Diagnosis
Diagnostic criteria: The diagnostic criteria revised by the Kawasaki disease research committee in Japan in September 1984 are usually used.
1.Main symptoms.
(1) Fever lasts for more than 5 days. High fever of 39–40 “C, mostly lasting about 10 days, antibiotic treatment is ineffective.
(2) End of extremity changes: hard swelling and congestion of hands and feet in the acute stage. 2 weeks later, large pieces of skin peeling from the ends of fingers (toes).
(3) Polymorphic erythematous rash. Spot, papular rash or measles, scarlet fever-like rash appears on trunk and extremities in 1 to 4 days of fever. It may fuse into patches, mostly on the trunk, but without blisters and crusts.
(4) Bilateral conjunctival congestion without secretions.
(5) Oral changes. Lips are congested, dry and cracked, bleeding, prune tongue, diffuse congestion of the oral cavity and mucous membranes, redness and swelling of the pharyngeal isthmus.
(6) Acute nonsuppurative cervical lymph node enlargement with a diameter greater than 1.5 cm.
Diagnosis is made with 5 of the 6 main symptoms mentioned above. If only 4 items are present, and 2-dimensional echocardiography or coronary angiography shows coronary artery aneurysm can also diagnose this disease, but other diseases should be excluded.
2.Secondary symptoms, as a diagnostic reference.
(1) Cardiovascular system.
Electrocardiographic changes.
Cardiac auscultation: tachycardia, gallop rhythm, low or split heart sounds.
Echocardiography and coronary angiography: coronary artery dilatation, coronary artery aneurysm.
(2) Digestive system: diarrhea, vomiting, abdominal pain, gallbladder effusion, etc.
(3) Urinary changes, proteinuria, increased leukocytes in urine sediment.
(4) Blood leukocytosis, left shift of nucleus, thrombocytosis, mild anemia, increased sedimentation, CRP(+), negative ASO, increased a2 globulin.
(5) Respiratory system: cough, chest X-ray shows lamellar shadow in the lung.
(6) Joints: redness, swelling, and pain.
(7) Neurological system: convulsions, coma, facial nerve palsy, cerebrospinal fluid mononuclear cell increase.
Treatment
1. Aspirin: the most commonly used drug. It has non-specific anti-inflammatory effect and can prevent platelet agglutination and thrombosis. In the acute stage, 80-100mg/kg per day, divided into 3 doses. After the fever subsides, reduce to 20-30 mg/kg per day in 2 doses for 2-3 months. In case of coronary artery aneurysm, aspirin should be taken continuously at 10 mg/kg daily orally once until 1 year after the aneurysm disappears.
2.Immunoglobulin: Within 10 days of fever, high-dose immunoglobulin can prevent and control coronary aneurysm and promote the recovery of diseased coronary artery. Give 2 g/kg at a time, with 3%-5% concentration in 12-24 hours, or 1 g/kg per day for 2 days, or 400 mg/kg per day for 5 days. Mostly used in combination with aspirin.
3, epinephrine: easy to cause thrombosis, and affect the repair of coronary artery lesions, should not be used alone in conventional treatment, individual cases of severe myocarditis can be short-term additional hormone. Recently, methylprednisolone has been reported in the treatment of this disease.
4, thrombolytic therapy: coronary artery thrombosis or the occurrence of myocardial infarction, intravenous input urokinase. Heparin can also be used intravenously.
5.Coronary angioplasty: for severe coronary artery stenosis, balloon catheter can be used to dilate the stenotic lesion; for left coronary artery trunk, left anterior descending branch proximal occlusion or multiple coronary artery occlusion, aortic and coronary artery bypass grafting is appropriate.
6.Other symptomatic treatment: Complicated heart failure, cardiogenic shock, arrhythmia should be treated symptomatically.