Wednesday, January 28, 2015

management for a child with Kawasaki disease is

The most appropriate choice of management for a child with Kawasaki disease is:


a. Admission for IV gamma-globulin and high-dose aspirin therapy.
b. Admission for antibiotics and steroids.
c. Discharge on high-dose aspirin therapy and follow up in 2–3 days.
d. Discharge on high-dose aspirin therapy and a second-generation cephalosporin.
e. Discharge on high-dose steroids.



kawasaki baby


The answer is a. Kawasaki disease, the most frequent cause of acquired pediatric cardiac disease, is an acute multisystem vasculitis of small and medium sized arteries. It occurs primarily in infants and children, with a peak incidence between 1 and 2 years of age. Diagnosis is based on the presence of fever for 5 or more days in association with four of the following five conditions: bilateral conjunctivitis, cervical lymphadenopathy, polymorphous rash, mucous membrane changes, and extremity findings. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often markedly elevated. The clinical course is divided into three phases. The acute phase (days 1–11) is
characterized by fever and myocarditis. The subacute phase (days 11–20) is characterized by resolution of the fever, rash, and adenopathy as well as the development of thrombocytosis and periungal desquamation. 

Risk for developing coronary artery thrombosis and sudden death is the greatest at this time. The convalescent phase (days 21–60) begins when the clinical findings have resolved and continues until the ESR is normal. All patients should be admitted for IV gamma-globulin and high-dose aspirin therapy. Neither steroids nor antibiotics are indicated. Steroids may actually be detrimental.

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