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川崎病英文DIAGNOSISTREATMENTANDLONGTERMMANAGEMENTOFKAWASAKIDISEASEASTATEMENTFORHEALTHPROFESSIONALSFROMTHECOMMITTEEONRHEUMATICFEVERENDOCARDITISANDKAWASAKIDISEASECOUNCILONCARDIOVASCULARDISEASEINTHEYOUNGAMERICANHEARTASSOCIATIONJANEWNEWBURGERMASATOTAKAHASHIMICHAELAGERBERMICHAELHGEWITZLLOYDYTANIJANECBURNSSTANFORDTSHULMANANNFBOLGERPATRICIAFERRIERIROBERTSBALTIMOREWALTERRWILSONLARRYMBADDOURMATTHEWELEVISONTHOMASJPALLASCHDONALDAFALACEANDKATHRYNATAUBERTPEDIATRICS200411417081733DOI101542PEDS20042182THISINFORMATIONISCURRENTASOFNOVEMBER52005THEONLINEVERSIONOFTHISARTICLEALONGWITHUPDATEDINFORMATIONANDSERVICESISLOCATEDONTHEWORLDWIDEWEBATHTTPCOMCGICONTENTFULL11461708PEDIATRICSISTHEOFFICIALJOURNALOFTHEAMERICANACADEMYOFPEDIATRICSAMONTHLYPUBLICATIONITHASBEENPUBLISHEDCONTINUOUSLYSINCE1948PEDIATRICSISOWNEDPUBLISHEDANDTRADEMARKEDBYTHEAMERICANACADEMYOFPEDIATRICS141NORTHWESTPOINTBOULEVARDELKGROVEVILLAGEILLINOIS60007COPYRIGHT2004BYTHEAMERICANACADEMYOFPEDIATRICSALLRIGHTSRESERVEDPRINTISSN00314005ONLINEISSN10984275DOWNLOADEDFROMCOMBYONNOVEMBER52005AMERICANACADEMYOFPEDIATRICSAMERICANHEARTASSOCIATIONENDORSEDCLINICALREPORTGUIDANCEFORTHECLINICIANINRENDERINGPEDIATRICCAREJANEWNEWBURGERMDMPHMASATOTAKAHASHIMDMICHAELAGERBERMDMICHAELHGEWITZMDLLOYDYTANIMDJANECBURNSMDSTANFORDTSHULMANMDANNFBOLGERMDPATRICIAFERRIERIMDROBERTSBALTIMOREMDWALTERRWILSONMDLARRYMBADDOURMDMATTHEWELEVISONMDTHOMASJPALLASCHDDSDONALDAFALACEDMDANDKATHRYNATAUBERTPHDDIAGNOSISTREATMENTANDLONGTERMMANAGEMENTOFKAWASAKIDISEASEASTATEMENTFORHEALTHPROFESSIONALSFROMTHECOMMITTEEONRHEUMATICFEVERENDOCARDITISANDKAWASAKIDISEASECOUNCILONCARDIOVASCULARDISEASEINTHEYOUNGAMERICANHEARTASSOCIATIONABSTRACTBACKGROUNDKAWASAKIDISEASEISANMUSTBEMADEBYPHYSICIANSINLIGHTOFTHEPARTICULARACUTESELFLIMITEDVASCULITISOFCHILDHOODTHATISCHARACCONDITIONSPRESENTEDBYINDIVIDUALPATIENTSPEDIATRICSTERIZEDBYFEVERBILATERALNONEXUDATIVECONJUNCTIVITIS200411417081733AHASCIENTIFICSTATEMENTSVASCULITISERYTHEMAOFTHELIPSANDORALMUCOSACHANGESINTHETHERAPYANEURYSMDIAGNOSISEXTREMITIESRASHANDCERVICALLYMPHADENOPATHYCORONARYARTERYANEURYSMSORECTASIADEVELOPIN15TO25OFUNTREATEDCHILDRENANDMAYLEADTOISCHEMICHEARTABBREVIATIONSMIMYOCARDIALINFARCTIONCICONFIDENCEDISEASEORSUDDENDEATHINTERVALIGIMMUNOGLOBULINTNFTUMORNECROSISACTOR2DMETHODSANDRESULTSAMULTIDISCIPLINARYCOMMITTEE2DIMENSIONAL2DE2DIMENSIONALECHOCARDIOGRAPHYIVIGINTRAOFEXPERTSWASCONVENEDTOREVISETHEAMERICANHEARTVENOUSIMMUNOGLOBULINESRERYTHROCYTESEDIMENTATIONRATECRPCREACTIVEPROTEINLVLEFTVENTRICULARRCARIGHTCORONARYASSOCIATIONRECOMMENDATIONSFORDIAGNOSISTREATMENTARTERYLADLEFTANTERIORDESCENDINGCORONARYARTERYLMCALEFTANDLONGTERMMANAGEMENTOFKAWASAKIDISEASETHEMAINCORONARYARTERYLCXLEFTCIRCUMFLEXCORONARYARTERYIVUSWRITINGGROUPPROPOSESANEWALGORITHMTOAIDCLINICIANSINTRAVASCULARULTRASOUNDMRAMAGNETICRESONANCEANGIOGRAPHYINDECIDINGWHICHCHILDRENWITHFEVERFOR5DAYSANDCTCOMPUTEDTOMOGRAPHYMRIMAGNETICRESONANCEIMAGINGIL4CLASSICCRITERIASHOULDUNDERGOELECTROCARDIOGRAPHYINTERLEUKININRINTERNATIONALNORMALIZEDRATIOTPATISSUEPLASRECEIVEINTRAVENOUSGAMMAGLOBULINIVIGTREATMENTORMINOGENACTIVATORECGELECTROCARDIOGRAMBOTHFORKAWASAKIDISEASETHEWRITINGGROUPREVIEWSTHEAVAILABLEDATAREGARDINGTHEINITIALTREATMENTFORCHILDRENWITHACUTEKAWASAKIDISEASEASWELLFORTHOSEWHOAWASAKIDISEASEISANACUTESELFLIMITEDVASHAVEPERSISTENTORRECRUDESCENTFEVERDESPITEINITIALTHERCULITISOFUNKNOWNETIOLOGYTHATOCCURSPREAPYWITHIVIGINCLUDINGIVIGRETREATMENTANDTREATKDOMINANTLYININFANTSANDYOUNGCHILDRENMENTWITHCORTICOSTEROIDSTUMORNECROSISFACTORANTAGFIRSTDESCRIBEDINJAPANINL967BYTOMISAKUKAONISTSANDABCIXIMABLONGTERMMANAGEMENTOFWASAKITHEDISEASEISNOWKNOWNTOOCCURINBOTHPATIENTSWITHKAWASAKIDISEASEISTAILOREDTOTHEDEGREEENDEMICANDCOMMUNITYWIDEEPIDEMICFORMSINTHEOFCORONARYINVOLVEMENTRECOMMENDATIONSREGARDING1ANTIPLATELETANDANTICOAGULANTTHERAPYPHYSICALACTIVITYAMERICASEUROPEANDASIAINCHILDRENOFALLRACESFOLLOWUPASSESSMENTANDTHEAPPROPRIATEDIAGNOSTICKAWASAKIDISEASEISCHARACTERIZEDBYFEVERBILATERALPROCEDURESTOEVALUATECARDIACDISEASEARECLASSIFIEDACNONEXUDATIVECONJUNCTIVITISERYTHEMAOFTHELIPSANDCORDINGTORISKSTRATAORALMUCOSACHANGESINTHEEXTREMITIESRASHANDCONCLUSIONSRECOMMENDATIONSFORTHEINITIALEVALUCERVICALLYMPHADENOPATHYCORONARYARTERYANEUATIONTREATMENTINTHEACUTEPHASEANDLONGTERMMANRYSMSORECTASIADEVELOPIN15TO25OFUNAGEMENTOFPATIENTSWITHKAWASAKIDISEASEAREINTENDEDTREATEDCHILDRENWITHTHEDISEASEANDMAYLEADTOTOASSISTPHYSICIANSINUNDERSTANDINGTHERANGEOFACCEPTMYOCARDIALINFARCTIONMISUDDENDEATHORISCHABLEAPPROACHESFORCARINGFORPATIENTSWITHKAWASAKIEMICHEARTDISEASE23INTHEUNITEDSTATESKAWASAKIDISEASETHEULTIMATEDECISIONSFORCASEMANAGEMENTDISEASEHASSURPASSEDACUTERHEUMATICFEVERASTHELEADINGCAUSEOFACQUIREDHEARTDISEASEINCHILDREN4THISREPORTWASAPPROVEDBYTHEAMERICANHEARTASSOCIATIONSCIENCETREATMENTOFKAWASAKIDISEASEINTHEACUTEPHASEISADVISORYANDCOORDINATINGCOMMITTEEONJUNE162004THISREPORTWASCOPUBLISHEDINTHEOCTOBER262004ISSUEOFCIRCULATIONDIRECTEDATREDUCINGINFLAMMATIONINTHECORONARYTHEGUIDANCEINTHISREPORTDOESNOTINDICATEANEXCLUSIVECOURSEOFTREATARTERYWALLANDPREVENTINGCORONARYTHROMBOSISMENTORSERVEASASTANDARDOFMEDICALCAREVARIATIONSTAKINGINTOACCOUNTWHEREASLONGTERMTHERAPYININDIVIDUALSWHODEINDIVIDUALCIRCUMSTANCESMAYBEAPPROPRIATEVELOPCORONARYANEURYSMSISAIMEDATPREVENTINGDOI101542PEDS20042182PEDIATRICSISSN00314005COPYRIGHT2004BYTHEAMERICANACADMYOCARDIALISCHEMIAORINFARCTIONEMYOFPEDIATRICSANEWFEATUREOFTHESERECOMMENDATIONSISAN1708PEDIATRICSVOL114NO6DECEMBER2004DOWNLOADEDFROMCOMBYONNOVEMBER52005ALGORITHMFORTHEEVALUATIONANDTREATMENTOFPAANDDERIVEDFROMPUBLISHEDDATAWHEREVERPOSSIBLETIENTSINWHOMINCOMPLETEORATYPICALKAWASAKIDISTHELEVELSOFEVIDENCEONWHICHRECOMMENDATIONSEASEISSUSPECTEDREFERTOCRITERIAFORTREATMENTOFAREBASEDARECLASSIFIEDASFOLLOWSLEVELAHIGHESTKAWASAKIDISEASELATERINTHISSTATEMENTANDFIG1MULTIPLERANDOMIZEDCLINICALTRIALSLEVELBINTERMEWEATTEMPTTOSUMMARIZETHECURRENTSTATEOFKNOWLDIATELIMITEDNUMBEROFRANDOMIZEDTRIALSNONRANEDGEOFTHEMANAGEMENTOFPATIENTSWITHKAWASAKIDOMIZEDSTUDIESANDOBSERVATIONALREGISTRIESANDDISEASETHERECOMMENDATIONSAREEVIDENCEBASEDLEVELCLOWESTPRIMARILYEXPERTCONSENSUSFIG1EVALUATIONOFSUSPECTEDINCOMPLETEKAWASAKIDISEASE1INTHEABSENCEOFGOLDSTANDARDFORDIAGNOSISTHISALGORITHMCANNOTBEEVIDENCEBASEDBUTRATHERREPRESENTSTHEINFORMEDOPINIONOFTHEEXPERTCOMMITTEECONSULTATIONWITHANEXPERTSHOULDBESOUGHTANYTIMEASSISTANCEISNEEDED2INFANTS6MONTHSOLDONDAY7OFFEVERWITHOUTOTHEREXPLANATIONSHOULDUNDERGOLABORATORYTESTINGANDIFEVIDENCEOFSYSTEMICINFLAMMATIONISFOUNDANECHOCARDIOGRAMEVENIFTHEINFANTSHAVENOCLINICALCRITERIA3PATIENTCHARACTERISTICSSUGGESTINGKAWASAKIDISEASEARELISTEDINTABLE1CHARACTERISTICSSUGGESTINGDISEASEOTHERTHANKAWASAKIDISEASEINCLUDEEXUDATIVECONJUNCTIVITISEXUDATIVEPHARYNGITISDISCRETEINTRAORALLESIONSBULLOUSORVESICULARRASHORGENERALIZEDADENOPATHYCONSIDERALTERNATIVEDIAGNOSESSEETABLE24SUPPLEMENTALLABORATORYCRITERIAINCLUDEALBUMIN30GDLANEMIAFORAGEELEVATIONOFALANINEAMINOTRANSFERASEPLATELETSAFTER7DAYS450000MM33WHITEBLOODCELLCOUNT15000MMANDURINE10WHITEBLOODCELLSHIGHPOWERFIELD5CANTREATBEFOREPERFORMINGECHOCARDIOGRAM6ECHOCARDIOGRAMISCONSIDEREDPOSITIVEFORPURPOSESOFTHISALGORITHMIFANYOF3CONDITIONSAREMETZSCOREOFLADORRCA25CORONARYARTERIESMEETJAPANESEMINISTRYOFHEALTHCRITERIAFORANEURYSMSOR3OTHERSUGGESTIVEFEATURESEXISTINCLUDINGPERIVASCULARBRIGHTNESSLACKOFTAPERINGDECREASEDLVFUNCTIONMITRALREGURGITATIONPERICARDIALEFFUSIONORZSCORESINLADORRCAOF2257IFTHEECHOCARDIOGRAMISPOSITIVETREATMENTSHOULDBEGIVENTOCHILDRENWITHIN10DAYSOFFEVERONSETANDTHOSEBEYONDDAY10WITHCLINICALANDLABORATORYSIGNSCRPESROFONGOINGINFLAMMATION8TYPICALPEELINGBEGINSUNDERNAILBEDOFFINGERSANDTHENTOESAMERICANACADEMYOFPEDIATRICS1709DOWNLOADEDFROMCOMBYONNOVEMBER52005RECOMMENDATIONSFORINITIALEVALUATIONTREATMENTTHATAREREPORTEDLYASSOCIATEDWITHKAWASAKIDISEASE31INTHEACUTEPHASEANDLONGTERMMANAGEMENTOFINCLUDEHAVINGPREEXISTINGECZEMAUSINGAHUMIDPATIENTSWITHKAWASAKIDISEASEAREINTENDEDTOASSISTIFIER30ANDLIVINGNEARASTANDINGBODYOFWATER32PHYSICIANSINUNDERSTANDINGTHERANGEOFACCEPTABLETHECASEFATALITYRATEINKAWASAKIDISEASEINJAPAN17APPROACHESFORCARINGFORPATIENTSWITHKAWASAKIIS008THESTANDARDIZEDMORTALITYRATIOTHEOBDISEASEWHEREPUBLISHEDDATADONOTDEFINEWELLTHESERVEDNUMBEROFDEATHSDIVIDEDBYTHEEXPECTEDBESTMEDICALPRACTICESOURREPORTPROVIDESPRACTICALNUMBEROFDEATHSBASEDONVITALSTATISTICSINJAPANININTERIMRECOMMENDATIONSULTIMATELYMANAGEMENTPATIENTSDIAGNOSEDBETWEEN1982AND1992WAS125DECISIONSMUSTBEINDIVIDUALIZEDTOAPATIENTSSPE95CONFIDENCEINTERVALCI084185OVERALLANDCIFICCIRCUMSTANCES23595CI096519FORBOYSWITHCARDIACSEQUEL33AEINTHEUNITEDSTATESTHEINHOSPITALMORTALITYEPIDEMIOLOGYRATEIS017THEINVESTIGATORSUSEDADMINISTRATIVEINTHEPASTKAWASAKIDISEASEMAYHAVEMASQUERDATATHATMAYINCLUDEREADMISSIONSFORCORONARYDIS15ADEDASOTHERILLNESSESANDOLDREPORTSONINFANTILEEASEVIRTUALLYALLDEATHSINPATIENTSWITHKAPOLYARTERITISNODOSADESCRIBEPATHOLOGICALFINDINGSWASAKIDISEASERESULTFROMITSCARDIACSEQUELAE34THETHATAREIDENTICALTOTHOSEOFFATALKAWASAKIDISPEAKMORTALITYOCCURS15TO45DAYSAFTERTHEONSETOF58EASEKAWASAKIDISEASEISMARKEDLYMOREPREVAFEVERDURINGTHISTIMEWELLESTABLISHEDCORONARYLENTINJAPANANDINCHILDRENOFJAPANESEANCESTRYVASCULITISOCCURSCONCOMITANTLYWITHAMARKEDELEWITHANANNUALINCIDENCEOF112CASESPER100000VATIONOFTHEPLATELETCOUNTANDAHYPERCOAGULABLECHILDREN5YEARSOLD9INTHEUNITEDSTATESTHESTATE35HOWEVERSUDDENDEATHFROMMIMAYOCCURINCIDENCEOFKAWASAKIDISEASEHASBEENBESTESTIMANYYEARSLATERININDIVIDUALSWHOASCHILDRENHADMATEDFROMHOSPITALDISCHARGEDATA1011ANESTICORONARYARTERYANEURYSMSANDSTENOSESMANYCASESMATED4248HOSPITALIZATIONSASSOCIATEDWITHKAOFFATALANDNONFATALMIINYOUNGADULTSHAVEBEENWASAKIDISEASEOCCURREDINTHEUNITEDSTATESIN2000ATTRIBUTEDTOMISSEDKAWASAKIDISEASEINCHILD1036WITHAMEDIANAGEOF2YEARSRACESPECIFICINCIHOODDENCERATESDERIVEDFROMADMINISTRATIVEDATAINDICATETHATKAWASAKIDISEASEISMOSTCOMMONAMONGETIOLOGYANDPATHOGENESISAMERICANSOFASIANANDPACIFICISLANDDESCENT325THEETIOLOGYOFKAWASAKIDISEASEREMAINSUN100000CHILDREN5YEARSOLDINTERMEDIATEINNONKNOWNALTHOUGHCLINICALANDEPIDEMIOLOGICALFEAHISPANICAFRICANAMERICANS169100000CHILDRENTURESSTRONGLYSUGGESTANINFECTIOUSCAUSEASELF5YEARSOLDANDHISPANICS111100000CHILDRENLIMITEDGENERALLYNONRECURRINGILLNESSTHATMANIFESTS5YEARSOLDANDLOWESTINWHITES91100000ITSELFBYFEVERRASHENANTHEMCONJUNCTIVALINJECTIONCHILDREN5YEARSOLD10THESEESTIMATESARESIMILARANDCERVICALADENOPATHYFITSWELLW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