儿科造血系统2kawasakidisease英文.ppt

Diagnostic criteria 4.Peripheral extremity changes, including erythema, edema, induration, and desquamation 5.Nonpurulent cervical lymphadenopathy 6.Nonexudative bilateral conjunctivitis Diagnostic criteria Patients with classic Kawasaki disease must have 5 of the former symptoms, with fever an absolute criterion. Differentials Staphylococcal infection (such as scalded skin syndrome, toxic shock syndrome) Streptococcal infection (such as scarlet fever, toxic shock-like syndrome). Throat carriage of group A streptococcus does not exclude the possibility of Kawasaki disease Differentials Measles and other viral exanthems Leptospirosis Rickettsial disease Stevens-Johnson syndrome Drug reaction Juvenile rheumatoid arthritis Lab Studies Mild-to-moderate normochromic anemia moderate-to-high WBC count ESR ↑, C-reactive protein ↑, and serum a-1-antitrypsin ↑. Culture results are all negative Lab Studies ANA, RF,ASO normal Platelets Thrombocytosis （2-3w） associated with severe coronary artery disease and MI. Liver enzymes AST, ALT↑ bilirubin ↑ Lab Studies Cardiac enzymes ↑ （ CK，CK-MB, cardiac troponin, LDH） Radiography: rule out cardiomegaly or subclinical pneumonitis. Imaging Studies Echocardiography: rule out CAAs and myocarditis, valvulitis, or pericardial effusion. Diffuse dilatation of coronary lumina can be observed in 50% of patients by the 10th day of illness. Echocardiography should be repeated in the second or third week of illness and 1 month after all other laboratory results have normalized. Imaging Studies Ultrasonography: Gall bladder ultrasonography （liver or gall bladder dysfunction ） scrotal ultrasound to evaluate for epididymitis. Imaging Studies MRA: defines CAA in patients with Kawasaki disease. noninvasive. Other Tests ECG acute infarction. Tachycardia, a prolonged PR interval, ST-T wave changes, decreased voltage of R waves may indicate myocarditis. Q waves or ST-T wave changes may indicate an MI. Medical Care