Harry Kaplovity MD Ped Cardiology . http://www.TheDoctorsVideos.com . Medical School: Albert Einstein College of Medicine Fellowship: New York University Medical Center
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Male Speaker: Sometimes kids go to pediatricians and they have fever, five, six days. They get sometimes glance in that. Looks like some lipstick on their face. Their eyes are red, and they don't discharge, and the pediatrician is saying to the parent, we have to do a very, very careful workup. Why? What's that all about? Male Speaker: What you are referring to is Kawasaki Syndrome. This is named after Dr. Kawasaki in Japan, who in the late 60s noticed a number of patients in Japan who died after having a febrile illness. They went back and they looked at the records on 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. And then you mentioned the eyes having conjunctivitis, but yet not having the discharge, and you mentioned the lips being cracked, and often the tongue will be red and the mucositis, where the whole mouth will appear red. You mentioned the lymph nodes, usually they are at least 1.5 cm. They will often have a rash, and that could be in various parts of the body, usually include the internal areas. And the last criteria are the hands. Well, the hands will look erythematous. 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 have 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 a problem. So we have some kids who have fever, and there was a large paper published in December of 2004 by a task force, that came up with the term Incomplete Kawasaki Syndrome. You have a patient, who has fever for four, five, six, seven days, and you don't have another course for it, and they have some of the criteria. And these are the patient who you have got to worry about. Then you will ask for a cardiology counsel and ask that they get an echocardiogram. Male Speaker: But that diagnosis is suspected that it may be proven, what can a doctor do to don't have a problem or less likely have a problem? Male Speaker: What we can do for it is we can give something to then decrease this inflammation. We give a medication called Gamma Globulin, and we also give them Aspirin, and the idea is that we are trying to decrease the inflammation. And 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 and an inflammatory process, where the body begins to weaken the blood vessels, or actually, almost like to break them down, because the body thinks it's foreign, and then the body won't begin to repair them. Now, in most parts of the body it doesn't make big deal of difference, you have lots of blood vessels in various parts of the body, but where it really makes a big deal of difference are the coronary arteries; those are the arteries that feed blood to the heart itself. They are not very large. And when those blood vessels get inflamed, when they heal, they can heal with stenosis, or some of the healing process and the scarring tissue, you end up getting narrowing within those blood vessels, and unfortunately what that can lead to are a couple of things. One, you have the narrowing itself that don't allow enough blood flow to go to various parts of the body. But then it can also lead to areas where you can form clots, and unfortunately, when Dr. Kawasaki had autopsy done on these patients, this is some of things that they found. Male Speaker: Is it worst when a child is under 2 or over 2? Male Speaker: In fact, it is worst under 2. It's harder to diagnose. Those kids are more common to have the Incomplete Syndrome, they may not have all the symptoms of Kawasaki Syndrome, yet we have to think of it and treat them. Male Speaker: Can Kawasaki almo
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