කවසාකි වෛරසය ශ්‍රී ලංකාවේ, ඔබේ දරුවා රැකගන්න, රෝග ලක්ෂණ මෙන්න

කුඩා දරුවකුට දින පහකට වඩා වැඩි කාලයක් තද උණක් පවතින්නේ නම් සහ දිව රත්පැහැ වී ස්ට්‍රෝබෙරි ගෙඩියක් සේ දිස්වන්නේනම් එය ‘කවසකි’ රෝග ලක්ෂණයක් විය හැකි යැයි රිජ්වේ ආර්යා ළමා රෝහලේ විශේෂඥ වෛද්‍ය දීපාල් පෙරේරා සඳහන් කරයි.

කොවිඩ් වෛරසය පැතිර යාමෙන් පසු ‘කවසකි’ රෝගය මතුවිය හැකි බැවින් කොවිඩ් වෛරසය පැතිර ගිය ප්‍රදේශවල දරුවන් පිළිබඳ වැඩි අවදානයක් යොමු කරන ලෙසද විශේෂඥ වෛද්‍යවරයා දෙමාපියන්ගෙන් ඉල්ලා සිටියි.

මෙය ස්වයං ප්‍රතිශක්තීකරණ රෝගයක් බැවින් එය දරුවාගේ හෘදයට බලපෑම් ඇති කළ හැකි බවද ඒ පිළිබඳව වඩාත් වැඩි අවධානයක් යොමුකර වෛද්‍ය ප්‍රතිකාර සඳහා දරුවා යොමු කරන්නැයිද හෙතෙම අවධාරණය කරයි.

‘කවසාකි’ රෝගය වැලඳුණ දරුවන් කීපදෙනකුටම ළමා රෝහලේ නේවාසික ප්‍රතිකාර ලබාදී මේ වන විට එම දරුවන් සායනික ප්‍රතිකාර ලබා ගන්නා බවද වෛද්‍ය දීපාල් පෙරේරා සඳහන් කරයි.

Source: Sri Lanka Puwath

Fever

Fever is typically high spiking (>39°C to 40°C) and remittent. In the absence of appropriate therapy, fever continues for 1 to 3 weeks. The spontaneous resolution of fever after 7 days should not be regarded as evidence that the diagnosis of KD has been excluded. Fever usually resolves within 36 hours after IVIG infusion has been completed; if not, the patient is considered to have resistance to IVIG, and further therapy is required.

Extremity Changes

Changes in the extremities are distinctive. Erythema of the palms and soles and firm and sometimes painful induration of the hands or feet often occur in the acute phase. Desquamation of the fingers and toes usually begins in the periungual region within 2 to 3 weeks after the onset of fever and may extend to involve the palms and soles. At 1 to 2 months after fever onset, deep transverse grooves across the nails (Beau’s lines) may be noted.

Rash

An erythematous rash usually appears within 5 days of fever onset. Most commonly, this is a diffuse maculopapular eruption. Scarlatiniform erythroderma and erythema multiforme-like rashes are also common. Less commonly, urticarial or fine micropustular eruptions are observed. The rash is usually extensive, primarily involving the trunk and extremities, and accentuation in the groin with early desquamation is a characteristic feature. An unusually severe form of psoriasis with plaques and pustular features can rarely occur during or after the acute KD illness. Patients may also experience a flare of new-onset atopic dermatitis during the subacute phase. Bullous, vesicular, and petechial rashes are not consistent with KD and should prompt a search for an alternative diagnosis.

Conjunctivitis

Bilateral bulbar nonexudative conjunctival injection usually begins shortly after fever onset and often spares the limbus, an avascular zone around the iris. Anterior uveitis is often observed by slit-lamp examination during the first week of fever. Subconjunctival hemorrhage and punctate keratitis are occasionally observed.

Oral Changes

Changes of the lips and oral cavity include (1) erythema, dryness, fissuring, peeling, cracking, and bleeding of the lips; (2) a “strawberry tongue,” with erythema and prominent fungiform papillae; and (3) diffuse erythema of the oropharyngeal mucosa. Oral ulcers and pharyngeal exudates are not consistent with KD.

Cervical Lymphadenopathy

Cervical lymphadenopathy is the least common of the principal clinical features. Lymph node swelling is usually unilateral, ≥1.5 cm in diameter, and confined to the anterior cervical triangle. In a small subset of patients, lymph node findings may be the most notable and sometimes only initial clinical finding, prompting a clinical diagnosis of bacterial lymphadenitis and significantly delaying KD diagnosis. In such cases, fever persists, and other typical KD features, such as rash and conjunctival injection, will follow. Imaging studies including ultrasound and computed tomography (CT) can be helpful in differentiating KD lymphadenopathy from bacterial lymphadenitis. In KD, multiple lymph nodes are enlarged, and retropharyngeal edema or phlegmon is common. In contrast, bacterial lymphadenitis is most frequently associated with a single node with a hypoechoic core. It has been increasingly recognized that cervical lymphadenopathy can be associated with deep neck inflammation leading to parapharyngeal and retropharyngeal edema and nonsuppurative phlegmon.

Other Illnesses With Similar Features

Other illnesses with similar clinical features should be considered before the diagnosis of KD is made, because the principal clinical findings that fulfill the diagnostic criteria are not specific. The presence of exudative conjunctivitis, exudative pharyngitis, oral ulcerations, splenomegaly, and vesiculobullous or petechial rashes should prompt consideration of another diagnosis. Measles shares many clinical features with KD and should be considered in the differential diagnosis in any unimmunized infant or child. KD occurs more commonly in the winter and spring in nontemperate climates when many respiratory viruses circulate, and a child with KD may have concurrent infection with a respiratory viral pathogen. In a child with clinical findings compatible with classic KD, the detection of respiratory viruses such as respiratory syncytial virus, metapneumovirus, coronaviruses, parainfluenza viruses, or influenza viruses does not exclude the diagnosis of KD. The detection of adenovirus in a nasopharyngeal sample from a patient with suspected KD poses a particular challenge because the illnesses have some similar clinical features. Adenoviruses (particularly species C) can persist in the tonsil or adenoid tissue, potentially confusing diagnosis of a subsequent febrile illness. In a patient with fever, exudative pharyngitis, exudative conjunctivitis, and a nasopharyngeal sample positive for adenovirus by respiratory polymerase chain reaction assay, KD is extremely unlikely; however, the diagnosis of KD should still be considered if adenovirus is detected in a patient with nonexudative pharyngitis. Other diagnostic features of KD not commonly observed in adenovirus infection include erythema and swelling of the hands and feet, strawberry tongue, and a desquamating groin rash. In children with some clinical features of KD and a positive rapid test or culture for group A streptococcus who do not improve after 24 to 48 hours of effective antibiotic therapy (streptococcal carriers), the diagnosis of KD should be again considered.

Source: Circulation