New coronavirus causes Kawasaki disease?

Kawasakidisease (Kawasakidisease), also known as skin and mucosal lymph node syndrome, is a somewhat mysterious skin disease. It is an acute, febrile and multi-systemic childhood disease. Recently, it has attracted attention again because of the new crown epidemic. According to the British “Daily Mail” report, in recent days in Europe and the United States, many dermatologists’ phone calls have been exploded, and the public is consulting the same question: & quot.My foot has bruises and rashes. Did I get the new coronavirus? & quot.Previously, doctors in northern Italy broke out, and there were a large number of seriously ill patients under the age of 9 in the local area. The symptoms of these children were similar to a fever and rash skin disease called Kawasaki disease. So, what is Kawasaki disease? This disease is a disease of systemic blood vessel inflammation. The most common symptoms are fever for more than 5 days, neck lymphadenopathy, red eyes, skin rash, peeling of hands and feet, and redness and swelling of the tongue in the shape of a strawberry. In severe cases, coronary artery inflammation and Aneurysm. Kawasaki disease is considered to be related to viruses, bacteria, family, immunity, environment and other reasons. The most relevant are adenovirus, herpes virus, coxsackie virus, streptococcus, etc., but no direct pathogens have been found so far. Unlike hand, foot and mouth disease, herpes simplex, chickenpox, etc., the rash and vasculitis of Kawasaki disease should not be caused by direct virus invasion, but an abnormal immune response to infection. Like the toxic shock syndrome mentioned later, the role of superantigens cannot be ignored. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. People who have experienced or seen Kawasaki disease will be very impressed. The disease mostly occurs in infants and young children under 5 years of age, mostly in male children. The typical symptom is fever, which can be as high as 40 ° C, and most people gradually lose fever within two weeks, and some may extend to four weeks. Conventional antibiotics, antiviral drugs, and antipyretics are not effective for this disease. The conjunctiva of the eyeball is congested obviously, the lips are congested and flushed, and then slowly dry, scab, chapped, and even bleed. The tongue and pharynx are congested, and the tongue shows the bayberry tongue. After 3-5 days of fever, scarlet fever-like erythema, measles-like rash, polymorphous erythema-like rash appear throughout the body, and even part of it can be manifested as systemic sterile pustular herpes. Generally not itchy, mostly on the trunk. Red and swollen hands and feet. About a week, the scalp at the end of the finger and toe of the hand, foot, and toe appears, and then the dandruff perineum, perianal, and even the whole body, without pigmentation. Systemic changes are arthritis, aseptic meningitis and hydrocephalus. & nbsp. & nbsp. & nbsp. Common diseases that need to be identified: scarlet fever: fever occurs 1-2 days of intensive erythema throughout the body, pale circles appear around the mouth, antibiotic treatment is effective, please refer to skin diseases accompanied by fever (four): scarlet fever. Measles (spot rash): It is also a rash after 3-5 days of fever, conjunctival congestion and catarrhal symptoms, but the typical performance is oral mucosal spots (Koplik spots), red spot papules appear throughout the body, and there is a certain rule of rash. Common in children who are not vaccinated against measles and adults with reduced immunity. For details, please refer to the popular viral infectious skin diseases popular science (7): measles. Toxic shock syndrome: different ages of onset, can be seen in young menstrual women, systemic congestive rash and hypotension can occur on the second day of the disease. Other symptoms include fever, flu-like symptoms, nausea, diarrhea, red lips, tongue, conjunctiva, dizziness or fainting, and difficulty breathing. The mortality rate is as high as 5% -15%. Drug eruption: I still remember a misdiagnosis many years ago! The child who went to the pediatric ward for consultation at the time was a distant relative of mine. Because of fever and other symptoms, he used antibiotics such as amoxicillin (ampicillin), but was admitted to the hospital without fever. At this time, a red rash appeared all over the body. Because ampicillin is also a star drug that causes eruptive drug eruptions, a generalized rash plus a certain incubation period, the first diagnosis that pops up in the mind of a dermatologist is a drug eruption! The next day the pediatrics reported that their director had seen the round and considered it to be Kawasaki disease! ! ! Specific reference to “Mistaken Ideas on Drug Eruption Three-Of course, there is no medicine to cure”, you must know that the two treatments are completely different, and after the diagnosis of drug eruption, it means that this drug may not be used for life in the future. There are also various types of drug eruptions. Generally, itchy rash is obvious, and there are no other features of Kawasaki disease mentioned above. Diagnostic criteria for Kawasaki disease: Continued high fever for more than 5 days + 4 of the following indicators (conjunctival hyperemia, mucosal changes, palm and plantar)

Is it possible for the new coronavirus infection to develop into Kawasaki disease?

& nbsp. It has been more than 5 months since the beginning of the new crown epidemic since early December last year. Although the domestic epidemic has been controlled, the epidemic abroad is still not optimistic. The number of infected people in the world has spread to all countries on the planet. Up to the latest information, except for China, the number of infected people in the world has exceeded 4 million, and the deaths have exceeded 300,000. But unfortunately, there is India, the second most populous country with the largest population. Will greatly increase the number of infected people. Due to the wide fluctuation range of the epidemic and the affected population, it is not surprising that various complications, including rare ones, occur. As a pediatrician, of course, the child is concerned. In the past month, it has been reported from the Internet that new coronaviruses can cause Kawasaki disease or Kawasaki-like disease. & nbsp. Knowledge point: Kawasaki disease was first discovered by the Japanese doctor Kawasaki Fusuo, and gradually accepted by people. This disease is also called skin and mucosal lymph node syndrome, which mainly occurs in children, even infants and young children. It is manifested as a series of syndromes such as fever, rash, and lymphadenopathy. The greatest harm is caused by coronary artery damage (blood flow requires the heart Pumped to the whole body, and the coronary arteries are the blood vessels that feed the heart), coronary aneurysms can occur seriously, or even rupture, seriously endangering the life safety of children, and also adversely affecting activities. At present, it has successfully replaced rheumatism as the acquired heart of children The most common cause of illness. The goal of treating Kawasaki disease is to reduce the risk of coronary artery dilation as much as possible. Therefore, human immunoglobulin is commonly used, commonly known as globulin, but human immunoglobulin is a blood product and is expensive to manufacture. Currently, one bottle of 2.5g, about 600 More, if it is Kawasaki disease, for a 10kg child, 20g is needed, and it is conservatively estimated that it will cost nearly 5,000 yuan. Of course, if there is medical insurance, it is an honour. If there is no medical insurance, it is unbearable, let alone Other expenses, the bigger problem is that globulin can greatly reduce the risk of coronary artery dilation, but it cannot completely block the possibility of coronary artery dilation. & nbsp. Although it has been more than 40 years since the discovery of Kawasaki disease, the cause of Kawasaki disease is still unclear. The length of this article is recommended. Kawasaki disease caused by infection is not uncommon in clinic, including viruses , Bacteria, mycoplasma, etc. Will the new coronavirus infection cause Kawasaki disease? Personally think it is possible, but the probability is very low, which is like the reason whether upper respiratory tract infection will be life-threatening. & nbsp. Why the probability is very low, first of all, a pediatrician in Shanghai some time ago also gave a basic explanation, if you are interested, you can search for it. & nbsp. Here I list some personal reasons why the new coronavirus is very unlikely to cause Kawasaki disease. 1. Although the cause of Kawasaki disease is not fully understood, a lot of medical practice has proved that Kawasaki disease is a vascular inflammation. The blood vessels involved in inflammation are mainly the small and medium arteries of the whole body, and the main place where the new coronavirus attacks is the lung tissue. Kawasaki disease can indeed cause pneumonia, but it is not as obvious as the new coronavirus pneumonia. 2. Kawasaki disease is mainly caused by fever, and some have lymphadenopathy, but the typical Kawasaki disease has a unique face of Kawasaki disease, such as conjunctival hyperemia, congestion and cracking of the lips, perianal peeling, and extremity swollen limbs. These are difficult to see in patients with new coronavirus infections. 3. There are also many atypical patients in Kawasaki disease, so we still need to evaluate based on laboratory test results. For example, white blood cells, C-reactive protein, platelets, and erythrocyte sedimentation rate of Kawasaki disease usually increase significantly, and the new coronavirus pneumonia, Children, in particular, are generally not severely ill, and even severe ones usually do not have such obvious blood changes. 4. The last important problem is that if Kawasaki disease is not actively intervened, the risk of coronary artery dilation is very high. Therefore, coronary artery dilation is used as an important diagnostic indicator of Kawasaki disease, and the possibility of coronary artery dilation caused by new coronary virus pneumonia is Very low, at least not reported in the country. 5. If there is indeed an example of Kawasaki disease in a child with a new coronavirus, I personally think whether there are other confounding factors, such as previous history of Kawasaki disease and other risk factors for Kawasaki disease. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. Finally, the above opinions represent only personal opinions, not

WHO warns of the occurrence of rare inflammation in children in Europe and the United States, is it related to the new coronavirus?

At a WHO press conference on April 29, such a news caused everyone’s attention-WHO experts pointed out: At present, we know that children in some European countries suffer from rare inflammatory syndrome, similar to Kawasaki disease. “We have asked clinicians around the world to be vigilant in order to systematically obtain information to better guide the treatment of this disease.” According to foreign media reports, there are reports of this kind of vascular inflammatory disease in children in Europe and the United States. As of April 29, the total number of cases has reached 100. This number does not seem to be large, but in fact it is worth alerting us. In the first instance, children with rare inflammatory reactions all have new coronavirus infections. However, new coronavirus infections are similar to inflammatory reactions similar to “Kawasaki disease”. Does the appearance of symptoms have a clear correlation? Further proof is needed for medical research. Many friends may have heard of “Kawasaki disease”, but they don’t really fully understand it. Let me briefly introduce you. Kawasaki disease is a systemic vascular inflammatory reaction disease in children. It was first discovered by Japanese doctor Fuzuo Kawasaki. Therefore, it is named Kawasaki disease, which occurs in children under 5 years old and is characterized by a severe inflammatory reaction in the blood vessels of the whole body. Children infected with this disease are described by doctors as feeling “the blood vessels of the whole body are burning” , There will be a variety of symptoms such as high fever, rash, swollen lymph nodes, hard swelling and congestion of the hands and feet, most of which are self-limiting and the prognosis is relatively good. However, because the cause of this disease has not yet been clarified, and the condition is more critical at the time of onset, it is a very difficult disease to treat. The British Pediatric Intensive Care Association has also issued a warning letter, pointing out that the onset of children’s cases has overlapping features of toxic shock syndrome and atypical Kawasaki disease, they have heart inflammation, accompanied by abdominal pain, gastrointestinal symptoms, etc., and The blood parameters of critically ill children after the new coronavirus infection are similar, but whether this severe inflammatory reaction is related to the new coronavirus infection is currently under further study. Judging from the epidemic statistics in China, the infection rate of new coronavirus in children in China is not high, and there are very few cases of critical illness. Only one death case of congenital diseases has been found among children infected, and there has not been any combination of new coronavirus infection. Report of systemic vascular inflammatory response. Whether it is New Coronavirus infection, which leads to further spread of the body’s inflammatory response, resulting in a systemic inflammatory response similar to Kawasaki disease, this possibility still exists, after all, after the New Crown Virus infection, severe patients have serious Inflammatory reactions, and whether children show more symptoms in the severe infection of new coronavirus, is also worthy of key research and consideration. Kawasaki disease is a relatively rare disease, which occurs all over the world, but according to statistical data, the incidence rate in Shanghai area of ​​China is one thousandth, Japan and South Korea are about three to five thousandths, while Europe and the United States The area is relatively lower. Therefore, in the case of the rapid spread of the new crown epidemic in Europe and the United States, and the large number of infections, this kind of child has a severe inflammatory reaction in the body. It is indeed necessary to consider its inevitable connection with the new crown virus. For children in our country, parents need not worry too much. On the one hand, such a situation has not occurred in the outbreak of the domestic epidemic, and the current epidemic is under full control, and the country has become a low-risk area. If you can actively protect and let children develop the good habit of washing hands frequently, the possibility of new coronavirus infection is actually not very big.

Scarlet fever past and present

& nbsp. & nbsp. & nbsp. & nbsp. & nbsp. Scarlet fever is an infectious disease caused by type B hemolytic streptococcus. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. So do you know the origin of scarlet fever? & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. From the literal meaning, scarlet, translated from ancient Chinese texts, is a bright red, slightly lighter than the red yellow of the apple, lighter than the magenta yellow and lighter than Casti Li Hong is yellow and dark, darker yellow and lighter than Rubia, blue, lighter and darker than pepper. The translation of Xinhua Dictionary is a color like orangutan blood. Some dictionaries are directly translated into bright red. The western translation of scarlet fever is scalatina or scafletfever. The scaflet translation is scarlet. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. The name Scarlet Fever was proposed by British doctor Thomas Seddonham in 1676 (also said in 1675). In 1953, the Italian doctor Giovanni Ingracia named it “Rosalia”, which was the first official confirmation. It was later introduced into Japan and into China via Japan, and the term was widely used. (Click the link to see the source); click to understand the relevant historical link. & nbsp. & nbsp. & nbsp. & nbsp. Although our motherland medicine is not the invention of the name scarlet fever, but our Chinese medicine also has a lot of research on this. ) ‘S “Golden Wings”, it is believed that scarlet fever has appeared at least at the end of the 18th century. However, according to historical data, before this, there was no history of scarlet fever-related clinical symptoms and patients in a large China. Therefore, there are modern times Researchers believe that scarlet fever was gradually introduced into China during the Qing Dynasty or before, and later became widespread in China, which is an alien imported disease. However, it has also been verified that scarlet fever has appeared in China long ago, but in the early stage, it was in the form of sporadic and sporadic, and did not attract attention. It was not until the late clustered cases that it was gradually passed down by historical records. But history is, after all, history, and sometimes it is difficult to make a textual research. But one thing is that scarlet fever has endangered the lives and health of many people in China, Europe, and even the Americas, and even claimed people’s lives. & nbsp. & nbsp. & nbsp. A typical scarlet fever is easy to judge, but when I get sick or the rash is not typical, what should I do? Here we briefly introduce those diseases that seem to be scarlet fever, but are not scarlet fever. & nbsp. & nbsp. & nbsp. 1. Acute rash in young children: Both diseases have a fever rash, both of which are fever first and then a rash, but the big feature of the acute rash in children is that the rash appears after fever or gradually subsides, and the blood There are generally no signs of obvious bacterial infections. In addition, the temperature of infants with acute rash is usually very high, and they are prone to high fever. The diarrhea and convulsions can occur in a small part. There are no special drugs, and there is no need for transitional treatment. Self-healing. & nbsp. & nbsp. & nbsp. 2. Drug rash: drug-induced rashes are diverse, and can cause mild symptoms, severe liver and kidney function damage, and even shock performance. Generally, the rash gradually subsides after the drug is stopped. The important problem is the throat Most are not red, and tonsils usually have no secretions. & nbsp. & nbsp. & nbsp.3, Kawasaki disease: Kawasaki disease is also called mucosal skin lymph node syndrome, the main feature is fever, rash can appear, rash can appear in any process of fever, and the rash performance is also diverse, especially atypical Kawasaki disease is not easy to distinguish from scarlet fever. In more cases, the current cause of Kawasaki disease is unclear. The patient’s initial stage is scarlet fever. Later, symptoms related to Kawasaki disease gradually appear. The clinical manifestations of the disease are judged according to the clinical characteristics. This situation requires a comprehensive evaluation of the patient’s indicators to achieve the purpose of diagnosis. The treatment of Kawasaki disease is very different from the prognosis of scarlet fever. Kawasaki disease is also called pediatric heart disease by pediatricians. & nbsp. & nbsp. & n