SNDROME DE KAWASAKI

Tomisaku Kawasaki (1961-1967).

sndrome febril agudo
Linfadenomucocutneo.
Cardiopata adquirida.
Primer caso Hospital Infantil de Mxico,
por el Dr. Rodriguez RS.
Dos casos, INP y INC
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
DEFINICION
Es una afeccin multisistmica febril,
exantemtica, con una fase aguda
autolimitada aunada a vasculitis
generalizada, con afeccin principal a
las coronarias y amplia variedad de
sntomas concurrentes.
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
ETIOLOGA

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
PATOGENIA

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
Superantigeno
IL-1
IL-6
TNT-alfa
INF-gamma
< Linfocitos
(T8)
IL-8
CD-4, CD-13
PATOLOGIA
CAMBIOS TEMPRANOS

Infiltrado inflamatorio, hipertrofia.
Pericardio, AV, ICC,


Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
CAMBIOS SUBAGUDOS

PMN a MN.
Fragmentacin de media y lmina elstica interna.
Afeccin cerca de su origen.
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
CAMBIOS TARDIOS

Cicatrizacin y fibrosis.
Calcificacin.

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment, Ho-
Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
EPIDEMIOLOGA
Edad
Sexo
Incidencia
Taza
Periodo de incubacin


Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment, Ho-
Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
DIAGNOSTICO
DIFERENCIAL
Sndrome de choque toxico.
Escarlatina.
Stevens-Johnson.
Artritis reumatoide juvenil.
Sarampin.

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
CHOQUE TOXICO
Edad >10a.
fiebre variable.
Conjuntivitis.
Edema de pies y manos.
Eritroderma.
Trombocitopenia.

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and
Treatment, Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
ESCARLATINA
Edad 2 8a.
Fiebre < 10 das.
Lengua aframbuesada.
Descamacin en colgajos.
Eritroderma papular.


Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
STEVENS-JOHNSON

Todas las edades.
Fiebre prolongada.
Conjuntivitis exudativa.
Ulceras, pseudomembranas.
Lesiones de tiro de blanco.

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment, Ho-
Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
ARTRITIS REUMATOIDE JUVENIL

Edad 2- 5a.
Fiebre prolongada.
Adenopata difusa.
Exantema color salmon.
Pericarditis.
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment, Ho-
Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
SARAMPIN.

Edad <5a.
Fiebre disminuye o remite posterior al
exantema.
Conjuntivitis supurativa.
Lesiones de koplik.
Exantema.
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
ESTUDIOS
Biometra

PCR, VSG

EKG

Ecocardiograma
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
DIAGNOSTICO
Fiebre (100%).
Conjuntivitis bilateral no exudativa
(85%).
Rash polimorfo (80%).
Cambios en labios y boca (90%).
Cambios en las extremidades (75%).
Adenopata cervical (70%).

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and
Treatment, Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.

Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
KAWASAKI INCOMPLETO
Fiebre + 5 das con 2 o 3 criterios clnicos,
PCR > 3.0mg/dL VSG 40mm/hr:

albumina < 3.0g/dL.
Anemia para la edad.
Elevacin de alanina aminotransferasa (590).
Plaquetas despues de 7 das >450000
Leucocitos > 15 000
Leucocitos >10 por campo/alta potencia
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
TRATAMIENTO
Inmunoglobulina 2g/kg/dosis (12hrs)


Acido acetil saliclico 80-100mg/kg/da
dividida en 4 dosis, posteriormente 3-
5mg/kg/da.
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.
Metilprednisolona 30mg/kg/dosis
(3dosis)

Metotrexate 10mg/kg/dosis (semanal)
Red Book, American Academy of Pediatrics, Pickering LK, Baker CJ, pg 454-459.Kawasaki diesase: An Update on Diagnosis and Treatment,
Ho-Chang Kou, Kuender D. Yang, Wei-Chiao Chang, Infectologa Clnica Pediatrca, Napoleon Saldaa, Cap 38, pg 515-524.