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KAWASAKI SYNDROME

Kawasaki syndrome is an uncommon childhood illness that is
characterized by high fever and inflammation of the blood vessels throughout the
body. Approximately 4000 children each year in the United tates develop
Kawasaki yndrome! about eighty percent of whom are younger " years of age.
#he cause of Kawasaki yndrome is unknown. $t has been hypothesized that an
infectious agent is involved in the etiology of Kawasaki syndrome but no specific
association has been confirmed. $n a single study from %apan! where a higher
incindence of Kawasaki yndrome than in the United tates has been noted
&'ac(eil! et.al.! )00*+.
Kawasaki yndrome was first described in ,*-0s by .r. #omisaku
Kawasaki! %apan. Kawasaki yndrome causes significant morbidity in most
patiens and can result in a range of cardiac and noncardiac complication. ome of
these complications may lead to a prolonged duration of illness! potential
longterm effects and death of patient. #he most serious complications of
Kawasaki yndrome are related to abnormalities of the coronary arteries!
including luminal dilatation and aneurysm. /oronary artery abnormalities can
occur in 0 )01 of untreated Kawasaki syndrome patients &2elay et al.! )00-+
ince its original description! Kawasaki disease has emerged in developed
countries as the commonest cause of ac3uired cardiac desease in childhood. #here
are considerable variation in incidence relating mainly to geographic and ethnic
factors. A study by 4eaton et al.! &)00"+ mentioned that the incidence of
Kawasaki desease in (ew 5ealand is defined with significantly variable risk
according to ethnicity. 'ost patients received appropriate rapid diagnosis and
treatment but there was considerable variation in practice in regard to number and
timing of echocardiograms.
Kawasaki desease has now been reported from all parts of the world!
including several centers in $ndia. 2ased on 6pidemiology and clinical features!
an infectious etiology has been suspected for long. $n india! however! ma7ority of
children with Kawasaki yndrome to remain undiagnosed probably because of the
lack of awareness among pediatricians. Kawasaki yndrome should be considered
in the differential diagnosis of all febrile illnesses in young children where the
fever persist for more than "89 days. #he clinical profile of Kawasaki yndrome
can be devided into three phases : Acute ;hase &08,0 days+! high grade fever
&unresponsive to antimicrobials+! extreme irritability and bilateral con7unctival
in7ection are the usual presenting features and characteristic of the early phase of
this desease< ubacute phase &,08)= days+! this phase corresponds to the period
when most of the clinical features seen in the acute state are subsiding. #here is a
risk of sudden death in this phase. /onvalescent phase! it begins when all clinical
signs have dissapeared and continous till the acute phase paramteres &e.g.
thrombocytosis! erythrocyte sedimentation rate+ return to normal. #his usually
occurs by the end of -8= weeks after the onset of the illness.
.evelopment of coronary artery abnormalities is the hallmark of K. and
accounts for most of the morbidity and mortality associated with the desease
Nama Maba : Giovanny Sumeinar
Nama Keluarga : Pediatry
& ingh! )00*+. Although the cause of Kawasaki disease remains unknown!
clinical trials have established effective therapies. #reatments with $ntravenous
immunoglobulin and have been shown to lower the rate of coronary artery
aneurysms to between >1 and "1.
Apart from the common cardiac complications! follow8up of Kawasaki
disease patients should not only focus on the coronary arteries. ;atients should
also be screened for behavioral difficulties during follow8up visits! and referral to
a clinical psychologist for behavioral intervention should be considered when
necessary &Atee3i and ?aras! )0,,+.
ibliogra!"y
Atee3i! (ahed and 4adell ?aras.)0,,.Behavioral Difficulties Secondary to
Kawasaki Desease.%urnal of #he Arab 2oard of 4ealth pecialization. @ol ,). (o
)
2elay! 6rmias . et al.)00-.Kawasaki Syndrome and Risk Factors for
Coronary Artery Abnormalities.#he ;ediatrics $nfectious .isease %ournal.@ol )"
4eaton et al.)00-.Kawasaki Disease in New Zealend%ournal of ;ediatrics
and /hild 4ealth.@ol )4
'ac(ail! Adam et al.)00*.!valuation of Seasonal "atterns of Kawasaki
Syndrome and Rotavirus Assosiated #os$itali%ation in California and New &ork
'((()'((* B+C "ediatrics.@ol )>
ingh! ur7itt.)00*.Kawasaki Disease)an ,ndian "ers$ective,ndian
"ediatrics.@ol 4-