Kawasaki syndrome in children is a very rare and serious disease 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-old people. 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 disease is dangerous because it causes very negative complications that can manifest itself in the form of aneurysms and their ruptures, the occurrence of such serious diseases as myocarditis, aseptic meningitis, arthritis, etc. This pathology in European countries has exceeded the incidence of rheumatic fever, and causes In most casescomplex heart defects. Treatment of Kawasaki syndrome in children should be timely.
Mechanism of development of Kawasaki disease
This disease develops as follows: in the child's body, the formation of antibodies begins, which infect their own endothelial cells, which are the main ones in the structure of the walls of blood vessels. Why this happens is still unknown to science. However, 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 the "media", begins to become inflamed and its cells gradually die off.
- The structure of the outer and inner membranes of blood vessels is destroyed, which leads to the appearance of expansions in the walls, which are aneurysms.
If Kawasaki syndrome is not treated, within two months the child begins to develop fibrosis of the walls of the vessels, as a result of which the lumen of the arteries begins to gradually narrow, and sometimes close completely.
A favorable prognosis of Kawasaki disease occurs only in cases where therapeutic measures have been started in a timely manner to eliminate this disease. However, the risk of death is very high, and the most common cause of this is arterial thrombosis or acute myocardial infarction. 3% of all cases end in the death of the patient.
Kawasaki syndrome is considered rheumatological, so the doctor is treating this diseaserheumatologist. Depending on what complications the disease has acquired, such specialists as a cardiac surgeon and a cardiologist can be involved in its treatment. Consider the causes of Kawasaki syndrome in children.
Causes of Kawasaki disease
In the field of medicine, which deals with the treatment of this disease, there is still no reliable information about the reasons for the onset of the inflammatory process of the vascular walls. However, there are several assumptions about this. The most common of them is the suspicion that there is some kind of hereditary predisposition in the body, which is aggravated by external influence - the ingestion of microorganisms of bacterial or viral etiology into the human body. These may include Epstein-Barr virus, rickettsia, parvovirus, spirochetes, streptococcus, herpes vulgaris, retrovirus, staphylococcus aureus, 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:
- Race, as Asians are more likely to develop the disease.
- Decrease in the body's immune defenses.
Kawasaki disease symptoms
The disease develops, as a rule, in three periods:
- 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 no more than two years.
Kawasaki syndrome in children (photo below) develops, as a rule, very abruptly. The temperature in a child can rise to the upper marks, and the first 6-7 days of the disease persist. If you do not immediately start the necessary treatment, the high temperature can last for 14 days. The longer such a feverish period lasts, the worse the prognosis for the recovery of a small patient.
Lymph node enlargement
If during the period of the disease the child has subfebrile temperature, the symptoms of Kawasaki disease may be an increase in lymph nodes, most often in the neck. This is joined by symptoms of severe intoxication of the body - weakness, abdominal pain, indigestion, tachycardia. At the same time, the child will behave very restlessly, may cry often, he will have 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 that which occurs with scarlet fever and measles. Elements of rashes are located, as a rule, in the groin and on the limbs. 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 feet. These skin manifestations disappear on the 6-7th day, however, erythema can persist for up to 2-3 weeks, after whichsevere peeling of the skin.
Conjunctivitis
Symptoms of Kawasaki syndrome in children can be acute conjunctivitis, as well as inflammation of the vascular elements in both eyes. The oral mucosa becomes dry, the 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 there is inflammation of the pericardium - the pericardial sac, as a result of which the process of development of mitral and aortic insufficiency begins. Coronary vessels expand, and aneurysms of the ulnar, subclavian and femoral arteries may also appear. 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 disease
The disease can be confirmed by the presence of a 5-7-day fever, and the mandatory clinical diagnostic criteria include:
- Conjunctivitis in both eyes.
- Injury to the mucous membranes of the mouth and throat.
- Adenopathy (local).
- Thickening and redness of the skin of the palms and feet, accompanied by severe swelling.
- Peeling of the skin on the fingertips at the 3rd week of the disease.
In cases where coronary artery aneurysms are detected during examination of a child, then three additional signs of the disease from the above are required to establish an accurate diagnosis.
Laboratoryresearch
Laboratory studies required for this include:
- biochemical blood test;
- general blood and urine tests;
- study of cerebrospinal fluid.
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 serious complications is high.
Drugs
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 agent is administered intravenously-drip 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 inflammation in the walls of blood vessels.
- "Acetylsalicylic acid". This drug is prescribed in large doses in the early days, followed by a decrease in dosage. The drug thins the blood, reduces the risk of thrombosis and stops inflammation.
- Anticoagulants. These medications can be Warfarin or Clopidogrel. They can be recommended to sick children in whom aneurysms have been identified. Appointed to prevent thrombosis.
Prescribing corticosteroid drugs for Kawasaki syndrome in children is questionable. However, hormonal drugs are known to increase aneurysm-forming factors as well as coronary thrombosis.
Conclusion
Children should be vaccinated against diseases such as measles, chicken pox, flu, because too long aspirin treatment 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.
