Kawasaki syndrome lasts several weeks and progresses in three stages:

- Acute phase: this is the most intense part of the disease when symptoms are more severe. It usually lasts one to two weeks.

- Subacute stage: This stage begins when the fever, rash, and lymph nodes disappear. However, the child still feels irritable, have poor appetite and mild redness of the eyes, scaly skin and may develop in the fingers and the toes. This stage usually ends three to four weeks after the fever manifested.

- Convalescent stage: This stage begins when all symptoms have disappeared clinicians, although the results of blood test called erythrocyte sedimentation rate (ESR), an indicator that there is still inflammation in the body, remain abnormal. When the results of ESR return to normal, usually six to eight weeks following the appearance of fever, recovery phase begins.

Prevention

Because it is unknown the cause of Kawasaki syndrome, there is no way to prevent it.

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- the medicines you take your child to rule out reaction to a medication
- any recent exposure to someone with strep throat to rule out scarlet fever, caused by a streptococcal infection
- any recent exposure to someone with measles to rule out measles if the child was not vaccinated against chickenpox
- any recent tick bite fever to rule out the Rockies

As part of the diagnostic study of Kawasaki syndrome, your doctor may order blood tests and diagnostic procedures to detect infectious and noninfectious causes of the symptoms of their children. Once there is the possibility of the presence of Kawasaki syndrome, your doctor may schedule an echocardiogram, a painless test that uses sound waves to outline the structure of the heart. This allows the doctor to detect any dilation or aneurysm in the coronary arteries.

In some cases, your doctor may recommend coronary angiography, a procedure that involves injecting dye into the arteries that carry blood to the heart for signs of aneurysm or narrowing typical of Kawasaki syndrome.

Your doctor will diagnose Kawasaki syndrome if your child has symptoms consistent with the definition of the disease and if there is no other explanation for these symptoms. Student researchers continue reliable diagnostic tests for the disease, but so far no evidence available.

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- conjunctivitis in both eyes (bloodshot eyes)
- symptoms that affect the mouth or throat, including redness and swelling of the lips that take the color of the strawberry.
- symptoms affecting the hands or feet, and inflammation, redness of the palms and soles of the feet or scaly skin on the tips of the fingers, toes, palms of the hands or soles of the feet.
- rash, mainly on the torso
- lymph glands in the neck

People with Kawasaki syndrome may have other symptoms that are not part of the definition of the disease. These may include:
- pain and swelling in joints
- diarrhea
- vomiting
- abdominal pain
- cough
- earache
- nasal drip
- irritability
- seizures
- weakness in the arms and legs.
- facial muscle weakness
- cardiac rhythm abnormalities
- signs of heart failure

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Kawasaki syndrome was first identified in 1967 in Japanese children, and in the course of nine years in America were reported cases of the disease in children living in Hawaii. Although researchers believe the Kawasaki syndrome could have been caused by an infection carried between Japan and Hawaii, there is no confirmation that Kawasaki syndrome is transmitted by contact between people. Recent evidence suggests that genetic factors may also be important, however, the cause of Kawasaki syndrome remains a mystery.

Kawasaki syndrome sick children and that triggers an inflammation (swelling) in different parts of the body. In the heart, this inflammation may be a myocarditis (inflammation of heart muscle), pericarditis (inflammation of the membranes covering the heart) or valvulitis (inflammation of the heart valves).

Kawasaki syndrome can cause a type of meningitis (inflammation of the membranes covering the brain and spinal cord) and can cause inflammation in the skin, eyes, lungs, lymph nodes, joints, and mouth. However, the most dangerous problem associated with Kawasaki syndrome is the threat of vasculitis (inflammation), especially in medium-sized arteries.

This vasculitis can be especially dangerous when it damages the heart’s coronary arteries, which causes abnormal enlargement (dilation) or bulge (aneurysm) in these vessels. In rare cases, arterial damage associated with Kawasaki syndrome can significantly interfere with the blood supply to the heart, to the point of causing a heart attack in a young child.

In the U.S. and other industrialized countries, Kawasaki syndrome is currently the most common cause of heart disease is not present at birth in children. According to U.S. government statistics, approximately 4,200 people with Kawasaki syndrome were hospitalized in 2000. Seventy-five to 80% of those were children under 5 years of age. It often affects boys more than girls.

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Call your doctor if symptoms of rheumatoid arthritis and joint pain, swelling, limited movement, redness or swelling in the eyes or pain in urination. Call your doctor immediately if you experience pain or burning during urination or a discharge from the penis or vagina. Tell your doctor if you have persistent diarrhea with blood or pain.

Forecast

With treatment, the prognosis of reactive arthritis is good, although the condition is quite variable. Severe cases may be associated with severe damage, eye problems and other symptoms that cause disability, while other cases are much milder and are only annoying. Risk factors in severe cases of the disease include one or more of the following:

- infertility in men
- venereal infections
- limited movement of the back
- condition of the hip
- inflammation of a finger or toe
- blood with signs of generalized inflammation throughout the body
- presence of a genetic marker called HLA-B27
- poor response to initial treatment

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For mild arthritis may suffice a nonsteroidal antiinflammatory drug (NSAID), with or without reliever such as acetaminophen (Tylenol and other brands). In more severe cases of arthritis, injections of corticosteroids into the inflamed joint can relieve pain, although relief is often temporary.

Other medications that may help include those used to treat rheumatoid arthritis, such as sulfasalazine, hydroxychloroquine or methotrexate (no generic prescription drugs) Doctors usually do not prescribe medicines called oral corticosteroids, because they usually work as well for the reactive arthritis. It also may be prescribed new drugs to treat rheumatoid arthritis, including adalimumab (Humira), etanercept (Enbrel) or infliximab (Remicade). The joint replacement surgery may help in cases of severe arthritis unresponsive to medication.

It is important to balance rest with exercise. Cycling or swimming, for example, can help reduce stiffness and keep the joint moving. Your doctor may refer you to a physiotherapist, occupational therapist or podiatrist. The tablets, templates or corrective orthotics can alleviate such a way as drugs do not.
For other manifestations of the disease, treatment options include:

- corticosteroid cream or ointment for the rash, it is important to control a dermatologist, especially if the rash affects the penis or face
- Corticosteroid drops or pills for uveitis
- NSAIDs or other painkillers for inflammation of the urinary tract (urethritis)

The health professional should coordinate regular checkups with specialists, which could include dermatologists, ophthalmologists, orthopedic surgeons or urologists.

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The doctor may suspect that you have reactive arthritis when they manifest the characteristic symptoms after having had an infection. Your doctor will examine you and ask you to have imaging tests such as radiographs of the pelvis or the lower area of ??the spine. Your caregiver may remove fluid from a joint with a needle for examination in the laboratory. The sore joint fluid could contain many white blood cells, although infection is not detected in the joint.

There is no evidence to confirm the diagnosis. Your doctor will diagnose reactive arthritis based on their history of infection, symptoms and physical examination. These tests may detect other conditions that can cause inflammation in the joint, such as infection or gout.

Duration

For unknown reasons, reactive arthritis often improves on its own after several months or years. However, it is often a chronic (long) and need a long-term treatment, even during a lifetime.

Prevention

There is no way to prevent reactive arthritis, but may prevent infections that could be triggered. You can help prevent gastrointestinal infections by cooking food thoroughly and washing hands thoroughly after touching animals and before preparing food. Can prevent STDs if you have protected sex.

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The back discomfort is usually worse when the person sits or stands still and best when kept in motion. Arthritis begins abruptly and usually affects one or more joints, especially knees, ankles, feet or wrists. People often have pain in the back of the ankle or tenderness at the base of the heel (inflammation where the tendon attaches to bone).

Symptoms vary depending on inflamed areas of the body:

- Arthritis joint pain, swelling, limited motion, especially in the ankles, knees, feet and less commonly on the wrists, fingers or other joints, tendon pain, pain in the lower back region, swelling a finger or toe.

- Conjunctivitis eyelid redness near the presence of a sticky secretion from the eye, especially during the morning (usually mild and temporary).

- Uveitis Redness near the iris of the eye, pain (especially when exposed to light) blurred vision.

- Urethritis: voiding (urinating) with pain, discharge from penis or vagina.

- Dermatitis: no pain or sores in the mouth, scaly rash on the soles of the feet, swelling at the tip of the penis.

Other rare symptoms include swelling of the prostate (prostatitis), bladder (cystitis) or the lining of the heart (pericarditis) and loss of the aortic valve.

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Kawasaki syndrome is treated with a single dose of gamma globulin, which is injected directly into the vein, along with aspirin taken by mouth. Gamma globulin is a collection of proteins and antibodies purified from donated blood, however is not known why it is effective against the disease. Gamma globulin injections may be repeated for several days if the fever continues.

Generally, parents are cautioned to give aspirin to children because it can trigger Reye’s syndrome, a serious condition that can damage the brain and liver. However, aspirin is the best treatment for Kawasaki syndrome, so the benefits outweigh the risk of contracting Reye’s syndrome, which is rare. The child usually continues to take aspirin for six to eight weeks after the acute symptoms yield of Kawasaki syndrome.

Not always beneficial other treatments such as corticosteroids or immunosuppressive drugs, however recommended if gamma globulin injections are not effective. It is sometimes recommended a procedure called plasmapheresis when the case of Kawasaki syndrome not responding to other treatments. With plasmapheresis, blood is removed from the body, it is filtered to remove proteins (including antibodies) and is then reintroduced into the body.

When To Call a Professional

Call your doctor immediately if your child develops a high fever, with or if other symptoms of Kawasaki syndrome.

Forecast

Without proper treatment, 20 to 25% of children with Kawasaki syndrome develop abnormalities in their coronary arteries. With treatment, this percentage decreases from 2 to 4%. In general, the risk of death from cardiac complications is about 1 to 2%, most commonly during the first two to 12 weeks of the disease.

Up to 25% of people with Kawasaki syndrome, coronary aneurysms during the first three months of the disease.

Aneurysms often disappear on their own one or two years after the occurrence of the disease. However, coronary artery disease may develop later in coronary arteries and swollen. For this reason, it is advisable periodically to all children who had Kawasaki disease. Children who still have symptoms of heart disease (such as chest pain) or heart failure during the acute phase of illness usually require regular assessment with stress testing, echocardiography and sometimes coronary angiography. If cardiac health deteriorates due to damage to the coronary arteries, surgery may be necessary to correct the problem.

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The most common infection causing reactive arthritis is a sexually transmitted disease called chlamydia (STD). Reactive arthritis can also be caused by gastrointestinal infection from bacteria such as salmonella, shigella, campylobacter or Yersinia infections that can cause diarrhea and vomiting.

These bacteria are often found in contaminated food and water. Although these infections are common, reactive arthritis is not. Scientists believe that people who develop reactive arthritis have a certain genetic trait. About 50% of people with reactive arthritis carry a gene called HLA-B27 compared with 8% of the general population, this supports the theory that genetic factors are a risk factor.

It is believed that reactive arthritis is an autoimmune disorder, meaning that the body’s immune system mistakenly attacks its own tissues. In this case, the immune system reacts to infection but continues attacking the body after removal of the infection.

Reactive arthritis typically includes arthritis, eye inflammation (conjunctivitis or uveitis) and inflammation of the urethra (urethritis). However, some people have only one or two of these diseases. Reactive arthritis is most common in people between 20 and 40, with a prevalence of about 0.03% (30 per 100,000).

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