Harry Kaplovity MD Ped Cardiology Medical School: Albert Einstein College of Medicine . Fellowship: New York University Medical Center . www.TheDoctorsVideos.com
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Host: Sometimes kids go to pediatricians and they have fever, five, six days. They get sometimes glands in that, looks like some lipstick on their face, the eyes are red and they don't discharge and the pediatrician is saying to the parent we have to be very, very carefully workup, why? Harry Kaplovity: What you are referring to is Kawasaki Syndrome. It was named after Dr. Kawasaki in Japan. When in the late 60s notice a number of patients in Japan who died after having a febrile illness and they went back and looked at the records of these kids. And they eventually came up with some criteria for what is called Kawasaki Syndrome. And probably the one criteria that almost all of them have is fever for at least five days. You mentioned the eyes have a conjunctivitises but you are not having a discharge, you mentioned the lips being cracked and often the tongue will be red, Mucositis, where the whole mouth appear red. You mentioned the lymph nodes, usually they are at least 1.5 centimeters, they will often have a rash and that could be in various parts of the body or usually into the inguinal area. Then the last criteria are the hands. Well the hands will look -- okay then maybe a week or two later the tips of the fingers will begin to peel. Now to make the diagnosis we say that you should the fever for at least five days and then four out of the other five criteria but unfortunately not all the patients read the book which is the problem. So we have some kids who have fever and there is a large paper published in December of 2004 by a task force that came up with the incomplete Kawasaki Syndrome. You have a patient who has fever for four, five, six, seven days and you don't have another cause for it, and they have some other criteria. And these are the criteria you have got to worry about and then you will ask of cardiology council and ask if they get an echo cardiogram. Host: Is that diagnosis suspected of maybe proving what can a doctor do so you don't have a problem or less likely have the problem. Harry Kaplovity: And what we can do for it is we can give something to them to decrease this inflammation. We give a medication called Gamma globulins and we also give them aspirin and then with time to decrease the inflammation. Now what we are trying to do is prevent problems with the blood vessels in the body. What I didn't tell you before is that what does happen with Kawasaki eventually is that it effects all the blood vessels in the body and it gives them an inflammation, an inflammatory process where the body begins to weaken the blood vessels or actually almost they break them down because the body thinks it's falling, and then the body won't begin to repair them. Now in most parts of the body it doesn't make a big deal of difference, there are lots of blood vessels in various parts of the body but what really makes a big deal of difference are the coronary arteries. Those are the artery that feed blood to the heart itself and they are not very large. And when those blood vessels get inflamed when they heal they can heal with Stenosis or there is some of the healing process and the scarring tissue you end up getting up narrow within those blood vessels and unfortunately what that lead to are a couple of things. One you have them narrowing itself that don't allow the blood flow to go to various parts of the body. But then they can also lead to areas where you can form clots and unfortunately when Dr. Kawasaki had autotrophy on all these patients these are some of the things that they found. Host: The drugs are better when a child is under two or over two? Harry Kaplovity: In fact it's worst under two. It's harder to diagnose, those kids are more common to have the incomplete form, where they have all the symptoms of Kawasaki syndrome. Here we have to think of it and treat them. Host: Can Kawasaki almost look to some people almost like in I think called scarlet fever? Harry Kaplovity: When you think about it you can have so
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