סליחה שזה באנגלית
Kawasaki disease is an illness that gives inflammation of the blood vessels in the whole body. It was first comprehensively described in Japan in 1967. Though some children without treatment for Kawasaki Disease get better on their own, 15 to 25% have damage to the coronary arteries. In Kawasaki disease damage can occur to many arteries, but the coronary arteries are the most vulnerable, making Kawasaki disease a leading cause of childhood heart disease after birth. What does Kawasaki Disease look like and how can we diagnose it? There is no laboratory test that can diagnose Kawasaki disease with 100% surety. Instead, we use a collection of criteria developed by Dr. Kawasaki and described by the Centers for Disease Control (Table 1). A child must have fever for more than 5 days plus four of five findings from the criteria on physical exam, without evidence of another disease. Lips and mouth are often bright red, as are both eyes, usually without fluid or crusting. The top layer of the tongue peels off, creating the appearance of “strawberry tongue,” which is red and glossy. Hands may be swollen and red. Kawasaki disease typically produces a rash as well, which is often worse in the groin area. There can be swollen glands (lymphadenopathy), usually one gland in the neck measuring at least 1.5 cm (normally glands are less than 0.5 cm). There are other clinical and laboratory findings that can support the diagnosis (Table 2). Children are often extremely irritable over the course of the entire illness. Occasionally the diagnosis of Kawasaki disease is unclear and a spinal tap is done to evaluate for causes of fever; this can show mild inflammation of the spinal fluid (aseptic meningitis). One-third of patients have a temporary joint pain (arthritis), usually in the small joints initially (fingers and toes), with progression to the large weight-bearing joints (knees, wrists, elbows, hips). Many children have diarrhea, nausea, and vomiting. The gall bladder may be large and children may have abdominal pain. The diagnostic criteria in Table 1 should be viewed only as a guideline, since some children develop coronary artery changes without meeting diagnostic criteria, referred to as “atypical Kawasaki disease”. Atypical disease is more common in infants, who often present with subtle or incomplete findings. Kawasaki disease is a self–limited illness, which means the symptoms go away on their own. However it may take 6-8 weeks for the symptoms to resolve and the laboratory results to return to normal, and the effects on the coronary arteries can last a lifetime. The illness can be divided into three stages: acute, subacute, and convalescent phases. The acute phase starts with fever, which lasts for at least 5 days (average of 11 days without treatment). Over the first week, the symptoms that comprise Kawasaki disease reveal themselves, but often one symptom appears as another disappears, making the diagnosis challenging, especially for children who see different physicians during the early days of their illness. An ultrasound of the heart (echocardiography or ECHO) is done at the time of diagnosis to look at the way the heart squeezes, and to get baseline measurements of the coronary arteries. Some children may have mild or moderately decreased heart output due to poor contraction of inflamed heart muscle; some may have a small amount of fluid around the heart (pericardial effusion). Very rarely, cardiac rhythm (electrical) disturbances may occur. The subacute phase begins when the fever stops. However, many parts of the body are still affected by the disease. During this stage one of the most characteristic symptoms of the disease may be seen, peeling of the skin of the palms and soles beginning under the fingertips and toes (periungual desquamation). Joint inflammation, may also be present, usually affecting the larger weight-bearing joints in this phase. Laboratory studies reveal a high platelet count (one of the cells in the blood that helps clotting) and an increase in blood proteins that promote clotting. The sedimentation rate, a blood test that shows the overall degree of inflammation, continues to be high and anemia (fewer red blood cells than usual) is common. Widening (dilation) or bubble formation (aneurysm) in the coronary arteries can be seen by echocardiogram in this phase. Third is a convalescent phase: the child continues to recover and labs return to normal. Although the child is usually feeling better, coronary aneurysms may continue to enlarge, reaching their biggest size 4 to 6 weeks from the first day of fever.
