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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Kawasaki’s disease

Chapter:
Kawasaki’s disease
Author(s):

Brian W. McCrindle

DOI:
10.1093/med/9780199204854.003.191108_update_001

November 28, 2012: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Pathogenesis—expanded discussion to include specific evidence regarding genetic susceptibility.

Clinical features—new illustration of all of the typical physical features of the diagnostic criteria.

Risk stratification—inclusion of stress echocardiography, MR angiography, and CT angiography. Classification of coronary artery abnormalities updated to emphasize the use of z-scores and identified cutpoints.

Management—(1)General—encouragement of physical activity within the context of any restrictions. (2) Immunosuppressive—enhanced discussion of evidence regarding the role of corticosteroids, also of both risk prediction and alternative treatments for patients not responding to initial IVIG treatment. (3) Long term—discussion a role for intravascular ultrasound to characterize arterial wall structure, particularly in adults suspected of coronary artery complications related to Kawasaki's disease.

Updated on 30 November 2011. The previous version of this content can be found here.

Kawasaki’s disease is an acute, self-limited, inflammatory vasculitis of unknown aetiology, with a peak incidence under 5 years of age.

Clinical features—the diagnosis is made in the presence of persistent fever for 5 days or more and at least four of the following five clinical signs: (1) nonpurulent conjunctivitis, (2) oropharyngeal inflammation, (3) cervical lymphadenopathy, (4) polymorphous exanthem, and (5) erythema of the palms and soles with subsequent desquamation. Incomplete presentations occur in approximately 25% of patients. The primary complications are cardiac, with coronary artery dilation and aneurysms evident in approximately 15 to 25% of untreated patients.

Management and prognosis—primary therapy consists of a single high dose of intravenous gammaglobulin, reducing the prevalence of coronary artery complications to approximately 4% if given within 10 days of the onset of fever. Persistent coronary artery lesions, with an ongoing risk of thrombosis and stenosis, are the predominant long-term morbidity. In adults, new presentations of myocardial ischemia with the associated finding of coronary artery aneurysms may suggest a previous episode of Kawasaki’s disease during childhood.

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