Pre-hospital recognition of Kawaski disease: a guide for paramedics

What is Kawasaki disease?Kawasaki disease is an acute systemic inflammatory illness of young children that can result in coronary artery aneurysms, myocardial infarction and sudden death in previously healthy children (Rowley et al, 2010).Dr Tomisaku Kawasaki, a paediatrician from Japan, documented visiting a four year old child with a rash, fever and an unknown presenting illness. He monitored fifty Japanese children with similar symptoms over a period of six years before finally documenting KD as a diagnosis in 1967 (Burns et al, 2004). Although positive that KD was a potentially fatal disease, other professionals disagreed. Other pathologists and paediatricians from Japan challenged Dr Kawasaki’s prognosis arguing that KD had no long–term side effects (Burns et al, 2000). This debate continued until a report was published in 1970 looking at ten autopsy reports from deceased children who had KD (Burns et al, 2000). The reports showed that patients had died as a result of coronary artery aneurysms secondary to KD demonstrating the long–term health repercussions for those with the disease. Since this initial diagnosis, KD has been seen in almost every country throughout the world (Brogan et al, 2002).KD has more cases reported in Japan than any other country (Brogan et al, 2001) although there has been no evidence suggesting that direct person–to–person contact increases the risk of spreading the disease (Tizard, 2005).Similarly, infantile polyarthritis nodosa (IPN) has been closely linked to KD since its diagnosis due to the close clinical signs of the two conditions. IPN is a rare and chronic condition affecting children, generally below the age of two. IPN affects small and medium arteries causing ischaemia and infarction (Thatayatikom et al, 2011), and, although paramedics are unlikely to be able to differentiate between IPN and KD in the pre-hospital environment, background knowledge of both is important in order to recognise and understand clinical changes in the presenting patient. It should be noted however that there are currently no protocols for the management of adult patients who have previously had KD during their childhood (Gordon, 2009).

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