Kawasaki Disease

Kawasaki Disease, What Is It? 
 
DAY was still early when a luxury car with a hardness of sliding down the freeway in Europe. Suddenly the car hit the curb and overturned. Eyewitnesses who saw the suspected drunk driver. Police arrived and found the driver of a 19-year-old girl, died. 

An autopsy showed the girl's sudden coronary heart attack, so could no longer control the car. Apparently, her medical records show, he had Kawasaki disease at age 2 years unnoticed by the doctor or his family.
Joni experienced similar tragedies, cute babies aged 8 months. It has been over 10 days he had fever and her mother had changed doctors. Eventually discovered that he suffered from Kawasaki disease. Unfortunately it was too late. Heart valves were severely damaged and his life was beyond help. 

Is it Kawasaki disease?


 Kawasaki disease was discovered by Dr. Tomisaku Kawasaki in Japan in 1967 and was then known as mucocutaneous lymphnode syndrome. In honor of its discoverer, then called Kawasaki disease. In Indonesia, many of us who do not understand this deadly disease, even though the medical community. This has led to a diagnosis often late with all the consequences. 

The apparition of this disease can also fool the eye so it can be diagnosed as measles, drug allergies, viral infection, mumps or even disease. The disease is more frequently attacked the Mongol race is mainly affected infants and most often in children aged 1-2 years. In fact, the author never found a PK on a 3-month-old infant who suffered from fever for 18 days. 

The incidence per year in Japan the highest in the world, ranging from 1 case per 1,000 children under five, followed by Korea and Taiwan. In the United States ranges from 0.09 (in the white race) to 0.32 (in the Asian-Pacific) per thousand children under five. In Indonesia, the authors found a case of PK since 1996, but there are doctors who declared already found previously. 

Indonesian Official new maps are recorded in the world after Kawasaki disease case report PK series of Advani et al filed on an international symposium to the 8th Kawasaki disease in San Diego, USA, early 2005. Allegedly, the case in Indonesia was not a bit and according to rough calculations, based on the number of global events and ethnicity in our country, every year there will be 3300-6600 cases of Kawasaki disease. 

But the reality of the detected cases are still very far below this figure. Approximately 20-40 percent of them suffered damage to the cardiac coronary vessels. Some will recover but others are forced to live with heart defects caused by coronary blood flow is disturbed. A small percentage will die of heart damage. 

The cause of Kawasaki disease are as yet not known, although allegedly caused by an infection, but no convincing evidence. Therefore prevention is also unknown. The disease is also not proved contagious. 

Early symptoms 

 Early symptoms in the acute phase is a sudden high fever and can reach 41 ° C. Fluctuating fever for at least 5 days but never reached normal. In children who are not treated, the fever can last for 1-4 weeks without a break. Antibiotics do not help. About 2-3 days after fever, other symptoms began to appear gradually the patches of red spots on the body like the measles. 

However, cough and cold symptoms are dominant in measles is usually mild or nonexistent in Kawasaki Disease. Other symptoms that arise are the two red eyes, but without the dirt (belekan), swollen lymph nodes on one side of the neck so that the disease is sometimes suspected mumps (parotitis), resembles a strawberry red tongue, lips red as well and sometimes cracked, palm and legs red and slightly swollen. Sometimes a child complains of pain in the joints. In the healing phase exfoliation occurs at the fingertips of the hands and feet and then come across the line-shaped depressions on the feet and hands nails (Beau's lines). 

Patients with Kawasaki disease should be admitted to hospital and receive supervision from the child's cardiologist. The most feared complication is in the heart (occurs in 20-40 percent of patients) because it can damage the coronary arteries. Complications to the heart usually takes effect after 7-8 days since the beginning of the onset of fever. 

At first this may occur vessel dilation and constriction can occur inside or blockage. As a result blood flow to the heart muscle disturbed so that it can cause damage to the heart muscle known as myocardial infarction. Examination of the heart becomes very important, including ECG and echocardiography (cardiac ultrasound). Sometimes ultrafast CT scan, MRA (Magnetic Resonance Angiography) and cardiac catheterization is required in severe cases. Laboratory tests for the disease is not typical. 

Usually the white blood cell count, erythrocyte sedimentation rate and C reactive protein is increased in acute phase. So the diagnosis is established on the basis of clinical symptoms and signs alone, so the experience of physicians are urgently needed. In the healing phase, increased blood platelets, and this will facilitate the occurrence of thrombus, or blood clots that clog coronary arteries. 

Treatment 

The drug is an absolute must given immunoglobulin intravenously for 10-12 hours. Drugs derived from the plasma of blood donors is effective to relieve symptoms of Kawasaki disease and reduce the risk of heart damage, but the expensive price constraints. The price of a gram of around Rp 1 million. Kawasaki Disease Patients require immunoglobulin 2 g per kg of body weight. 

For example, a child weighing 15 kg for example, requires 30 grams or costing about USD 30 million. Patients are also given salicylic acid to prevent heart damage and blockage of coronary arteries. If there are no complications the child can be discharged within a few days. In the case of a late and already there is damage to the coronary vessels longer hospitalization and intensive treatment to prevent further heart damage. 

If the drugs do not work, sometimes required coronary bypass operation (coronary bypass) or even, though very rarely, a heart transplant. Death can occur in 1-5 percent of patients who are generally delayed and the peak occurs at 15-45 days after the initial onset of fever. Nevertheless, sudden death may occur many years after the acute phase. PK can also damage the heart valves (especially mitral valve) that can cause sudden death a few years later. Possible recurrence of this disease is about 3 percent. 

In patients who clinically have been recovered though, is said to be abnormal coronary vessels in the inner layer that facilitates the occurrence of coronary heart disease in young adulthood later. If found acute coronary heart attacks in young adults, may need to consider the possibility of Kawasaki disease ever exposed while still a child. May we all need to be aware of this disease in order not to cause further casualties.