Mnemonics of Kawasaki Disease
FREE CLaSS In AC
F – Fever >5 days
R-Rash (polymorphic)
E-Edema of hand and foot
E- Erthyema of sole and palm
C- Conjunctival congestion (Bulbar)
La- Lymphadenopathy (Cervical >1.5 cm unilateral
Ss- Strawberry tongue ,cracked lip
In -IvIG 2g /kg
A- Aspirin Dose 80 -100 mg per kg day until afebrile for 48 hour followed by 3 -5mg per kg per day
C -Clopidogrel if coronary abnormalities
Treatment of Kawasaki Disease
ACUTE STAGE
Intravenous immunoglobulin 2 g/kg over 10-12 hr and
Aspirin 80-100 mg/kg/day divided every 6 hr orally until patient is afebrile for at least 48 hr
CONVALESCENT STAGE
Aspirin 3-5 mg/kg once daily orally until 6-8 wk after illness onset if normal coronary findings throughout course
LONG-TERM THERAPY FOR PATIENTS WITH CORONARY ABNORMALITIES
It is recommended that the KD patient who has experienced solitary small aneurysm take aspirin indefinitely. Decisions about the inclusion of additional antiplatelet medications or anticoagulation for patients with larger or numerous aneurysms should be undertaken in conjunction with a paediatric cardiologist.
Oral aspirin 3-5 mg/kg once per day
1 mg/kg/day of clopidogrel (maximum: 75 mg/day)
Most experts add warfarin or low-molecular-weight heparin for those patients at particularly high risk of thrombosis
ACUTE CORONARY THROMBOSIS
Acute thrombosis can occasionally develop in a coronary artery that is stenotic or aneurysmal; in this case, thrombolytic therapy may be lifesaving.
prompt thrombolytic treatment with tissue plasminogen activator or another thrombolytic drug under a paediatric cardiologist’s supervision.
COMPLICATIONS
Patients with coronary artery aneurysms should receive long-term follow-up that includes routine echocardiography, stress testing, and maybe angiography if there are significant aneurysms present. For the treatment of coronary stenosis caused by KD, catheter intervention has been utilised using percutaneous transluminal coronary rotational ablation, directed coronary atherectomy, and stent insertion; some patients also required coronary artery bypass grafting.
To lower the risk of Reye syndrome in patients taking long-term aspirin therapy, influenza vaccinations should be given every year.
During the six weeks following varicella vaccination, aspirin can be replaced with another antiplatelet medication.
The measles, mumps, rubella, and varicella vaccinations should typically be delayed until 11 mo after IVIG administration because IVIG may interfere with the immune response to live virus vaccines because of specific antiviral antibodies. Non-live vaccinations do not need to be delayed.
15% of patients will develop IVIG-resistant KD, which is indicated by persistent or relapsing fever 36 hours after the initial IVIG injection. Patients who are IVIG resistant are more likely to develop CAA. Patients with IVIG resistance often receive an additional dose of 2 g/kg IVIG. When fever continues after the first IVIG, corticosteroids have also been utilised as a subsequent or “rescue” therapy in a variety of dosages and delivery methods. Corticosteroids are used as rescue therapy, however the best manner to deliver them is unclear, which has resulted in significant practise difference between centres. For the treatment of IVIG-resistant illness, tumour necrosis factor inhibitors such infliximab and etanercept have also been used.