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Sample on the Kawasaki Disease Case Study

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INTRODUCTION

Kawasaki disease also known as Mucocutaneous Lymph syndrome that  is a sickness that affects the skin and lymph nodes in children mostly under five years old. Korean and Japanese children fall pray to this Illness. Some researchers claim that the origin of the disease is unknown, and the pathophysiology is still under investigation.

BACKGROUND

Once the disease becomes detected early, it can be cured without any major problems, but if left unattended to it could lead to heart problems and eventually death at the acute stages. Estimations claim that a percentage of 20-25% of untreated children die from this illness, 2% of them are patients that die who are below two years. The cause of death in those who are two years is complete (CAA) Coronary artery aneurysms and myocardial infarction. Collins, D. R. (1997) points out that: the illness becomes associated with diverse Symptoms which include the following: Swollen Lymph Nodes, Severe redness, a rash on the chest stomach and genitals. Other signs are a swollen tongue with big red bumps with a white coating, swollen palms, swollen soles that are affected by purple color, a sore, irritated throat, and swollen lymph nodes as best explained by Let’s forget the mucocutaneous research that proved to be clinical, the illness is a generalized Vasculitis disorder of both small and medium-sized arteries. It is important to know that Vasculitis takes place in the blood vessels of the entire body which are the veins, arterioles, large arteries, and capillaries.

PATHOPHYSIOLOGY

When we look at the early stages of the disease a lot of changes, take place in the body which if ignored or neglected would lead to fatal consequences. As the sickness slowly begins to infest the body the endothelial cells together with Vascular media end up leading to edematous (where a lot of fluids accumulate in cells). At this point in stage, the internal elastic lamina is intact and after a period 7-9 weeks of the fever, eventually an increase in neutrophils occurs in the body. As this takes place slowly cytotoxic or lymphocytes together with immunoglobulin proliferate in the body hence leading to the inflammatory cells to produce cytokines like the tumor necrosis factor, vascular endothelial growth factor, etc. The white blood cells produce Interleukins in the body during this stage as the body reacts to the illness. The production of metalloproteinase by the cells continues whereby vascular damage is caused due to these processes since the focus becomes pinpointed on endothelial cells that cause fragmentation to the elastic lamina. As time goes by the affected vessels head to the state of aneurysms whereby the monocytes and fibroblasts replace the inflammatory cells, then the Intima begins to thicken making the walls narrow due to a state of thrombus. At this stage, an oversized coronary aneurysm may rupture and with time inflammation occurs in the micro vessels further leading to Eosinophil. The most dangerous stage is when there is an increase in serum platelet count this is where an individual may lose his or her life usually before this illness gets worse. There are different stages in this disease that happen as time elapses. Once a fever becomes detected in the early stages that last for about five days, parents need to be on the lookout for at least any four symptoms of this disease, Once the skin on hands and feet begin peeling there are other symptoms that develop in the later stages are harsh on the patient. Symptoms such as joint pain and diarrhea and if left untreated it leads to Vasculitis and the inflammation of blood vessels leading to the result of Arrhythmias. It’s advisable for the doctor to conduct an echocardiogram to check if the heart is functioning properly. It’s important for the Doctor to conduct a blood plus Urine test so as to determine if there is any other disease in the patients system

PROGNOSIS OF THE ILLNESS

In the United States of America it’s estimated that 1% of the population that is affected by the illness dies especially children who are under one year and 4% of the population are below two years. In the nation of Japan, the death rate is estimated to be 0.1-0.3% exclusive of adults since mainly this disease hardly affects the older generation. Kawasaki has proven to be deadly leading to many deaths in the younger population due to the age limit the disease targets in terms of heart disease. The Illness has proven to be worse than rheumatic heart disease as studies have shown and illustrated by Kato & H, (1995) . The cardiovascular complications that come about from this illness include: Myocardial dysfunction, myocarditis, MI myocardial Infarction, myocarditis, pericarditis (25% of patients suffer from acute sickness) in this case the patients have little pericardial effusions. It’s important not to forget systematic arterial aneurysms, hemopericardium, and lastly coronary rupture aneurysms. Research has shown that 20-25% of patients who are untreated for the illness develop cardiac problems together with (CAAs).The study has also demonstrated that patients who fail to suffer from CAAs recover at a fast rate without any problems but those with CAA are at a risk of coronary atherosclerotic disease. (CABG) Coronary Artery Bypass Grafting is a method that is used when dealing with children with severe deficits in their body and those children that have a good follow up later on future finally recover. The parents who make sure that the children are attended to after they have their CABG they have a 95% survival rate. Some patients require a repetition of the above procedure after some time it’s important to note that the sole goal is to as to increase their survival rate and to treat the ailing disease. When an individual or a patient is going through his illness rarely are transplants administered to them apart from the case scenario where the patient has a large aneurysm. This disease is also known to bring some problems associated with the bones whereby Arthritis is one of these diseases. There are risks factors one needs to consider when the patient is suffering from aneurysm are as follows: the male sex, fever for more than ten days, Age below one year cardiomegaly and temperature occurrence as stated by Takahashi, Shinzō & Zaidan. (1993).

LAB TESTS

It’s important to use lab tests so as to detect the presence of any other disease that may alter the results of the lab finding. The Lab values taken also might indicate the likelihood of an aneurysm that’s why tests are necessary using the following guidelines. Albumin, 3.5, Hematocrit < 35%, Albumin <3.5 g/dL, white blood cell count> 12000/μL, and Thrombocytopenia < 350000/μL. These are what should guide one in matters regarding Lab values. An incomplete Kawasaki disease is a direct preceptor of CAA in the body. The biggest for the development is the predictor is the fever that lasts for more than eight days and delayed the diagnosis of this illness leads to the development of aneurysms. One thing that should be noted is that echocardiograms results showed that 5% of children that do not form aneurysms have the decrease in ventricular function. Once one can determine the age group he or she should consider, that age groups delay treatment. It’s important to note that the reoccurrence rate in this illness in Japan is 3% and in the United States a 1% percent rate which when treated in the first phase would reduce this percentage.

EDUCATION

One thing that is crucial for the patient to understand is that the need of close pediatric and cardiology checkup will help in better recovery for the patient. The use of the drug Aspirin needs to be taught to the guardians since this medication needs proper administration until the Doctor give further instruction to refrain from the drug. Lastly it’s important for trustees to realize such individuals need special care suffering from the illness, and they have to have a watchful eye on their patient

CONCLUSION

Kawasaki disease is a treatable disease if detected at an early stage and public awareness, education programs need to be a necessity to parents during their early stages of parenthood. If everyone had this knowledge, perhaps the mortality rate would reduce in Japan and the States.

REFERENCES

Collins, D. R (1997). Michael’s story: On the wings of love : a grandson’s life and death from Kawasaki’s disease. Mahomet, Ill: Mayhaven Pub. Kato & H. (1995). International Kawasaki Disease Symposium. Kawasaki disease: Proceedings of the 5th International Kawasaki Disease Symposium, Fukuoka, Japan, 22-25 May 1995. Amsterdam: Excerpta medica. Takahashi, Shinzō & Zaidan. (1993) . International Symposium on Kawasaki Disease, American Heart Association.,. Proceedings of the Fourth International Symposium on Kawasaki Disease. Dallas, Tex: American Heart Association.

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