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      Fiebre en el paciente pediátrico. La importancia de la exploración física repetida Translated title: Fever in the paediatric patient. The importance of repeated physical examination

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          Abstract

          RESUMEN Los cuadros clínicos consistentes en fiebre e inflamación sistémica con afectación mucocutánea pueden ser debidos a múltiples etiologías. El pronóstico de estos, en algunas ocasiones, depende del diagnóstico e instauración de tratamiento precoz. Se presenta el caso clínico de un niño atendido en el servicio de urgencias por fiebre, dolor abdominal y cervical. En su caso, los hallazgos de leucocitosis, neutrofilia, elevación de reactantes de fase aguda y transaminasas orientan inicialmente hacia una patología gastrointestinal. Sin embargo, la exploración física continuada junto a un alto índice de sospecha permitió establecer el diagnóstico correcto de enfermedad de Kawasaki mediante ecocardiografía en los primeros cinco días de evolución de la enfermedad. Se trató con gammaglobulina intravenosa, con evolución favorable y resolución completa del cuadro a los cuatro meses del diagnóstico.

          Translated abstract

          ABSTRACT Clinical pictures consisting of fever and systemic inflammation with mucocutaneous involvement can be caused by multiple aetiologies. Prognosis, in some cases, depends on diagnosis and on early treatment. We present the clinical case of a boy seen in the emergency department with fever, and abdominal and cervical pain. In this case, findings of leucocytosis, neutrophilia, increased acute phase reactants and transaminases initially lead to gastrointestinal disease. However, continued physical examination and high degree of suspicion enabled to make the correct diagnosis of Kawasaki disease using echocardiogram within the first five days of the disease. The treatment was intravenous gamma globulin, with a favourable evolution and complete recovery four months after diagnosis.

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          Coronary artery dimensions in febrile children without Kawasaki disease.

          Coronary artery (CA) dilatation on echocardiography is a criterion for treatment with intravenous immunoglobulin for incomplete Kawasaki disease (KD). However, CA dimensions for febrile children are unknown. We compared CA dimensions in children with febrile illnesses other than KD to those of normal afebrile children and to KD patients.
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            Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease.

            Although some laboratory findings are known to be indicators of the risk of giant coronary aneurysm formation among Kawasaki disease patients, an appropriate cut-off point to predict aneurysm formation is not clear. One hundred and five patients with giant coronary aneurysms were selected from the 15th and 16th nationwide surveys of Kawasaki disease in Japan. A total of 2936 patients without Kawasaki disease were recruited from a single hospital as a control group. Odds ratios were calculated for six laboratory data with specific values as cut-off points. Receiver operating characteristic (ROC) curves were observed to determine the most appropriate laboratory tests and cut-off points. Hematocrit, leukocyte count, neutrophil proportion, and hemoglobin had one or more peaks of odds ratio for specific cut-off points, but they did not have a clear cut-off point for the predictor according to the receiver operating characteristic curves. Alanine aminotransferase (ALT) increased the risk of giant coronary aneurysms continuously so no clearly appropriate cut-off point was identified. Serum sodium concentration of 135 mEq/L had a peak of odds ratio, and those with <135 mEq/L had the highest odds ratio (4.78). This value seemed appropriate with a sensitivity of 78% and specificity of 57%, although the predictive positive value was as small as 5%. The author's propose that a serum sodium concentration of <135 mEq/L at the patient's first visit to hospital may be a predictor of giant coronary aneurysms due to Kawasaki disease.
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              Atypical and incomplete Kawasaki disease.

              Kawasaki disease (KD) is the most common systemic vasculitis in childhood after Henoch-Schonlein purpura, and the most common cause of acquired heart disease among children living in Western countries. Its diagnosis relies on clinical findings; laboratory tests are useful to rule out other causes of unexplained fever but are not specific for the diagnosis of KD. Numerous efforts to produce a diagnostic algorithm have been made, but without success. Expert opinion is therefore required in doubtful cases, especially those that lack classical criteria (the so-called atypical or incomplete cases). Renal, gastrointestinal, neurologic, pulmonary and ocular involvements have all been described. Infants may be at higher risk of complications since recognising manifestations of the disease might be more difficult in this group. Approaches to treatment and follow-up of KD are changing in parallel with changes in concepts of what constitutes classical and incomplete KD. Guiding this evolution is the probability that the diagnosis is actually KD, the duration of the child's illness and the desired effects of therapy. Until a gold standard for diagnosing KD is available, these therapeutic decisions will continue to be made on an individual basis.
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                Author and article information

                Journal
                albacete
                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Castellano-Manchega de Medicina de Familia y Comunitaria (Albacete, Castilla La Mancha, Spain )
                1699-695X
                2386-8201
                2020
                : 13
                : 2
                : 153-156
                Affiliations
                [1] Guadalajara orgnameHospital Universitario de Guadalajara orgdiv1Servicio de Pediatría España
                Article
                S1699-695X2020000200010 S1699-695X(20)01300200010
                eaedc5d5-5030-4af6-9941-2bdc563650f3

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 29 March 2019
                : 17 June 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 8, Pages: 4
                Product

                SciELO Spain

                Categories
                Un paciente con...

                Pediatría,Fever,Pediatrics,Cardiología,Fiebre,Enfermedad de Kawasaki,Cardiology,Kawasaki Disease

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