Kawasaki disease
Kawasaki disease also known as the mucous membrane of skin lymph node syndrome (mucocutaneous lymphnode syndrome) is the major mucosal skin rash and swollen lymph nodes multiple artery inflammation characterized by acute febrile diseases, from Kawasaki rich role in the world after the first report of different Another race of the disease reported in Japanese children in the highest prevalence rates in Japan every year, there had been a pandemic continued each month in the United States and South Korea to more cities every year, is popular in China also have Kawasaki disease epidemic However, the prevalence of the vast majority of children with no detailed reports in the months to the age-year-old but there are also adult patients ratio of men to women. ~.: Relapse rate%%
Cause: the cause of Kawasaki disease causes the disease causes have not yet been fully clarified once suspected of dust mites spread of the Rickettsia and sore blisters acid bacilli (prupionilacterium acnes) is the cause of the disease-but not confirmed, nor reports with the relevant retroviral The patients in the peripheral blood mononuclear cells found associated with retroviral retroviral activity of the Japanese study found that patients with the HLA-BWzz frequency than the general population about high-power while the United States popular in the Boston area while the detection rate of HLA-BW Therefore increased genetic susceptibility and infection may be the cause of the disease
The acute phase of T-lymphocytes reduce the cycle of T cells activated T cells decreased activation of these B-lymphocyte immune abnormalities might be lymphoid tissue infection from the virus and the affinity of the endothelial cells may be multiple reasons for vasculitis the recent discovery of giant Macrophage T cells and B cells of the vascular endothelial cells cytokines proliferator-activated cell surface antigen, such as cell adhesion factor may be in the incidence of this disease plays an important role in national study found that the disease was increased to IgGIgG characterized as B cells Cloning activated B cell growth factor and the activation of IL– mean significantly increased activity of tumor necrosis factor also increased other acute phase of increased blood coagulation and platelet activation may be related to aneurysm formation
An autopsy found that coronary artery damage is still up to other parts of the aortic abdominal aorta carotid subclavian artery and pulmonary artery pathological changes in infants with nodular more arteritis was similar to the whole of the artery inflammation; endometrial thickening of blood vessel cells and a single grain Nuclear cell infiltration within the stretch of the wall and the membrane rupture necrosis and a heart aneurysm endocarditis myocarditis and coronary thrombosis can be caused by myocardial infarction often leads to death
Symptoms: Kawasaki disease clinical performance based on clinical performance and to exclude other diseases in the following items can be set up with the diagnosis
⑴ sustained fever, more
⑵ bilateral film with congestive
⑶ erythema multiforme
⑷ strawberry-red lips tongue, mouth and throat mucous membrane diffuse congestive
⑸ acute congestive sclerosis hand and foot edema recovery began peeling fingertips
⑹ acute suppurative neck swelling
Inspection: Kawasaki disease should do what checks up to the acute phase increased leukocyte × / L above the left with the mild anemia in the prevalence of weeks or more up to platelet × / L above; ESR by up to mm / h more positive C-reactive protein serum immunoglobulin especially IgE complement increased slightly increased serum aminotransferase under increased involvement of other organs of different laboratory abnormalities were proteinuria pyuria; CSF lymphocytes increased low-voltage electrocardiogram ST-T wave PQ and change the QT interval and the Director of arrhythmia; X-check the heart increases-dimensional echocardiography visible coronary artery or coronary artery expansion and formation of the majority is about coronary artery involvement at the same time
Bacterial infection and the virus cultivation serological examination found that some cases without positive anti-Proteus antibody or OXq OX-X-specific antigen positive but Rickettsia of serological tests negative
Complications: What are the cause of Kawasaki disease complications No information about the treatment: the treatment of Kawasaki disease in most cases the disease is self-limited period of acute febrile diseases can be used aspirin ~ mg / kg at the oral; according to blood Concentration ~ mg / dl dose adjustment period after the fever can reduce dose ~ mg / kg daily times aspirin can slow down and prevent the occurrence of coronary thrombosis in the treatment of ECG should be regular inspections and follow-up peacekeeping echocardiography Necessary to do coronary angiography aspirin treatment based on clinical course may be to serve as a few months if the treatment of coronary artery aneurysms occurred should continue to coronary artery aneurysms dissipated
Have a high risk of coronary patients in the use of aspirin at the same time can still be γ-globulin daily mg / kg for aspirin use, compared with single-γ-globulin can significantly reduce coronary artery disease
Adrenal Paper on the application of controversial hormone was identified that promotes the formation of aneurysms, but also a report in the incidence of early impact of glucocorticoid to prevent the occurrence of coronary
A small number of coronary artery aneurysms are larger and can not flinch from the need for coronary artery bypass surgery
Differential Diagnosis: Kawasaki disease easily be confused with the diseases and bacterial diseases (especially Staphylococcus epidermis scarlet fever and leptospirosis loss syndrome) virus rash (such as measles) Rickettsia of disease (such as with the Rockies Banzhen Heat) toxoplasmosis limb pain of juvenile rheumatoid arthritis and multiple nodules in infants distinguish artery Yandeng
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