diaphragm.

Joints

In approximately 35% of cases, Kawasaki disease is accompanied by joint damage - arthralgia and arthritis. Joint syndrome often lasts no more than a month. Usually the knees, ankles and small joints of the feet and hands are affected.

Urinary system

Sometimes Kawasaki disease leads to the development of urethritis or bullous cystitis.

Heart and blood vessels

Damages to the cardiovascular system in Kawasaki disease manifest themselves in the form of myocarditis, causing pain in the heart, increased heart rate and arrhythmias. Often pathological processes cause the development of acute heart failure.

Approximately 1.5-2 months after the onset of the disease, the patient may develop aneurysms of the coronary vessels, provoking myocardial infarction. Sometimes aneurysmal enlargements form on the walls of other arteries: subclavian, ulnar, femoral.

These manifestations of Kawasaki disease are the most dangerous to life and health. As a rule, the reverse development of aneurysms occurs within a month, but high risk death from thrombosis and myocardial infarction persists for 3 months.

In more rare cases, Kawasaki disease provokes the development of other cardiovascular pathologies:

• cardiomegaly;
• hemopericardium;
• valvulitis;
• or ;
• pericarditis.

General condition

Against the background of all the symptoms described above, children with Kawasaki disease become restless, overly irritable or lethargic.

Stages of the disease

There are several periods during the course of Kawasaki disease:

• acute – lasts about 2 weeks, manifested by fever, myocarditis, general intoxication and asthenia syndrome;
• subacute – lasts from 2 to 3 weeks, manifested by an increase in the level of platelets in the blood and symptoms of cardiovascular pathologies;
• recovery - occurs by the second month of the disease, but can take several months or 1-2 years.

Diagnostics

General and biochemical blood tests will help confirm the diagnosis, in which characteristic changes will be detected.

To identify this disease, there are the following diagnostic criteria-symptoms accompanying a 5-day fever:

• bilateral conjunctivitis;
• lesions of the oral mucosa;
• polymorphic rash;
• erythema and hardness of the palms and feet;
• enlarged cervical lymph nodes.

To make a diagnosis, it is enough to identify at least 4 signs, and with the additional detection of a coronary aneurysm - 3.

To confirm the diagnosis, the following are carried out: laboratory tests blood:

• – increased ESR, signs of anemia and leukocytosis with a shift to the left;
• biochemical and serological tests - increased levels of transaminases, immunoglobulins and seromucoid, detection of CEC.

Urine tests may show leukocytosis and the presence of protein.

To avoid misdiagnosis differential diagnosis Kawasaki disease is carried out with the following diseases:

• childhood infections: scarlet fever, rubella;
• Stevens-Johnson syndrome;
• juvenile rheumatoid arthritis;
• mycoplasma pneumonia;
• flu;

To obtain data on the nature of changes in the blood vessels, heart, nervous system and other organs, the following studies are performed:

• chest x-ray;
• ECG (regular and Holter);
• coronary angiography;
• CT and MRI;
• Ultrasound of various organs;
• lumbar puncture followed by cerebrospinal fluid analysis.

Treatment

After Kawasaki syndrome is detected, the child is hospitalized for inpatient treatment. At the first stage, therapy is aimed at eliminating fever, stabilizing immune reactions and preventing possible complications from the cardiovascular system, which can be provoked by an increased tendency to thrombus formation.

To plan drug therapy include the following drugs:

• immunoglobulins are administered intravenously for 8-12 days to eliminate inflammatory processes in the walls of blood vessels and fever (if after the first administration the temperature does not decrease, then such drugs are used again);
• Aspirin is used to prevent blood clots and as an anti-inflammatory agent (Kawasaki disease is the only exception to avoiding the use of acetylsalicylic acid in children younger age and after achieving the required therapeutic effect, the dosage of the drug is reduced to prophylactic).

In addition to these drugs, children with identified aneurysms are recommended to take (Clopidogrel, Warfarin, etc.).

Previously, glucocorticosteroids were used to treat this disease. However, the advisability of their use has been refuted, since taking such drugs increases the risk of coronary thrombosis. The use of antibiotics also turned out to be ineffective.

Remember! Therapy for Kawasaki disease should only be carried out under medical supervision and with regular laboratory and instrumental studies capable of identifying it possible complications and allowing you to adjust the intake of certain medications. Self-medication in such cases can lead to the development of myocardial infarction and other severe consequences this dangerous disease(up to and including death).

After eliminating the acute manifestations of the disease, the patient is prescribed prophylactic Aspirin and recommended dispensary observation at the cardiologist.

If severe stenosis of the coronary vessels occurs, cardiac surgery is performed to bypass and catheterize or rotational ablation.

Forecasts

With modern identification and proper treatment Kawasaki disease can be successfully treated in most cases. Aneurysms most often appear in children under one year of age.

Even with favorable prognosis This disease has a risk of death in 0.8-3% of patients. Most common cause The death of a child is coronary artery thrombosis and myocardial infarction. In more rare cases, death occurs due to severe myocarditis, leading to severe acute heart failure. In addition, the risk of child death increases significantly in the absence of timely diagnosis and proper treatment.

After an illness, approximately 20% of children experience changes in the walls of the coronary arteries. In the future, they may cause early atherosclerosis and calcification of the coronary vessels, leading to coronary heart disease. Subsequently, the risk of myocardial infarction in such patients also increases. In connection with such long-term consequences of Kawasaki disease, persons who have had this disease should be registered with a cardiologist and undergo a complete cardiological examination at least once every 3-5 years (from mandatory EchoCG).

Kawasaki syndrome is named after a pediatrician from Japan who discovered the disease in 1961. It is now considered a common cause of pathology of the cardiovascular system. The risk group includes children from Eastern countries (Japan, Korea, China, Thailand, etc.). Thus, in Japan, this disease occurs 10 times more often than in European countries. The development of the syndrome is provoked by a virus that easily penetrates the child’s body infancy or preschooler. The infection affects the mucous membranes, circulatory and lymphatic systems, and skin. As a rule, boys get sick 2 times more often than girls. This disease is not a death sentence. If treatment is started in a timely manner, it can be effective therapy, therefore, it is very important to promptly seek help from a pediatrician, rheumatologist, cardiac surgeon, infectious disease specialist, and in the future regularly undergo preventive examinations with specialized specialists.

Reasons

The exact causes of the syndrome have not yet been studied, but there are a number of factors that provoke the development of the disease.

Prerequisites for the dynamic development of the disease:

• penetration of bacterial and viral infections into the body (staphylococcus, candida, rickettsim, streptococcus, spirochetes, herpes virus, Epstein-Barr, retro- or parvovirus, etc.);
• race (Asian, Mongoloid type);
• hereditary predisposition (the disease develops in 9-10% of people whose descendants suffered the syndrome in the past);
• weakened immunity.

Classification

The disease is characterized by three periods: acute (lasts about 7-10 days), subacute (within 14-21 days) and a period of remission (from several months to two years).

There is complete and incomplete Kawasaki syndrome.

Complete Kawasaki syndrome is characterized by the following symptoms:

• fever for 4-5 days;
• elevated temperature;
• erythema of the soles and palms;
• rash;

Incomplete Kawasaki syndrome is accompanied by the following manifestations:

• signs of heart damage;
• fever;
• temperature that does not go down within 4-5 days;
• rash all over the body;
• anemia;
• formation of coronary aneurysms.

Symptoms

This disease is characterized by:

• increased body temperature (up to 38-39.5 C);
• fever for 3 or more days;
• persistent swelling and redness of the extremities;
• the formation of small flat spots of red color;
• oblong whitish cavities on the nail plates;
• rash on the palms, groin, feet;
• purple skin color on the palms and soles;
• scarlet-like blisters on the skin;
• skin seals on the palms and soles;
• peeling of the skin;
• conjunctivitis;
• redness of the sclera;
• anterior uveitis (inflammation choroid eyes);
• cracks on the lips with bleeding;
• enlarged tonsils;
• swelling, color - bright scarlet;
• rapid heartbeat;
• pain in the heart area;
• joint pain;
• joint hardening;
• abdominal pain, nausea, vomiting, constipation;
• inflammation of the brain;
• loss of strength;
• insomnia, etc.

Infants (up to one year old) experience increased excitability, sleep disturbances, and itching as a result of profuse rashes on the body. Due to swelling and pain, they may refuse to eat. Gastrointestinal upset in the form of diarrhea and vomiting may also occur.

Diagnostics

To confirm the diagnosis, you will need to undergo an examination by a pediatrician, therapist, dermatologist, infectious disease specialist, cardiologist, rheumatologist, do a general and clinical blood test, and a chest x-ray. In addition, the doctor will definitely prescribe an ECG, antiography of the arteries, and ultrasound of the heart. You may also need a diagnosis of cerebrospinal fluid, a lumbar or lumbar puncture, an echocardiogram and a general urine test.

Treatment

Kawasaki syndrome is usually treated with conservative methods, serious consequences for the heart and blood vessels are eliminated surgically. The patient is placed in a hospital, where manipulations are carried out under the supervision of a doctor. The earlier the syndrome is identified and measures taken, the greater the likelihood of no complications and rapid treatment of the disease.

Treatment for Kawasaki syndrome includes:

• intravenous administration of immunoglobin ( best results from the administration of this medicine in the first 10 days of the development of the disease);
• anti-inflammatory therapy (taking aspirin for 5-10 days);
• taking blood thinning medications;
• administration of anticoagulants ();
• corticosteroid therapy.

Medicines should only be prescribed by an experienced doctor. In the absence of treatment for Kawasaki syndrome, the disease develops within 12-14 days, but the consequences usually appear later. In a quarter of cases, pathologies appear 2-4 months after the syndrome.

For complications of Kawasaki syndrome, the disease is treated surgical techniques, including coronary artery bypass grafting, plastic surgery and vascular stenting.

Adequate assistance in treating the syndrome can only be provided by an experienced therapist, cardiologist, rheumatologist, or cardiac surgeon.

Prevention

To prevent Kawasaki syndrome, the following measures are taken:

• vitamin therapy;
• well preventive treatment viral and bacterial infections upper respiratory tract; compliance correct mode and food quality.

Forecast

As shown medical practice If help is provided in a timely manner, recovery occurs in 98% of cases. For the remaining 2% of patients, there is a high risk of death from acute heart failure, myocardial infarction, or rupture of a coronary artery aneurysm. In some cases, rapid death occurs as a result of severe heart failure.

Kawasaki syndrome is dangerous because in the future patients may experience problems in the cardiovascular system. Thus, in patients who suffered from the disease in early childhood, school age Diseases such as calcinosis may appear. .

The early dynamic development of the diseases listed above is facilitated by smoking and a steady increase in blood pressure And increased level lipids or lipoproteins ().

In order to prevent the development of complications after Kawasaki syndrome, it is necessary to constantly monitor a cardiologist, rheumatologist, and undergo regular (once every 2-3 years) full examination heart and general diagnostics of the vascular system.

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