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Present Kawasaki disease in Indonesia

Kamis, 10 Desember 2009

Present Kawasaki disease in Indonesia

Does Kawasaki disease (PK) that?

PK Tomisaku discovered by Dr. Kawasaki in Japan in 1967 and then known as mucocutaneous lymphnode syndrome. To honor its discoverer, the disease was finally called Kawasaki. In Indonesia, many of us who do not understand this dangerous disease, even though the medical community. This is what led to the diagnosis is often late with all the consequences. Appearance of this disease can also fool the eye that can be diagnosed as measles, allergy medicines, viral infections, or even the mumps disease. The disease is more frequently attacked the Mongol race is primarily attacked a toddler and most often occurs at the age of 1-2 years. In fact, the author never found a PK at a 3-month-old baby who suffered from fever for 18 days.

Incidence rate per year in Japan is the highest in the world, which range from 1 case per thousand children under five. Ranking was followed by Korea and Taiwan. As in the United States ranges from 0.09 (in the white race) to 0.32 (in the Asian-Pacific) per thousand children under five. In Indonesia, the authors found that the case of PK has existed since 1996. However, there are doctors who declared've found before. However, Indonesia has only officially recorded in Kawasaki disease map of the world after a series of case reports of Advani PK et al filed on an international symposium to Kawasaki disease-8 in San Diego, USA, in early 2005.

Predictably, the case in Indonesia was not a little, and according to rough calculations, based on the number of global events and ethnicity in our country, every year there will be 3300-6600 cases of PK. But in reality, the detected cases are still very far below this figure. Between 20 and 40 percent suffered damage to the coronary arteries of heart. Some will recover. However, others were forced to live with heart defects caused by coronary blood flow is disrupted. A small percentage will die of heart damage.

PK until the cause is unknown, although allegedly due to an infection. However, there is no convincing evidence to that effect. Therefore, how to prevent it is also unknown. The disease is also not proved contagious.

The initial symptoms in the acute phase are a sudden high fever and can reach 41 degrees Celsius. Fluctuating fever for at least 5 days, but never reached normal. In untreated children, fever may last for 1-4 weeks without a break. Antibiotics did not help. Approximately 2-3 days after fever, other symptoms began to appear in stages, namely red blotches on the body similar to measles. However, symptoms of a cold cough dominant measles are usually mild or nonexistent in the PK.

Other symptoms that arise are the two red eyes, but without the dirt, swollen lymph nodes on one side of the neck which sometimes suspected mumps disease (Parotitis), resembling a strawberry red tongue, lips red as well and sometimes cracked, and the palm hands and feet were red and slightly swollen. Sometimes a child complains of pain in the joints. In the healing phase, exfoliation occurs at the tips of your fingers and feet and then come across the line-shaped basin at the foot and hand nails (Beau's lines).

PK patients should be hospitalized in the hospital and get control of the child cardiologists. The most feared complication is in the heart (occurs in 20-40 percent of patients) as they may damage the coronary arteries. Complications to the heart usually starts happening after a day-to-7 and 8 since the beginning of fever. At first, these vessels can occur dilation and constriction can occur inside or blockage. As a result, blood flow to the heart muscle that can cause disturbed damage to the heart muscle known as myocardial infarction.

Examination of the heart becomes very important things, including ECG and echocardiography (cardiac ultrasound). Sometimes ultrafast CT scan, Magnetic Resonance Angiography (MRA) or cardiac catheterization is required in severe cases. The laboratory for this disease is not typical. Normally, white blood cell count, blood creep rate, and increased C reactive protein in acute phase. Thus, the diagnosis is established on the basis of clinical symptoms and signs alone, so the doctor's experience was needed. In the healing phase, an increase in blood platelets, and this will facilitate the occurrence of thrombus, or blood clots that clog coronary arteries of heart.

The drugs are an absolute must given by intravenous immunoglobulin for 10-12 hours. Drug plasma obtained from blood donors is powerful, both to relieve the symptoms of PK and reduce the risk of heart damage. But the expensive price to be constraints. Price of one gram of around is Rp 1 million. PK patients require immunoglobulin 2 g per kg of body weight. For example, a child weighing 15 kg requires 30 grams, at a price of about Rp 30 million. Patients are also given salicylic acid to prevent heart damage and coronary artery blockage. If there are no complications, then the child can be discharged in a few days.

In the case of late and had coronary artery damage, need of hospitalization is longer and intensive treatment to prevent further heart damage. If the drugs do not work, then sometimes required coronary bypass surgery (coronary bypass) or even, though very rarely, a heart transplant. Death can occur in 1-5 percent of patients who are treated late, and a peak occurs at 15-45 days after the initial fever. Nevertheless, sudden death may occur many years after the acute phase. PK also can damage the heart valves (especially mitral valve) that can cause sudden death a few years later. Possible recurrence of this disease is about 3 percent.

In patients who clinically had fully recovered even say that the coronary arteries will have abnormalities in the inner lining. This allows the occurrence of coronary heart disease, later in young adulthood. If found in acute coronary heart attacks in young adults, it may need to consider that the patient may have exposed PK as a child. May we all need to be aware that the disease does not cause further casualties?

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