Thursday, 11 January 2018

Treatments Methods And Diagnosis For Kawasaki Disease

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Kawasaki disease is a rare condition that mainly affects children under the age of five. It's also known as mucocutaneous lymph node syndrome. After a few weeks the symptoms become less severe, but may last longer. At this stage, the affected child may have peeling skin on their fingers and toes. Fever and irritability are often the first indications of the disease. Fever ranges from moderate (101° to 103° F) to high (104° F and above). The lymph glands in the neck may become swollen. A rash usually appears on the back, chest and abdomen early in the illness; in infants it may develop in the groin. In some cases, the rash may spread to the face. The rash appears as poorly defined spots of various sizes, often bright red. Fever continues to rise and fall, sometimes for as long as three weeks.
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 Bloodshot eyes may develop, and the eyes can become sensitive to light.
The child's tongue will commonly be coated, slightly swollen, and resemble the surface of a strawberry, sometimes referred to as "strawberry tongue." The lips usually become red, dry and cracked; the inside of the mouth may turn darker red than usual.

Diagnosis
Kawasaki disease can look similar to other common childhood viral and bacterial illnesses. No single test can detect Kawasaki disease, so doctors usually diagnose it by checking the symptoms and ruling out other conditions. The doctor will do a physical examination and have your child take other tests to help in the diagnosis. These tests may include:

  • C-reactive protein (CRP) test: A high level of C-reactive protein in the blood, produced by the liver, can indicate an inflammation.
  • Erythrocyte Sedimentation Rate (ESR) test: A sample of red blood cells is placed into a test tube of liquid. If the time taken for the red blood cells to fall to the bottom is fast, this can indicate an inflammatory condition, such as Kawasaki.
  • Blood tests : Besides helping to rule out other diseases, blood tests look at white blood cell count, which is likely to be elevated, and the presence of anemia and inflammation, indications of Kawasaki Disease. Testing for a substance called B-type natriuretic peptide (BNP) that's released when the heart is under stress may be helpful in diagnosing Kawasaki disease earlier, recent research found. But, more research is needed to confirm this finding.
  • Electrocardiogram : This test uses electrodes attached to the skin to measure the electrical impulses of your child's heartbeat. Kawasaki disease can cause heart rhythm complications. 
  • Urine test: This can help indicate whether something else may be causing symptoms.
  • Platelet count: Platelets are cells in the blood that clump together to help stop bleeding, and in Kawasaki disease, they are usually high.

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Treatments For Kawasaki Disease
Treatment should start as soon as possible, ideally within 10 days of when the fever begins. Usually, a child is treated with intravenous (IV) doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection.
A child also might be given a high dose of aspirin to lower the risk of heart problems. Some kids with Kawasaki disease are put on a low dose of aspirin for a long time to prevent heart problems. Kawasaki disease is usually treated in hospital, because of the risk of complications. Prompt treatment increases the chance of a faster recovery and reduces the risk complications.
Some medications are used in treatment, this treatments include :

  • Aspirin : High doses of aspirin may help treat inflammation. Aspirin can also decrease pain and joint inflammation, as well as reduce the fever. Kawasaki treatment is a rare exception to the rule against aspirin use in children but only when given under the supervision of your child's doctor. 
  •  Intravenous immunoglobulin (IVIG) : This decreases the risk of coronary aneurysms, but how it works remains unclear. 
  • Corticosteroids and tumor necrosis factor inhibitors : These may be used if other therapies do not work.

After initial treatment
If the heart problems persist, the doctor may refer the patient to a pediatric cardiologist, a doctor specialized in diagnosing and treating childhood heart problems. The following may be necessary:

  • Anticoagulant medications, such as warfarin, heparin, or aspirin, to prevent blood clots. 
  • Coronary artery angioplasty, a procedure opens up an artery that has narrowed by inflating a small balloon inside the artery. This operation involves rerouting the blood around a diseased coronary artery by grafting a section of blood vessel from the leg, chest or arm to use as the alternate route. 
  • Stent placement. This procedure involves implanting a device in the clogged artery to help prop it open and decrease the chance of another blockage. Stent placement may accompany angioplasty.
  • Anticoagulant drugs. These medications such as aspirin, clopidogrel (Plavix), warfarin (Coumadin, Jantoven) and heparin can also help prevent clots from forming.

There is no known prevention for Kawasaki disease. Approximately ly one child in a hundred may develop the disease a second time. Parents should know that nothing they could have done would have prevented the disease.



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Author: Richard Smith