Kawasaki disease - diagnosis, therapy and prognosis

How is the diagnosis made?

If there is a suspicion of Kawasaki syndrome, the child is hospitalized. Since the laboratory findings are quite unspecific on the whole, the diagnosis is mainly due to the symptoms, especially in the acute phase. Nevertheless, there are a number of different studies being carried out to rule out other causes and complications and to monitor the course of the disease. These include, above all, blood tests (blood count, signs of inflammation, antibodies, erythrocyte sediment rate etc.) and an ultrasound examination of the heart.

Which therapy is there?

The aim of treatment is to reduce the inflammatory processes and thus the complication rate. Crucial is the beginning of therapy before the 10th day of illness - studies have shown that then the frequency of changes to the heart by a factor of 10 is lowered.

To stimulate the immune system is given once (rarely twice) an infusion of immunoglobulins over 6-12 hours, in addition to acetylsalicylic acid (high over about 2 weeks, then with a lower dose for 6-8 weeks or - if there are sores - over several months, then possibly replaced by anticoagulants).

What are the course and prognosis?

The prognosis depends primarily on the extent to which the heart is affected. Usually the disease heals without consequences. Since the introduction of immunoglobulin therapy, the prognosis has also improved many times over with organ involvement. Even existing changes in the coronary arteries can regress. The initial mortality rate of 1-2% has decreased to currently 0.4%.

It is still unclear how far coronary arteries, whose changes have regressed (or were not visible at all), are susceptible to disease and whether the risk of atherosclerosis is increased in adulthood. Therefore, those affected will undergo long-term cardiological follow-up.

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