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Bilateral nonexudative limbal sparing conjunctivitis 

Bilateral nonexudative limbal sparing conjunctivitis 

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Patients who have acute Kawasaki disease (KD) should be treated promptly with intravenous immunoglobulin (IVIG) to prevent coronary artery abnormalities (based on strong research evidence). (19) Patients who have persistent or recrudescent fever following primary therapy with IVIG should receive another dose of IVIG at 2 g/kg (based primarily on co...

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... than 90% of children who have KD develop bilateral, nonexuda- tive conjunctivitis that spares the lim- bus (ie, with clearing around the iris (Fig 2). Anterior uveitis also may be detected on slit-lamp examination dur- ing the acute phase of the disease. ...

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Purpose: Although a significant number of reports on new therapeutic options for refractory Kawasaki disease (KD) such as steroid, infliximab, or repeated intravenous immunoglobulin (IVIG) are available, their effectiveness in reducing the prevalence of coronary artery lesions (CAL) remains controversial. This study aimed to define the clinical ch...

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... A diagnosis of KD consists of refractory and prolonged fever for more than 5 days and traditional four of five clinical presentation symptoms. However, patients with atypical or incomplete KD pose a challenge for pediatricians, particularly young infants <6 months old and older children at high risk of CAA development (1,9). Atypical or incomplete presentation refers to patients with prolonged fever that only fit two or three clinical features. ...
... KD may be misdiagnosed without careful clinical observation or echocardiogram finding. The current treatment recommendation is administering IVIG therapy within 10 days of the onset of illness (1,11), and postponed treatment is the leading cause of CAA formation (4,7,(9)(10)(11). Clinicians should closely follow up patients who are suspected of KD but do not fit the criteria. ...
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Background: Kawasaki disease (KD) is a form of vasculitis that primarily affects children under the age of 5 years old. Patients may be missed or diagnosis delayed when initial clinical symptoms do not fulfill the traditional criteria or a normal echocardiography was found. In this study, we aimed to analyze factors that clinicians could use to differentiate febrile children suspected of KD. Method: We retrospectively enrolled in this study a total of 50 febrile children who were initially suspected of KD, but they did not meet the American Heart Association (AHA) criteria for a diagnosis. However, some of these patients were diagnosed with KD during their second visit. We analyzed patients' characteristics, clinical symptoms, and laboratory data (initial data in the first visit). Results: In total, 50 patients were enrolled in the study. Of those, ten patients were diagnosed with KD on their second visit (group 1), while the other 40 patients still did not fit a KD diagnosis (group 2). A higher neutrophil-to-lymphocyte ratio (NLR, p = 0.037) and higher C-reactive protein levels (CRP, p = 0.02) were found in group 1 when compared to group 2. A patient with a NLR >1.33 combined with a CRP more than 33 mg/L was more likely to have KD (Sensitivity 90%, specificity 69.2%, p = 0.001; Odds ratio 20.25, 95% confident interval 2.3–178.25). Conclusion: Among patients suspected of KD that did not initially meet the criteria, clinicians should pay special attention to elevated neutrophil-to-lymphocyte ratios and CRP levels and closely follow up such patients.
... Demographic factors, such as young age, particularly younger than 6 months and older than 9 years, male gender, more days of fever, Asian and Pacific Islander race, and Hispanic ethnicity have been associated with poor clinical outcomes. Laboratory parameters, such as more white blood cell count, thrombocytopenia, hyponatremia, low hematocrit and low serum albumin, elevated C-reactive protein (CRP) and transaminitis, have all been associated with poor response to intravenous immunoglobulin (IVIG) and the development of coronary artery lesion (CAL) [9][10][11]. Eladawy et al. [12] assessed the children with KD in 2011; more than one tests of liver function were performed on admission for them and observed that 45.4% of these patients have one impaired liver function test at least. ...
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Background Kawasaki disease (KD) is a systemic syndrome of inflammatory with unknown cause and usually occurs in children. It is the most common cause of acquired heart disease in industrialized countries. Objectives The aim of this study was to examine the course of cardiovascular involvement in patients with KD after treatment with intravenous immunoglobulin and aspirin. Patients and Methods This retrospective study was performed on all children who were admitted with diagnosis of KD and had received intravenous immunoglobulin therapies and aspirin in Ali Ibne Abi Talib hospital during 2004 to 2013 years. Analysis was done by SPSS-20 with 0.05 as significant level. Results Out of 53 patients, 60% were male. Early involvement of the right and left coronary heart disease were 20.75% and 26% respectively. The frequency of aneurysm for left and right coronary artery was 3 (5%) cases. The mean of left coronary artery and right coronary artery diameters in before and after treatment were 2.39 ± 0.84, 1.95 ± 0.72 and 2.12 ± 0.54, 1.81 ± 0.31 mm respectively and they had significant differences (P = 0.001). The means of duration of fever for with and without coronary aneurysm (13 ± 4.2 vs. 8.8 ± 2.8 days), sedimentation rate (121.5 ± 21 vs. 73.9 ± 29.8 mm) and alkaline phosphatase (808 ± 101 vs. 476 ± 148 Iu/L) in patients with KD had significant difference of P = 0.04, P = 0.03 and P = 0.003 respectively. Conclusions We found coronary artery disease and aortic aneurysm is almost similar to other studies and showed age, duration of fever onset, intravenous immunoglobulin, sedimentation and alkaline phosphatase have a role in coronary involvement and aneurysm.
... Laboratory tests reveal a marked systemic inflammatory response [3]. KD is the leading cause of acquired heart disease in children in most developed countries, including Japan and the USA [4,5]. KD predominantly causes vasculitis in mediumsized arteries, with a striking predilection for the coronary arteries [2,4]. ...
... KD is the leading cause of acquired heart disease in children in most developed countries, including Japan and the USA [4,5]. KD predominantly causes vasculitis in mediumsized arteries, with a striking predilection for the coronary arteries [2,4]. The earliest pathological change in the vessel wall is edema of endothelial and smooth muscle cells with intense inflammatory infiltration of the vascular wall, initially by polymorphonuclear cells and rapidly thereafter by macrophages, lymphocytes (primarily CD8+ T cells), and plasma cells [4]. ...
... KD predominantly causes vasculitis in mediumsized arteries, with a striking predilection for the coronary arteries [2,4]. The earliest pathological change in the vessel wall is edema of endothelial and smooth muscle cells with intense inflammatory infiltration of the vascular wall, initially by polymorphonuclear cells and rapidly thereafter by macrophages, lymphocytes (primarily CD8+ T cells), and plasma cells [4]. ...
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