Diseases and conditions primarily affecting children and some

adults:

I. Kawasaki disease

Kawasaki disease is a noncontagious severe childhood illness that causes inflammation of the
blood vessels (vasculitis). The disease is likely related to a virus, bacteria, or other pathogen.
However, a specific cause has not yet been identified.

Symptoms:

Of Kawasaki disease include a prolonged fever (at least 5 days), reddened eyes, swollen red
lips and tongue, a rash, swollen feet and hands, and swollen lymph nodes.

If untreated, the illness usually lasts several weeks and most children fully recover. However,
complications related to blood vessel damage, usually in the coronary arteries, sometimes
develop. In rare cases, the damage can lead to a heart attack and death. Children younger
than 1 year of age have an increased risk of developing complications. Early diagnosis and
treatment decreases the length of the illness and can effectively prevent most blood vessel
and heart damage.

Treatment:

Treated with medications. Long-term management, which may include continued medication,
activity restriction, and repeated testing, may be necessary.

Early treatment of Kawasaki disease effectively prevents most blood vessel and heart
damage. If children with Kawasaki disease are hospitalized and treated within 10 days after
the first signs of illness, the risk of heart disease and aneurysms decreases by at least 80%.3

Medications

Medications used to treat Kawasaki disease include intravenous immunoglobulin (IVIG),

aspirin, and possibly anticoagulants.

• Intravenous immunoglobulin (IVIG)

Intravenous immunoglobulin (IVIG) generally is used to reduce inflammation of blood vessels.

IVIG usually is given in one dose through a vein, over 10 to 12 hours. The child's condition
usually improves very rapidly with this medication.

• Aspirin therapy

At first, aspirin is used to relieve symptoms such as inflammation and fever. Smaller daily
doses are then given to lower the risk of forming life-threatening blood clots. Because of the
risk of Reye's syndrome, aspirin usually is not recommended for children. For this reason,
aspirin should be given only under the guidance of a health professional. If the child is
exposed to or develops chickenpox or influenza while taking aspirin, talk with a health
professional right away. See the topic Reye's Syndrome for more information.
 Anticoagulants

If a large aneurysm is detected, anticoagulants may be given. These medications help

prevent new clots from forming.

• Follow-up treatment

If echocardiogram results from initial follow-up exams are normal, the child probably will not need
further care. However, if these test results show problems with the coronary arteries, long-term
management of the disease may be necessary. This care may include:

• Repeated exams and tests every year or every 3 to 5 years, depending on the child's
risk for heart problems.
• Continued low-dose aspirin therapy, sometimes combined with other medications that
lower the risk of blood clots forming.
• Restriction of strenuous physical activity.

• What to think about

Treatment with immunoglobulin (IVIG) sometimes interferes with the effectiveness of

immunizations against measles, mumps, rubella (MMR), and chickenpox. This is more likely a
problem when the immunizations are given too soon after treatment. Talk with your health
professional about how long to wait before your child receives these immunizations.

Pernioiosis -- Perniosis is an inflammatory disease of the skin of the arms and legs and is
triggered by prolonged exposure to cold temperature. The disorder is characterized by painful,
itchy skin lesions on the lower legs, hands, toes, feet, ears and face. The lesions usually last for
two to three weeks.

Synonoms: Pernio, Childblain, Erythema, Cold Induced vascular disease.

Epiglottitis

What is it?

Epiglottitis is an acute infection of the epiglottis, which is a flap of cartilage in the

throat, at the entrance to the larynx. During the infection the epiglottis may rapidly
swell, blocking the passage of air into the lungs. Because this is potentially fatal,
epiglottitis is a medical emergency.

What causes it?

Epiglottitis is caused by a bacterium called haemophilus influenzae type B.

Who is affected?

Epiglottitis tends to occur in children aged between 1 and 6 years, although it

may occur at any age.
What are the symptoms

Symptoms usually come on very suddenly, with a high fever and a very sore
throat, which causes the child to drool saliva as it is too painful to swallow or
even speak. Breathing is noisy and becomes increasingly difficult over a matter
of hours. The tongue and lips may look blue. Typically the child looks ill, and will
sit upright with their mouth open to help breathing. There is minimal or no
coughing (unlike viral croup - it can be difficult to tell the difference between
epiglottitis and croup, but they require different treatments).

How is it diagnosed & treated?

If your child has a sore throat and difficulty breathing you should call for
immediate medical help. Do not lie the child down or attempt to look in their
throat (or put anything in their mouth such as a spatula) as this can trigger
spasm which immediately closes the airway completely and causes death
within minutes. Once in hospital doctors can carefully examine the child to
make a diagnosis. It may be necessary to insert a tube into the windpipe under
general anaesthetic to keep the airways open. An x-ray may be taken and blood
tests done to check for the presence of the H.influenzae bacteria. Antibiotics are
given intravenously and humidified oxygen, which is oxygen that has been
moistened, is given to help the patient breathe.

Further help

With good treatment children usually recover quickly, within 2-3 days. Those who
have been in close contact with the child may be offered antibiotic treatment to
reduce their risk of developing the infection. In the UK and many other countries,
children are routinely vaccinated against H.influenzae with the HiB vaccine and
epiglottitis has become very rare.

Meconium
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Information

Meconium is the medical term for the newborn infant's first stools. Meconium is
composed of amniotic fluid, mucous, lanugo (the fine hair that covers the baby's
body), bile, and cells that have been shed from the skin and the intestinal tract.
Meconium is thick, greenish black, and sticky.
During pregnancy the baby floats in the amniotic fluid that fills the mother's
uterus. This fluid protects the baby while he grows and develops. The baby
swallows the amniotic fluid which contains all the other constituents mentioned
above. All of the contents other than the amniotic fluid itself are filtered out and
remain behind in the intestine while the amniotic fluid is absorbed and re-
released into the uterine space when the fetus urinates. This cycle maintains the
amniotic in a clear, healthy state during the nine months of pregnancy. This
process of recycling the amniotic fluid occurs about every 3 hours.

In some cases, the baby stools while still inside the uterus, passing meconium.
This usually happens when the baby is under stress. Once the meconium is
passed into the amniotic fluid, it is possible for the baby to breathe the meconium
into his lungs. This condition is called meconium aspiration and can cause
inflammation in the baby's lungs after he is born.

This inflammation can cause the baby to go into respiratory distress. If meconium
is detected in the amniotic fluid when the mother's water breaks, special
precautions are taken to clear the fluid from the baby's stomach and lungs. See
Meconium aspiration.

Last Reviewed: 2/19/2002 by Elizabeth Hait, M.D., Department of Pediatrics,

Rainbow Babies and Children's Hospital, Cleveland, OH. Review provided by
VeriMed Healthcare Network.