PAEDIATRICS

ResponseKawasaki disease
(Staph) Scalded skin syndrome, toxic shock syndrome
(Strep) Toxic shock syndrome, scarlet fever
SJS/TEN
Drug hypersensitivity reaction
Erythema multiforme
Measles, other viral exanthem (Adenovirus, Enterovirus, EBV) (I got marked wrong for measles as low prevalence)
Rheumatic disease Juvenile idiopathic arthritis, Reactive arthritis, polyarteritis nodosa
PIMS-TS
DRESS - Drug reaction with eosinophilia and systemic symptoms

ResponseFever for 5 or more days and >⅘ of:
CREAM
Conjunctivitis - bilateral non purulant conjunctival injection
Rash - Poolymophous rash (Polymorphous = rash can be anything)
Edema - palmar and plantar erythema, desquamation (Ew. American spelling)
Adenopathy - Cervical lymphadenopathy - (>15mm, usually unilateral, non purualant and painful)
Mucous membrane (mouth) changes - reddened or dry cracked lips, strawberry tongue, diffuse redness of oral or pharyngeal mucosa

Diagnosis is challenging as no definitive test available for diagnosis. Incomplete KD manifestations, symptoms can be sequential rather than simultaenous.
Lots of mimics

ResponseEcho - Cardiac/coronary artery imaging to determine or exclude complications of KD - Coronary artery aneurysm, Ectasia, MR, Ventricular dysfunction, effusion. At presentation and at 6-8 weeks
ECG - long PR and QT intervals, T wave changes
Blood + urine cultures - exclude serious bacterial isllness
Strep A testing - Serology/ASOT, Anti DNAase, Throat swabs - exclude invasive/recent strep infection
Measles serology - exclude measles
FBC - thrombocytosis (2nd week illness), Normochromic, normocytic anaemia
CRP/ESR - severity assessment (non specific)
LFT’s - Hypoalbulminaemia and raised liver enzymes
There is no single test to confirm kawasaki disease.

ResponseSpecific
IV immunoglobulin 2g/kg (Gold standard - Ideally in first 10 days of illness, Aneurysm risk 20-25% drops to 3%)
Aspirin 3-5mg/kg daily for 6-8 weeks
Corticosteroids - A bit controversial - if high risk for aneurysm

Supportive
Paracetamol
IV hydration

Weird and wonderful
?anticoagulation for multiple coronary aneurysms
?fibrinolytics for coronary artery thrombus
? Influenza vaccine to prevent reyes syndrome if on aspirin

ResponseCardiac:
Coronary artery aneurysms, MI, Arrhythmias, Cardiac failure/impaired LV function, Myocarditis, Pericarditis, Pericardial effusions, Valve dysfunction (Typ. MR)
Vascular - Peripheral vascular changes (Aneurysms, ischemia)
CNS - Aseptic meningitis
GI - hepatitis
Resp - Pneumonitis
Eyes - Uveitis
MSK - Arthritis/arthralgia
Kawasaki disease Shock Syndrome (KDSS) - sustained hypotension - life threatening
Macrophage activation syndrome (MAS) - persistent fever post IVIG - very rare
Sensorineural hearing loss (usually transient)

ResponsePaediatric infomatory multisystem syndrome temporarily associated with SARS-COV-19 =
MISC-C - Multisystem Inflammatory Syndrome in Children associated with Covid 19

Age <21
Evidence of inflammation on labs (Raised CRP/ESR/Procalcitonin, Ferritin, Neutrophils, low lymphocytes + albumin)
COVID <=4 weeks
Multi system >2 organ involved + requires hospitalisation for severe illness
Fever >38 >24h

Treatment = same as kawasaki disease