exam 2: Kawasaki & Multisystem Inflammatory Syndrome (MIS C) & Rheumatic fever

KD epidemiology

in toddlers younger than 5

mostly asian and pacific islander descent

boys affected more

MIS C epidemiology

1-20yrs old

mostly hispanic or latino and others affected by covid19

more in boys

classic KD

5 days fever AND at 4 features:

dry lips, strawberry tongue

bulbar conjunctivitis

maculopapular rash

painful induration of palms and soles (acute phase)

periungual desquamation (subacute phase)

cervical lymphadenopathy

KD cardiac findings

coronary artery dilation

aneurysm formation

tachycardia

MIS cardiac findings

tachycardia

cardiogenic shock

KD dermatologic findings

rash

extremity changes

MIS dermatologic findings

rash

KD GI findings

vomiting

diarrhea

MIS C GI findings

vomiting

diarrhea

abdominal pain

KD head findings

conjunctivitus

oral mucous membrane changes

cervical lymphadenopathy

KD neurocognitive findings

irritability

MIS C neurocognitive findings

irritability

headache

lethargy

rheumatic fever (RF)

inflammatory connective tissue disease

GAS infection

affect: heart, joints, brain, skin tissue

leading cause of HF

RF patho

autoimmune response > bacterial cell wall and heart valve tissue similar > antibodies destroy > damage to valves

how does RF spread

poor living conditions, overcrowding, lack of health care & knowledge

RF etiology

sx occur 1-3weeks

occur after untreated GABS infection

RF findings

carditis

polyarthritis

erythema marginatum

subcu nodules

chorea

carditis s&sx

Chest pain

• Fatigue

• Fever

• Tachycardia

• Pericardial friction rub

• CHF – signs and symptoms

• Cardiomegaly

• Chest x-ray

• Echocardiogram

• Activity restrictions

carditis

progressive valve damage of mitral or aortic

permanent dmg

polyarthritis

2 or more large joiontsp

polyarthritis findings

• Pain

• Swelling – (edema)

• Tenderness

• Heat

• Erythema - Red

• Inflammation

• Painful for 1-2 days after which another joint is affected

erythema marginatum

Pink macules

•Blanching in center

•Wavy

•Well-demarcated border

•Transitory, nonpruritic rash

•Trunk & proximal portion of extremities

Subcutaneous Nodule

Non-tender,0.5-1cm, persist indefinitely, gradually resolve

found in bony prominences

chorea findings

Involuntary, purposeless, jerking movements of arms, legs, and face (increased by anxiety + fine motor movements)

• Facial grimacing

• Speech disturbances

• Emotional changes

RF tx

penicillin (acute, long term) or erythromycin

aspirin (fever, arthritis, arthralgia)

corticosteroid (if significant carditis)