Distinguishing features of roseola infantum include an erythematous and morbilliform rash that consists of rose-colored macules appearing on the neck, trunk, and buttocks and less frequently on the face and extremities that begins as the fever abates.
The mucous membranes are often spared, and the rash resolves in 1 to 2 days. Patients with roseola infantum also are at increased risk for febrile convulsions. Laboratory studies often show leukopenia. Erythema infectiosum also called fifth disease is caused by Parvovirus B Like KS, it is characterized by fever, adenopathy, and rash. Unlike KS, a prodrome of malaise, pharyngitis, coryza, and fever precedes the illness.
The characteristic "slapped cheek" rash generally follows about 10 days later. In the second phase of the illness, the rash spreads to extremities and becomes symmetrical, morbilliform, and lacelike or annular with central clearing and is often mildly pruritic. It spares the mucous membranes, palms, and soles. In its final phase, the rash may remit and recur for weeks with stress, exercise, or bathing. Complications of erythema infectiosum include arthritis, hemolytic anemia, aplastic crisis, and nonimmune hydrops in the fetus and newborn.
Similarities to KS include fever, rash, and cervical lymphadenopathy. Mononucleosis is typically characterized by a triad of membranous tonsillitis with or without exudates, cervical lymphadenopathy, and splenomegaly.
The first type of exanthem is erythematous, maculopapular, and rubella-form and is more prominent on the trunk and proximal upper extremities occasionally it is seen on the face, forearms, and legs.
This is the classic, non-antibiotic-related EBV rash. The second type is an erythematous or copper-colored ampicillin-associated rash that begins on the trunk and spreads to the face and extremities.
EBV infection can be diagnosed in the clinic with the monospot test or with specific EBV antibody tests. Gianotti-Crosti syndrome, an infantile, papular acrodermatitis originally associated with hepatitis B surface antigen that may occur after viral infection, is caused by pathogens such as EBV, cytomegalovirus, enteroviruses, and respiratory syncytial virus.
Like KS, this syndrome includes a desquamative rash and lymphadenopathy. The rash is characterized by a sudden eruption of symmetric, flat-topped, discrete, nonpuritic, skin-colored to erythematous papules on the malar face, extremities, and buttocks Figure 4 that spares the trunk, mucous membranes, and antecubital and popliteal fossae.
The lesions then fade and desquamate spontaneously within 2 to 3 weeks but may remain for up to 8 weeks. The lymphadenopathy is generalized and inguinal, and maxillary nodes can be enlarged for 2 to 3 months after onset. The rash associated with Gianotti-Crosti syndrome is desquamative like that of Kawasaki syndrome.
However, it is uniquely characterized by a sudden eruption of symmetrical, flat-topped, discrete, nonpuritic, skin-colored to erythematous papules on the malar face, extremities, and buttocks. HSP is a systemic vasculitis with deposition of IgA-containing immune complexes throughout the body.
Like KS, HSP is characterized by fever; rapidly fading rash; swollen hands, feet, and periorbital areas; arthritis; and abdominal pain. Unlike KS, HSP is classically described as intermittent purpura, arthralgias, abdominal pain, and renal disease. HSP also may be preceded by an upper respiratory tract infection, mild fever, and headache. The initial lesions are symmetrical, blotchy, erythematous macules that become urticarial and then purpuric within a day. The palpable purpuric lesions are seen on the buttocks, extensor surfaces of extremities, back, scrotum and, occasionally, the face.
In a child younger than 2 years, edema of the scalp, hands, feet, and periorbital tissues may develop before the appearance of purpuric lesions.
Cutaneous hemorrhage may be the sole manifestation of any attack, with arthralgia and arthritis noted as a migratory, periarticular swelling of the knees and ankles. Patients also may have colicky abdominal pain associated with vomiting and melena, and mild renal involvement with transient proteinuria, hematuria, and focal glomerular involvement.
Abnormal findings on laboratory tests include leukocytosis, thrombocytosis, and elevated erythrocyte sedimentation rate ESR. Skin biopsy specimens show IgA, C3, and fibrin deposits. JRA has characteristics similar to those of KS, including lymphadenopathy, rash, and high, spiking fevers.
These fevers are dramatic, with sweats and chills, and temperatures often spike to 40C F before plunging to several degrees below normal picket fence temperature. The rash is a transient, evanescent, salmon-colored, nonpruritic rash that is primarily noticeable on the chest and abdomen. It often appears and disappears with the fever spikes. Many patients may initially complain of mild sore throat and joint symptoms that become a progressively destructive arthritis primarily affecting the wrists.
Hepatosplenomegaly during the rash, anemia, and leukocytosis also may be present. SJS is a condition caused by a severe allergic reaction to drugs such as sulfonamides, NSAIDs, and phenytoin and by infections such as those caused by Mycoplasma pneumoniae and herpes simplex virus. Like KS, SJS is characterized by pharyngitis, fever, conjunctivitis, a maculopapular rash involving the hands and feet, and hemorrhagic lips.
The rash tends to be vesicular with crusting of edematous, erythematous eruptions involving the face, hands, and feet. Bullous erythema multiforma, with lesions that may slough off as large pieces of skin, also may be noted. The current recommendation is to administer varicella and annual influenza vaccines immediately and to delay MMR vaccination for 11 months after the administration of IVIG, at which point varicella vaccine should be readministered to ensure adequate immunogenicity.
Parents should be advised to visit their local immunisation centre for further advice and to re-present if an unimmunised child is exposed to varicella.
Parents should be reassured that Kawasaki disease is not contagious and that most children recover fully, without any long term cardiac or other sequelae. Some patients may require long term treatment under specialist supervision. Approximately half of the coronary artery aneurysms resolve within 1—2 years, 24 but stenosis of the affected vessel at entrance and exit to aneurysmal area may occur with healing. The long term effects of Kawasaki disease on adult coronary artery disease are unclear, as data from cohort studies are not yet available.
The opportunity should be taken to advise families of the potentially increased long term cardiovascular risk and the need for minimisation of risk factors. It is prudent to advise families to reduce known, modifiable factors for cardiovascular disease, such as obesity, smoking and lack of exercise, and to consider measuring plasma lipids and blood pressure in early adulthood, or earlier if there is a family history. Mild behavioural disturbances in the weeks following Kawasaki disease usually resolve without specific therapy.
Children with previous Kawasaki disease may desquamate with subsequent febrile illnesses, although in the absence of other features this does not represent a true recurrence, which is rare.
Expert advice may be sought if the diagnosis is unclear. Competing interests: None. Provenance and peer review: Not commissioned; externally peer reviewed. Australian Family Physician.
Search for: Search AFP. Filter Relevance Date. Issues by year. Volume 42, Issue 7, July Kawasaki disease The importance of prompt recognition and early referral. Background Kawasaki disease is an acute, febrile vasculitis of childhood that affects medium sized arteries, particularly the coronary arteries.
Consequently, it is the leading cause of paediatric-acquired heart disease in developed countries. It is important to have a high index of suspicion for Kawasaki disease in any child with prolonged fever of unknown origin and to refer to a paediatric facility promptly, as timely treatment reduces coronary artery damage.
Objective To provide an evidence based review that will help guide the safe and timely recognition, referral and management of typical and incomplete Kawasaki disease. Discussion Kawasaki disease is most common in children aged 6 months to 4 years. A high index of suspicion is needed to consider the diagnosis. There are specific diagnostic criteria, though incomplete Kawasaki disease may occur where the child does not meet all diagnostic criteria.
There may be co-existing illnesses, which make the diagnosis more difficult. Persistent fever, skin manifestations and extreme irritability may be some cues to consider the diagnosis. If there is strong clinical suspicion the child should be referred, as early treatment significantly decreases the risk of long term cardiac artery damage.
What are the diagnostic criteria? The diagnosis is made by the presence of fever for at least 5 days onset of fever considered day one of illness and at least four out of the following five diagnostic criteria that often appear sequentially: conjunctival injection — redness without exudate, typically bilateral with perilimbal sparing a ring of normal conjunctiva around the iris.
This appears early in the illness and due to its transitory nature should be sought on history as well as clinical examination. In the sub-acute phase of Kawasaki disease from about day 10 onward , there may be desquamation of the fingers and toes polymorphous skin rash — usually begins in the nappy area where there may be desquamation early in the disease and spreads to involve the trunk, extremities and face. Rash may be maculopapular, annular or scarlatiniform.
This is the least frequently seen criteria, but is more common in older children. What is incomplete Kawasaki disease? When should I suspect Kawasaki disease? Fever Kawasaki disease should be suspected in any child with a persistent fever with no other likely explanation. Skin manifestations Rash and peeling desquamation of the nappy area rash is common in the acute phase.
Figure 1. Polymorphous skin rash affecting the trunk in a child with confirmed Kawasaki disease. Figure 2. Dry, red lips and polymorphous rash in a child with confirmed Kawasaki disease.
Kawasaki disease has telltale symptoms and signs that appear in phases. The first phase, which can last for up to 2 weeks, usually involves a fever that lasts for at least 5 days. Doctors can treat the symptoms of Kawasaki disease when it's caught early.
Most kids will feel better within a few days of starting treatment. If the condition isn't found until later, patients can have serious complications that affect the heart, such as:. Doctors don't know what causes Kawasaki disease. They believe it doesn't spread from person to person. It's most common among children of Japanese and Korean descent, but can affect any child.
Kawasaki disease symptoms can look similar to those of other childhood viral and bacterial illnesses. Your child's hands and feet may also be tender and painful to touch or put weight on, so they may be reluctant to walk or crawl. Children under 1 year of age may not have as many of the key symptoms compared with older children. Read more about the symptoms of Kawasaki disease. Sometimes, a child may be diagnosed with Kawasaki disease if they have a high temperature and only 1 key symptom, or if the high temperature has only lasted 4 days.
Tell the doctor assessing your child if your child has recently had symptoms of Kawasaki disease but no longer has them.
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