I have been asked to write an article on the emotional and mental symptoms of Kawasaki disease. The first case was described in Japan in 1961 by Dr. Tomisaku as Kawasaki syndrome, infantile mucocutaneous lymph node. In 1970 were described the first cases of sudden death with autopsy findings showed that coronary aneurysms and thrombosis also documented after echocardiography. In 1983 they were first used high-dose immunoglobulin in the treatment of disease.

Epidemiology

Japan: Data are collected at intervals of 2 years from 1970. Until 1994, 128,306 were described casi.Il peak of disease was 1 year old and 85% of cases occur under 5 years of age with a male / female ratio of 1.5:1. The mortality rate is currently of 0.08-0.1% with a male / female ratio of 3:1. The annual incidence is approximately 70-80 cases per 100,000 children under 5 years but in some years the disease has had a particular epidemic trend with an increase of more than 6 times of cases. (December 1978 - June 1979, January 1982-June 1982, November 1985 - May 1986). Unlike other countries in the world where the disease predominantly affects children of middle class high in Japan this difference between socio-economic classes is not evident.

United States: The incidence of the disease is much lower, 10.3 cases per 100,000 children younger than 5 years.

Europe: Germany 2.9 / 100,000, United Kingdom 3,4 / 100,000, Italy: A retrospective study (Tamburlini G et al 1984) performed in the northeast of the country for the years 1981-82 reported an incidence of 14.7 cases/100.000 children under 5 years with a peak incidence in spring and autumn.


The emotional and mental symptoms of Kawasaki disease are:


-Fever for more than 5 days.

-Bilateral conjunctival redness.

-Changes in lips and oral cavity. (Redness of the lips, strawberry tongue, diffuse redness of oral mucosa and pharyngeal).

-Acute non-purulent cervical lymphadenopathy.

-Polymorphous rash

-dependent changes of the extremities. (Redness of the palms and foot edema hard)

-Late desquamation

-depression.

Diagnosis:

Presence of 5 / 6 symptoms

Presence of 4 / 6 symptoms the presence of coronary aneurysms appear two-dimensional echocardiography or coronary angiography.

Rehydration therapy is necessary in children with high fever and often inadequate fluid intake. Antibiotics are of no utility but should be administered until it has been ruled a bacterial infection. In children with severe myocarditis diuretics may be necessary, inotropes or sometimes implantation of pacemakers. The involvement of the coronary arteries by means of two-dimensional echocardiography should be monitored weekly during the first month of illness. If shown to contain alterations coronary infusion of high doses of immunoglobulin (2 g / kg 8-12 hours).

Usually you add aspirin 80-100 mg / kg / day until there is fever. The treatment consists of a dose of aspirin (3-5 mg / kg / day) continued until the observed regression of coronary artery disease. If you experience the presence of large aneurysms, the risk of obstruction or stenosis and increased EPR is therefore useful to start anticoagulation therapy with warfarin.

Prolonged treatment is necessary if they are proven severe coronary alterations and two-dimensional echocardiography should be performed at intervals of one year. In patients with coronary artery stenosis is recommended to perform exercise testing and possibly myocardial scintigraphy with thallium. In patients with severe stenosis is advisable and possible coronary artery bypass surgery.

Kawasaki disease, also known as the cutaneo adenopathy syndrome, or Kawasaki syndrome, is a multi-systemic disease, febrile, acute in children, characterized by inflammation of blood vessels. The condition was named after a Japanese pediatrician, Tomisaku Kawasaki, who first described it in 1967. Although it is most common among Asian children, the disease can affect children of all races.



The Kawasaki disease is characterized by inflammation of blood vessels in the whole body, but there is no specific test for the diagnosis; the diagnosis is relying on a series of signs and symptoms. The Kawasaki disease symptoms are: -fever that can last for over 5 days -erythema, severe growth areas; -conjunctival congestion -red, swollen, dry lips;  -strawberry-language with bright red dots on the top -pulp; skin-peeling fingers; -redness and swelling of the fingers, lips, palms, soles; -lymphadenopathy.

Most children having the Kawasaki disease symptoms are aged between 1 and 8 years old, but this disease can affect teens too, and it is twice more common in boys than in girls. 50% of children develop heart problems such as arrhythmia after 4 weeks of evolution of this disease, arterial aneurysms, formation of blood clots. Other meningitis symptoms include inflammation of the brain, the joints and bladder complications. These problems can be solved in time without permanent damage of the affected organs.

Patients recover if all coronary arteries are not affected in the first 8 weeks. For those with impaired survival depends on the severity of this disease. Following treatment, less than 1% of children die. Those who do not survive- death occurs within the first month, but even the several aneurysms resolve in matter of years. Almost every year, those who do not resolve their problems in this period progress to dissection.

The treatment uses high doses of aspirin to reduce inflammation and prevent the formation of clogs. There can also be used an intravenous treatment based on gamma globulin. This treatment proved effective in reducing the formation of aneurysms in coronary arteries.

Pathogenic aspects - Coronary artery is observed in almost all fatal cases. It is a typical proliferation and an infiltration of the vascular wall with mono nuclear cells. Aneurysms and thrombosis can be seen in patients suffering from the Kawasaki disease. Other events include myocardial infarction, pericarditis, cardiomegaly, myocardial infarction and myocardial ischemia.

Causes of the Kawasaki disease - The Kawasaki disease causes are unknown, but researchers believe the disease is not contagious. There are a developed number of theories according to which some bacterial or viral infections or environmental factors could trigger the Kawasaki disease. There is a common belief that there is a close connection between an unusual form of Staphylococcus aureus to eliminate toxins from a septic shock syndrome and Kawasaki syndrome. Some risk factors for KS includes: -age between 2 and 5 years; -male gender; -part of an ethnic-Asians group