0071643192.pdf

PEDIATRICS

COMPLICATIONS

■ Aneurysms of coronary arteriesdevelop in 20% of patients who are

untreated. Patients at highest risk are male, <1 year old, and with the

greatest degree of inflammation.

■ Hydrops of gallbladder

■ Mortality <1% for children in the United States.

Rheumatic Fever

■ Mediated by the host immune response to a preceding group A strep infection

■ Affected patients are typically school age

■ Symptoms develop 2–3 weeks after a strep infection, with target organs

including heart, joints, CNS, and skin.

TABLE 5.8. Diagnostic Criteria for Kawasaki Syndrome

Fever =5 days, andfour out of five of the following criteria:

1. Bilateral conjunctivitis


2. Oropharyngeal changes (fissuring of lips, “strawberry tongue,” erythema of lips of pharynx)


3. Changes to skin on hands/feet (erythema →desquamation)


4. Rash on torso


5. Cervical lymphadenopathy (at least one lymph node greater in size than 1.5 cm)

And no other diagnosis to explain symptoms.

TABLE 5.7. Phases of Kawasaki Syndrome

Acute Phase (1–2 wk)

■Fever

■Lymphadenopathy (usually anterior cervical)

■Conjunctivitis (bilateral, painless, without exudate)

■Oropharynx: Cracked lips, “strawberry tongue”(prominent papillae on tongue), pharyngeal

erythema

■Rash on perineum, often progressing to torso

■Erythema/edema of hands and feet

■Vasculitis may affect virtually any organ system: Pneumonitis, myocarditis, enteritis, meatitis,

hepatitis, uveitis.

Subacute Phase (2–4 wk)

■Thrombocytosis (platelets up to 500,000–1,000,000/mm^3 )

■Resolution of fever

■Desquamation of hands and feet

Convalescent Phase (>2 mo)

■Scarring and calcification of affected coronary arteries