Ребёнок с лихорадкой
Модератор: Pyankov Vasily
Ребёнок с лихорадкой
Ребёнок 4-х месяцев лихорадка до 39ºС в течении 4 дней, затем ещё дней 10 до 38ºС, увеличение шейных лимфоузлов, конъюнктивит, мелкопятнистая сыпь на лице и туловище, яркая гиперемия губ и слизистой рта. В анализах крови высокий лейкоцитоз (20 — 42), нарастающая анемия (Hb 108 — 78, Эр 3,7 — 2,9), тромбоцитоз (483 — 1286), СОЭ 11 — 63, гипоальбуминемия, снижение протомбинового индекса (52 — 28), CRP 48, лейкоцитурия. ЭхоКГ на 1-й неделе без особенностей, на 3-й неделе:
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- член секции Эхокардиографии РКО
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Kawasaki disease
Diagnostic criteria established by the American Heart Association (AHA) are fever lasting longer than 5 days and 4 of the 5 following main clinical features:
Changes in the peripheral extremities: Initial reddening or edema of the palms and soles, followed by membranous desquamation of the finger and toe tips or transverse grooves across the fingernails and toenails (Beau lines)
Polymorphous rash (not vesicular): Usually generalized but may be limited to the groin or lower extremities
Oropharyngeal changes: Erythema, fissuring, and crusting of the lips; strawberry tongue; diffuse mucosal injection of the oropharynx
Bilateral, nonexudative, painless bulbar conjunctival injection
Acute nonpurulent cervical lymphadenopathy with lymph node diameter greater than 1.5 cm, usually unilateral
If a patient presents with 4 or more of the principal criteria, AHA guidelines suggest that Kawasaki disease can be diagnosed on day 4 of the fever.
Echocardiography is the study of choice to evaluate for coronary artery aneurysms. Serial echocardiograms should be obtained as follows:
At the time of Kawasaki disease diagnosis
At 2 weeks
At 6-8 weeks after the onset of the illness
Diagnostic criteria established by the American Heart Association (AHA) are fever lasting longer than 5 days and 4 of the 5 following main clinical features:
Changes in the peripheral extremities: Initial reddening or edema of the palms and soles, followed by membranous desquamation of the finger and toe tips or transverse grooves across the fingernails and toenails (Beau lines)
Polymorphous rash (not vesicular): Usually generalized but may be limited to the groin or lower extremities
Oropharyngeal changes: Erythema, fissuring, and crusting of the lips; strawberry tongue; diffuse mucosal injection of the oropharynx
Bilateral, nonexudative, painless bulbar conjunctival injection
Acute nonpurulent cervical lymphadenopathy with lymph node diameter greater than 1.5 cm, usually unilateral
If a patient presents with 4 or more of the principal criteria, AHA guidelines suggest that Kawasaki disease can be diagnosed on day 4 of the fever.
Echocardiography is the study of choice to evaluate for coronary artery aneurysms. Serial echocardiograms should be obtained as follows:
At the time of Kawasaki disease diagnosis
At 2 weeks
At 6-8 weeks after the onset of the illness
Пьянков Василий Алексеевич
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Кавасаки. На ЭКГ недельной давности не было ничего особенного. В начале заболевания был ещё транзиторный синовит тазобедренных суставов. При первой ЭхоКГ диаметр RCA был 2,2 мм, при втором до 4,1 мм. LMCA с 2,4 до 2,9 мм
http://circ.ahajournals.org/content/110/17/2747.full
http://circ.ahajournals.org/content/110/17/2747.full
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In a recent retrospective study, intravenous immunoglobulin (IVIG) administered in combination with prednisolone seemed potentially to be a better first-line rescue therapy for Kawasaki disease than did prednisolone or IVIG alone. The study involved 359 patients with Kawasaki disease who were not responsive to first-line rescue treatment with intravenous immunoglobulin (IVIG). Those who were subsequently treated with a combination of IVIG and prednisolone had a significantly reduced incidence of coronary artery abnormalities (15.9%) compared with patients treated with IVIG or prednisolone alone (28.7% and 30.6%, respectively), up to 1 month after treatment.
Efficacy of intravenous immunoglobulin combined with prednisolone following resistance to initial intravenous immunoglobulin treatment of acute Kawasaki disease. J Pediatr. Aug 2013;163(2):521-526.e1.
Efficacy of intravenous immunoglobulin combined with prednisolone following resistance to initial intravenous immunoglobulin treatment of acute Kawasaki disease. J Pediatr. Aug 2013;163(2):521-526.e1.
Пьянков Василий Алексеевич