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Kapia ka buana ka matuku a bungi (matuku 5+), disama dia Kawasaki, ne disama dia bana

Emergency numbers differ by country. This page uses 911, the number for the United States and Canada. Many other countries use 112, 999, or another number. Find the number for your country.

Padi muana mutekete anyi muana mutekete (pa tshibidilu pankatshi pa ngondo 6 ne bidimu 5) upeta disama dia luya lukole (\(38.5\text{ to }40.5\text{ degrees Celsius}\) anyi \(101.3\text{ to }104.9\text{to }40.5\text{degree Celsius}\) anyi \(101.3\text{ too ne ku }104.9\text{\)}) didi ditungunuka too ne ku 4 anyi 45 Dituku dia 5 dilondangana** nansha mudibu ne ibuprofen ne acetaminophen, nangananga padibi bienda pamue ne mesu makunze a mashi kaayi ne pus (bilateral non-exudative conjunctivitis), mishiku mikunze mitoke anyi "ludimi lua fraise", tshipupu tshia mubidi, bianza anyi makasa bikunze, anyi tshitupa tshia lymphe tshiuwule ku luseke lumue lua nshingu, baledi ne baminganga badi ne bua kukonkonona diakamue bua Disama dia Kawasaki (Mucocutaneous Lymph Node Syndrome) ne Multisystem Inflammatory Syndrome mu bana (MIS-C). Disama dia Kawasaki i disama dia mishipa ya mu mishipa ya munkatshi ne tshintu tshia kumpala tshidi tshikebesha disama dia mutshima kudi bana mu Amerike wa ku Nord, ku Mputu ne ku Est kua Asie. Padibu kabayi baondapa panyima pa Dituku dia 10 dia luya, disama dia Kawasaki didi dibunda bimanu bia mishipa ya mu mikolo ya muana nkayende mu 25 pa lukama lua babedi, difikisha ku mishipa ya mishipa ya mu mikolo ya kashidi, dinyanguka dia mashi, disama dia mutshima (disama dia muoyo), anyi lufu lua tshimpitshimpi lua mutshima, padibu bafila mishipa ya mu mishipa ya mu mashi (IVIG)** kumpala kua dituku dia 10 didi dipuekesha njiwu ya disama dia mishipa ya mu mikolo kumbukila ku 25 pa lukama too ne ku 4 pa lukama.

Shi muana udi ne luya udi mutekete anyi udi ne lutatu lua kumujula, udi ne tshimpumpu tshia violet/tshikunze tshidi katshiyi tshitoka (petechiae anyi purpura), nshingu mikole, dipuyakana dia lukasa, dikoba dia bule anyi dia bule, anyi disama dikole dia mu difu ne difu, bikila nimero wa lupitadi lua muaba unudi (911 mu États-Unis ne mu Canada, 112 mu matunga masanga a ku Mputu, 999 mu Royaume-Uni) anyi tangila tshilaminu tshietu tshia matunga masanga tshia nomba ya tshimpitshimpi diakamue. Bua bipupu bia bana bapiabapia badi muinshi mua ngondo 3 anyi bipupu bia luya, bala kapia kakole ka muana ne disama dia tshimpitshimpi. Londa tshipupu tshia buana tshia matuku a bungi ne mikenji ya disungula dia Kawasaki idi kuinshi eku.

Enza nunku mpindieu

  1. Bala "Dituku dia kumpala dia luya" bu dituku dia kumpala dia mu kalandriye mudi luya lua muanebe lufika anyi lupite pa \(38.0\text{ degrees Celsius}\) (\(100.4\text{ degrees Fahrenheit}\)): Nansha mudi luya lupueka mu tshitupa tshîpi munkatshi mua mêba 3 kunyima kua dinua dia ifeneprofine anyi acamine, Tshikondo tshia mêba 24 tshidi tshibala bu dituku dikuabu. Mu Dituku dia 4 anyi dia 5 dia disama dia luya lukole didi kadiyi diumvuika, muanebe udi dijinga ne dikonkonona dia munganga ne mateta a mashi (CRP, ESR, CBC, CMP), kuitaba dijadikibua dia ku telefone dia se: "ntshipupu tshidi tshishala."
  2. Angata binjinjimbi bia mesu, ludimi/mishiku, tshitupa tshia mubidi/tshiadi, ne bianza/makasa a muanebe dituku dionso: Mu disama dia Kawasaki, bimanyinu bitanu bia kale (CRASH criteria) misangu ya bungi kayena imueneka yonso dituku dimue to, tshilonda tshikunze tshidi mu tshitupa tshia diaper anyi mêsu makunzubile tshidi mua kufika ku tshibungubungu mu dituku dia 3 ne kujika mu dituku dia 5 anu padi mishiku mikunze mipanduluke imueneka. Kuleja binjinjimbi bia munganga wa tshimpitshimpi bia matuku 2, 3, ne 4 kudi misangu ya bungi kujadika disama diakamue.
  3. Enza "Glass Tumbler Blanch Test" pa tshitupa tshionso tshia mputa diakamue: Fina luseke lua dikopo dia kunua dimpe pa bitupa bia mputa. Shi bipese bikunze bishala bikunze anyi bikunze muinshi mua tshienzedi tshia dikalashi (non-blanching petechiae or purpura), ndaku diakamue ku tshibambalu tshia malu a mpukapuka tshidi pabuipi bua kumbusha disama dia Meningococcal Sepsis (Meningococcemia).
  4. Tangila bana ba muinshi mua ngondo 12 bua "Disama dia Kawasaki didi kadiyi dikumbane": Bana ba muinshi mua tshidimu tshimue (ne nangananga muinshi mua ngondo 6) batu misangu ya bungi bapeta Disama dia Kawasaki didi kadiyi dikumbane, didi dileja matuku 5+ a kapia kakole, tshiji tshikole, ne anu bimanyinu 1 anyi 2 bia kale (pa kumbusha bimanyinu bia dipatuka tshitoka pabuipi ne mputa wa tshiamu tshia BCG anyi tshitupa tshia diaper), kadi bana ba muinshi mua ngondo 6 badi ne njiwu mikole (up to 35 to 50%) ya mishipa minene ya mishipa ya mu mikolo.
  5. KUPEDI Aspirine nansha kakese (Acetylsalicylic Acid) kudi muana udi ne kapia kumbelu pa kumbusha padi munganga wa mu lupitadi mumane kujadika disama dia Kawasaki: Kupesha muntu manga a aspirine kumbelu padiye ne kapia ka virus (nangananga grippe anyi varicella/chickenpox) kudi mua kufikisha ku lufu lua Reye Syndrome (dipanga dia tshiadi tshikole ne disama dia buongo). Anu kasumbu ka lupitadi ke kadi kafila manga a aspirine mulongolola pamue IVIG padibu bapeta disama dia Kawasaki.
  6. Lomba mateta a mashi adi aleja disama (CRP ne ESR) ne Echocardiogramme wa bana pikala luya lufike ku dituku dia 5 ne bimanyinu bia mubidi anyi bia dikoba: Bilondeshile American Heart Association (AHA) ne Tshilongelu tshia malu a bana tshia mu Amerike (AAP), muana yonso udi ne \(\ge 5\text{ matuku}\) a luya ne 2 anyi 3 ya disama (anyi muana yonso \(< 6\text{ months}\) with \(\ge 7\text{ days}\) of unexplained fever even with zero physical signs) requires laboratory screening (CRP >= 3.0 mg/dL or ESR >= 40 mm/hr) ne echocardiogram wa mishipa ya mu mikolo.

Danger

Mateyi abidi a diagnostic adi akebesha disama dia Kawasaki: 1. The "Antibiotic Rash & Sterile Pyuria" Trap: Muana udi mu difuku 3 dia disama dia Kawasaki utu misangu ya bungi ne mpala mukunze ne tshitupa tshimue tshia mu nshingu tshidi tshiuwule (tshidibu babikila ne: Strep throat) anyi globules blanc mu mashi ende (sterile pyuria ku disama dia mu tshina tshia mashi, tshidibu bela meji ne: disama dia mu tshina tshia mashi). Tshibambalu tshia luondapu tshidi tshifunda manga a ku mishiku amoxicillin, ne dituku didi dilonda muana udi upatuka mu tshipupu tshia mubidi tshia Kawasaki, tshidibu bamba mu dishima bu "tshipupu tshia manga a amoxicillin" padi kapia katungunuka ne kukola panyima pa dituku dia 7. Vuluka ne: Strep throat wa bactérie mulelela udi wandamuna bikole mu mêba 24 too ne ku 48 kunyima kua yeye mumane kutuadija amoxicillin; Shi luya lukola ludi lushala munkatshi mua meba 48 kunyima kua diangatshila dia antibiotique ne mêsu makunze anyi mishiku mitapa, bidi mua kuikala disama dia Kawasaki, ki ndisama dia Strep to. 2. Kuindila bua kukosa minu/makasa (Desquamation) Kumpala kua kupeta disama dia Kawasaki: Dikoba dia ku minu ne ku makasa didi dimueneka bu dia mabeji ntshimanyinu tshimanyike tshia disama dia Kawasaki, kadi ntshimanyinu tshia panyima pa matuku tshidi katshiyi tshituadija too ne ku dituku dia 10 too ne ku dituku dia 21 kunyima kua dibanga dia kapia, panyima pa matuku 10 mimpe bua tshikondo tshia IVIG bukubi bua mioyo budi bumane kutuadija kujika. Mu matuku 1 too ne ku 7, keba maboko ne mikolo mikunzubile, mifuba, mifuba (ne dipatuka dia kumpala dia tshitupa tshia mu tshiadi/diaper, tshidi tshienzeka ku ntuadijilu kua matuku 3 too ne ku 5).

Mutshi wa dipangadika: kukonkonona muana udi ne matuku 4 too ne ku 5+ a luya

Ingidija tshimfuanyi etshi tshia malu a luondapu tshidi tshimanyine pa American Heart Association (AHA) Kawasaki Disease Diagnostic Algorithm bua kusungula tshipupu tshia buana tshidi tshienda tshikola:

flowchart TD
    Start["Muana udi ne luya lukole (>= 38.0 C / 100.4 F) udi ubuela mu dituku dia 4 anyi dia 5+"] --> RedFlags{"."}
    RedFlags -->|"EYOWA: Tshimanyishilu tshia sepsis anyi tshia MIS-C"| Call911["BIKILA 911 / 112 / 999 NANSHA YA KU MUDIMU WA BANA DIAMUE<br/>Udi wela meji ne: udi ne disama dia meningococcal, disama dia toxique, anyi disama dia mutshima dia MIS-C"]
    RedFlags -->|"NO: Didimuija pankatshi pa nsongo, ditokesha anyi kakuyi nsongo"| CountSigns{"2. Tangila 5 Classic Kawasaki 'CRASH' Criteria:<br/>1. Conjonctivitis (Mesu onso abidi makunze, KAKUENA pus)<br/>2. Disama (Disama dia mubidi/mu tshiadi dia mishindu ne mishindu)<br/>3. Adenopathie (Tshitupa tshia mu nshingu tshidi tshivula >= 1.5 cm)<br/>4. Ludimi lua fraise / Mishiku mikunzubile<br/>5. Bianza ne makasa biuwule/bikunze"}
    CountSigns -->|"4 anyi 5 malu adiku<br/>(Ne >= 4-5 matuku a luya)"| CompleteKD["DISAMA DIA KAWASAKI DIJIKIJA (DIA KALA)<br/>Ndaku ku tshibambalu tshia malu a mpukapuka a bana lelu<br/>Tuadija IVIG (2 g/kg) + Protocol wa Aspirine wa mu lupitadi + Echocardiogramme wa ntuadijilu"]
    CountSigns -->|"2 nansha 3 Criteria Present (With >= 5 Days Fever)<br/>ANY Infant < 6 Mois Ne >= 7 Days Fever Unexplained"| IncompleteKD["MUSHINDU WA KUJIKIJA (ATYPICAL) KAWASAKI DISEASE<br/>Same-Day Pediatric ED Lab Panel: Check CRP, ESR, CBC, Albumin, ALT, Urine<br/>If CRP >= 3.0 mg/dL or ESR >= 40 mm/h> Perform Echogram & Give IV"]
    CountSigns -->|"0 anyi 1 Tshipiminu + Tshifu tshikole/Mushiku udi upatuka"| ViralWorkup["EXAMEN MEDICAL WA BANA WA DITUKU DIMUE<br/>Kukonkonona Adenovirus, EBV, Pneumonia, UTI, Sinusitis, anyi Occult Infection"]

Tshitupa 1: "CRASH and Burn" mnemonic, mushindu wa kumona bimanyinu 5 bia kale bia disama dia Kawasaki

Baminganga ba bana ba pa buloba bujima batu balonga AHA Diagnostic Criteria for Complete Kawasaki Disease ku diambuluisha dia mnemonic "CRASH and Burn": Burn (5+ days of high, unremitting fever) pamue ne nansha 4 pa 5 ya CRASH bimanyinu bia disama:

1. Dikosolola dia 5 CRASH Bimanyinu (Ne mudibi bimueneka kumbelu)

CRASH Mukanda Tshikebelu tshia luondapu Tshimuenekelu tshia bushuwa ne dikonkonona dia baledi Bualu bua mushinga budi butshisunguluja ne bipupu bia pa tshibidilu
C , Conjunctivitis (Present in 85-90%) Bilateral Bulbar Non-Exudative Conjonctivitis Mêsu onso abidi adi alua mutoke wa mashi/mutoke pa tshitupa tshitoke tshia dîsu (bulbar conjunctiva), misangu ya bungi ne dijingulula dia butoke (photophobia). 1. ZERO Pus anyi Goopy Crusting: Bishilangane ne pinkeye wa bactérie anyi wa virus, mêsu adi maume/a mâyi kaayi ne tshintu tshidi tshipatuka tshia jaune.
2. "Limbal Sparing": Tangila biyampe kunyunguluka iris wa mekala, kudi misangu ya bungi 1-millimeter halo mutoke pabuipi ne iris munyunguluka kudi sclera wa pambelu mukunze.
R , Rash (Present in 70-90%) Polymorphous Exanthem (Non-Vesicular Rash) Bitupa bikunze bia maculopapular, bipese bia buena bia tshipatshila, anyi bitoka bikunze bitangalake mu mubidi, mu tshiadi ne mu bianza (kakuyi bipumbishi biuwule tente ne mâyi). Tangila diaper / Groin Crease (Perineal Accentuation): Mu bana 60 too ne ku 70% ba Kawasaki, tshipupu tshidi tshilua tshikunze tshikole mu tshitupa tshia tshiadi/tshia tshiadi tshia kumpala ne tshituadija kupatuka (desquamating) mu tshitupa tshia diaper kubangila ku Dituku 3 to ne Dituku 5.
A , Adenopathy (Present in 50-70%, lest common sign) Unilateral Cervical Lymphadenopathie (\(\ge 1.5\text{ cm}\)) Divulangana dikole, kadiyi dishintuluka, dia lymphome ku luseke lumue lua nshingu wa kumpala didi ne bule bua 1,5 centimètres (0,6 inches) mu butshiama. Misangu mivule utu umueneka mu difuku dia 1 anyi dia 2 kumpala kua disama dia nsukadi anyi dia mêsu makunze, bienza bua baminganga bafike ku dimona bibi ne: ndisama dia mu nshingu didi difumina ku bactérie (lymphadenitis) ne kumufundila manga adi kaayi mua kujikija luya.
S , Strawberry Tongue & Oral Mucositis (Present in 90%) Mashintuluka a mu mishiku ne a mishiku 1. Mishiku: Mishiku mikunzubile, mifuba, miume, mitapuluke, mitapuluke, ne mashi apatuka.
2. "Ludimi lua Fraise": Tshilamba tshitoke tshidi tshipatuka bua kushiya ludimi lukunze lukole ludi ne bintu bia kutokesha nabi (papillae).
3. Diffuse red throat.		 KAKUENA mputa ya mukana anyi tshintu tshidi tshipatuka mu mishiku: Bishilangane ne disama dia bianza ne makasa ne mukana (Coxsackievirus) anyi Herpetic Gingivostomatitis, Kawasaki udi ukebesha KAKUENA bilonda anyi bipumbishi bia munda mua matama anyi pa mishiku.
H , Mashintuluka a bianza ne makasa (mu 80%) Acute Acral Erythema & Indurated Edema \(\rightarrow\) Subacute Peeling Matuku 1 too ne ku 7: Bianza bia bianza ne makasa bidi bilua bikunze anyi bikunze, ne nyima ya bianza/makasa idi ikola mikole, mifuba, ne isama (muana udi ubenga kuimana anyi kuenda anyi kukuata bintu bia kunaya nabi).
Matuku 10 too ne 21: Dikoba didi dipatuka mu bitupa binene kutuadijila kuinshi kua muelelu wa minu ne minu ya makasa (periungual desquamation).		 Divula dia tshianza/makasa dia kumpala didi disama bualu bua disama dia nsongo mu munu mukese ne mu bitupa bia mu nshingu; muana udi mua kudila dîba dionso diudi uvuala bisabata anyi bimana.

2. Bimanyinu bibidi bia pa mutu bidi baledi ne bua kumanya (Extreme Irritability ne BCG Scar Redness)

  1. Kawasaki Irritability" (Aseptic Meningitis):
  2. Pabuipi ne muledi yonso wa muana udi ne disama dia Kawasaki udi wambila munganga ne: "Ndi mumone muananyi mutekete usama ne luya lua bungi kumpala, kadi tshitu muanji kumumona ne kanyinganyinga ne kayi ne busambi nansha mudi ibuprofen mupuekeshe luya."
  3. Dibungama dikole edi didi dienzeka bualu disama dia Kawasaki vasculitis didi difikisha ku disama dia tshitupa tshia buongo (meningitis aseptique) kudi babedi batue ku 40 pa lukama.
  4. Erythema ne Crusting kumpala BCG Mputa wa tshiamu tshia dikuba natshi bantu:
  5. Mu matunga mudi bana batekete bapeta Bacillus Calmette-Guérin (BCG) tshiamu tshia tuberculose ku diboko dia kuulu anyi ku dikaya (bu mudi Japon, Corée du Sud, Royaume-Uni, Amerike wa ku Sud, ne mu Asie/Europe), dikala dikunze, difu, anyi dipingana dia tshitupa tshia mubidi tshia kale tshia BCG didi anu bu disama (specific) bua disama dia Kawasaki mu muana udi ne luya.

Tshitupa 2: "Disama dia Kawasaki didi kadiyi dikumbane" mu bana batekete, bua tshinyi bana ba muinshi mua tshidimu tshimue badi mu njiwu mikole

Netuambe tshinyi bikala muana webe wa ngondo itanu anyi muana wa bidimu bibidi muikale ne tshipupu tshikole munkatshi mua matuku 5, 6 anyi 7, muikale ne tshikisu, ne muikale anu ne mishiku mikunze ne mêsu makunzubile** (2 pa 5 CRASH bimanyinu pamutu pa 4)? - Disama dia Kawasaki didi kadiyi dikumbane didi anu bu dia njiwu (anyi dia njiwu mipite) kupita Kawasaki mujima: - Kufika ku 20 too ne ku 30 pa lukama ya bantu bonso badi ne disama dia Kawasaki, ne kupita pa 50 pa lukama ya bana batekete badi ne bidimu muinshi mua ngondo 6, badi "Kawasaki kayi mukumbane," mbuena kuamba ne: muana kena upeta bimanyinu bia pambelu 4 pa 5 to, kadi mishipa yabu ya mu mikolo idi anu ne disama dia muomumue didi dibutula. - Mushindu kayi udi tshisumbu tshia bena Amerika tshia muoyo (AHA) Udi upeta disama dia Kawasaki didi kadiyi dikumbane ku diambuluisha dia mateta a mashi ne a mashi: Padi muana ne \(\ge 5\text{ matuku}\) a luya ne anu bimanyinu 2 anyi 3 bia disama (anyi muana \(< 6\text{ months}\) has \(\ge 7\text{ days}\) of unexplained fever), the Emergency Department checks inflammatory markers (CRP >= 3.0 mg/dL and/or ESR >= 40 mm/hr) plus 6 Supplemental Laboratory Criteria: 1. Anemie bua bidimu. 2. Bungi bua plakete buvule (Thrombocytosis >= 450,000 / mm3 kunyima kua dituku dia 7 dia luya). 3. Albumine mukese wa mu mashi (<= 3.0 g/dL). 4. Elevated Liver Enzyme (ALT). 5. Bungi bua selile ya mashi mitoke (WBC >= 15,000 / mm3). 6. Sterile Pyuria (>= 10 WBCs per high-power field pa tshikebelu tshia mashi ne tshilele tshia bactérie tshia mashi tshidi katshiyi tshimpe). - Shi 3 nansha kupita apu pa 6 ya mu laboratware i biyampe (anyi shi echocardiogram ileja divulangana dia mishipa ya mu mikolo ne Z-score \(\ge 2.5\)), muana udi upeta diakamue disama dia Kawasaki didi kadiyi dikumbane ne bamuondapa ne IVIG.

Tshitupa 3: Dishilangana dia disama, disama dia Kawasaki ne MIS-C ne Scarlet Fever ne Adenovirus ne disama dia nsukadi

Malu a bungi a ku buana adi akebesha luya lua matuku a bungi, mêsu matuku, ne mputa. Ingidija tshilejelu etshi tshia difuanyikija dia malu a luondapu bua kumvua mushindu udi baminganga ba malu a mpukapuka babatapulula:

Tshintu 1. Disama dia Kawasaki (KD) 2. Disama dia mubidi wa bungi mu bana (MIS-C / PIMS-TS) 3. Tshipupu tshikunze (Group A Strep) 4. Adenovirus (Pharyngoconjunctival Fever) 5. Tshipupu (Rubeola)
Tshisumbu tshia bidimu bia bungi Ngondo 6 too ne ku bidimu 5 (80% badi muinshi mua bidimu 5) 5 too ne ku 13 bidimu (bana bakulumpe ba mu kalasa ne bansonga; bidi bienzeka mbingu 2 too ne ku 6 kunyima kua disama dia SARS-CoV-2) 3 too ne ku 15 bidimu (bitupa bia muinshi mua bidimu 2) Bidimu bionso bia buana Bana badi kabayi bapeta disama dia tshiadi tshia bidimu bionso
Tshimuenekelu tshia mêsu Meso abidi kaayi apatuka (kaayi ne pus) mêsu makunze ne limbal sparing Conjonctivitis non-exudatif wa ku nseke ibidi Mêsu matoke a pa tshibidilu (tshipupu tshikunze katshiena tshikebesha disama dia mêsu dikunze to) Misangu ya bungi exudative/watery pinkeye (misangu ya bungi udi utuadija mu dîsu dimue, pashishe utambakana mu dikuabu) + disama dia mu mishiku/tshifu Mêsu makunze, ne mayi ne ditshina dia munya dikole + "3 Cs": Tshifu, Coryza (mu mishiku idi ipueka), Conjonctivitis
Bimanyinu bia mu difu ne bia tshipupu Disama dia munda dikese anyi dikola dia mu tshifu; tshipupu tshia muoyo tshidi tshikepela (< 5%) Bimanyinu bia tshifu tshikole mu 85% (disama dikole dia mu tshifu didi difuanangana ne disama dia appendicite, disama dia nsukadi, disama dia tshiadi) + disama dia mashi misangu ne misangu/tshipupu tshia muoyo (50%+) Disama dia nshingu, mutu usama, difuka; diandamuna dia lukasa ku penicillin/amoxicillin mu meba 24-48 Disama dia mu mikolo didi dimueneka ne matonsile matoke, kapia kakole munkatshi mua matuku 5-7 Mabala matoke a Koplik munda mua matama -> tshipupu tshidi tshituadija ku mulongo wa nsuki/kunyima kua matshi ne tshitangalaka panshi
Bungi bua plakete mu tshikebelu tshia mashi HIGH (Thrombocytosis) kubanda too ne ku \(500,000\text{ too ne ku }1,000,000/\mu\text{L}\) mu lumingu luibidi LOW (Thrombocytopenia) + lymphocytes mikese (lymphopenia) + troponin/BNP wa bungi Ma plakete a pa tshibidilu; Strep swab wa lukasa Ma plakete a pa tshibidilu; PCR wa mupuya wa virus muimpe Maplakete makese/a pa tshibidilu

Tshitupa 4: Diondapa dia mu lupitadi (IVIG ne 10-Day Coronary Window) ne dilonda dia kumbelu

1. Bua tshinyi "Dituku dia 10" didi ne mushinga (ne netuambe tshinyi pikala disama dienzeka kunyima kua dituku dia 10?)

  • Mushindu udi mishipa ya mu mikolo yenzeka: Pankatshi pa Dituku dia 7 ne dia 14 dia disama dia Kawasaki didi kadiyi diondapibua, neutrophiles ne macrophages badi babuela mu tshitupa tshia mishipa tshia ku dia bakaji tshidi tshipueka (LAD) ne mishipa ya tshiadi tshia ku dia balume (RCA), udi ushipa tshitupa tshia munda tshidi tshienza bua mashi a bungi a mu mishipa apita mu tshimanu tshia mushipa tshidi tshitekete pambelu mu aneurysme wa saccular anyi fusiforme.
  • Tshiamu tshia Gold-Standard (IVIG 2 g/kg Kupita pa meba 10 to ne ku 12 + Aspirine):
  • Difila dimue dia bungi dia Imunoglobuline mu mushipa (IVIG, \(2\text{ grams per kilogram}\)) mufila mu matuku 10 a kumpala a disama dia tshiadi udi wimanyika tshiluilu tshia mubidi mu mêba 24 too ne ku 36 mu bana 85 too ne ku 90 pa lukama (ne udi ukepesha dienza dia aneurysme coronaire kumbukila ku 25% too ne ku $< 4$%).
  • (Dimanya: Shi muana mupeta disama edi mu difuku dia 11, 12, anyi pashishe ne utshidi anu ne kapia kakole, CRP/ESR mubandile, anyi divulangana dia mioyo, baminganga badi anu bamupesha IVIG mpindieu).
  • Dilonda dia disama dia Kawasaki didi kadiyi ditantamena IVIG (The 36-Hour Fever Check):
  • Mu bana 10 too ne ku 15 pa lukama, luya ludi lupingana anyi lutungunuka mêba 36 anyi kupita apu kunyima kua IVIG dijikija dia mashi. Bana aba badi dijinga ne diakamue dose muibidi wa IVIG, intravenous corticosteroids (methylprednisolone), anyi luondapu lua bioloji (infliximab anyi anakinra) mu lupitadi bua kukuba mutshima wabu.

2. Mulongo wa malu adibu ne bua kulonda bua kulama baledi panyima pa lupitadi

Padi muanebe ujika mu lupitadi munkatshi mua mêba 24 too ne ku 36 ne badi bamupatula kumbelu ne aspirine wa mukana wa dituku dionso (3 to 5 mg/kg/day) bua bukubi bua mashi adi kaayi malelela:

  • Upima luya lua muanebe kunyima kua mêba 6 onso mu matuku 7 kunyima kua yeye mumane kupingana kumbelu: Shi kapia (\(\ge 38.0\text{ degrees Celsius} / 100.4\text{ degrees Fahrenheit}\)) upingana dîba kayi dionso kunyima kua dipatuka mu lupitadi, bikila munganga webe wa bana anyi tshibambalu tshia malu a njiwu bua kupingana dituku adi, tshipupu tshidi tshipingana tshidi tshileja IVIG-resistant recrudescent vasculitis tshidi tshilomba diondapa dia lukasa.
  • Kujikija bionso bisatu bia echocardiogramme ya bana batekete: Nansha biobi bikala echocardiogramme wa mu lupitadi wa ku ntuadijilu uvua muimpe 100 pa lukama, divulangana dia mishipa ya muoyo didi mua kumueneka mu tshikondo tshia subacute. Kulekedi nansha kakese echocardiogramme ya kulonda mu mbingu 1 too ne ku 2 ne mbingu 4 too ne ku 6 kunyima kua diondapibua.
  • Lama muana udi unua aspirine dituku dionso ku grippe ne ku tshipupu (Reye Syndrome Prevention): Padi muanebe unua aspirine wa tshitupa tshîpi ku dituku munkatshi mua mbingu 6 (anyi kupita apu pikala dikola dia mutshima dienzeke), enza bua muana ne bena mu nzubu bonso bapete dikuba dia grippe dia tshidimu tshionso didi kadiyi dienza mudimu, ne ubikile munganga webe wa muoyo diakamue pikala muanebe mupete **Grippe anyi Varicella (tshiamu) bua bobu kushintulula tshintu tshikuabu tshia kuondopa natshi manga adi apangisha mashi a mashi (clopidogrel) anyi kufila manga a dikuba nawu.
  • Kulekela manga a tshipupu tshia virus (MMR ne Varicella) bua ngondu 11 kunyima kua diangatshila dia bungi IVIG: Bualu bunene bua \(2\text{ g/kg}\) bua IVIG udi ne bintu bidi bikuba mubidi ku disama dia nsukadi, dia nsukadi, dia nsukadi ne dia nsukadi bidi biendakana mu mashi a muanebe munkatshi mua tshidimu tshijima, bifila MMR anyi Varicella dikuba dia mubidi kumpala kua dîba didi dipangisha tshiluilu tshia mubidi wa muanebe bua kuenza mudimu wa dikuba dia kashidi. Tangila kalandriye kebe bua kufila MMR/Varicella Ngondo 11 kunyima kua dituku dia IVIG dibueja.

Tshitupa 5: Disungula dia lumuenu lua njila lua "Red-Amber-Green" lua NICE bua disama dia buana dionso didi dienda dikola

Nansha mudi disama dia kapia dia matuku atanu dia muana kadiyi disama dia Kawasaki, baledi badi dijinga ne tshiamu tshia mudimu tshidi tshimanyine pa bimanyinu bia mushinga bua kumanya dîba didi disama dia mutantshi mule dilue sepsis wa bactérie, pneumonie, pyelonephritis (disama dia mifuba), osteomyelitis, anyi toxic shock syndrome. Biangatshila ku UK National Institute for Health and Care Excellence (NICE NG143) ne Tshilongelu tshia malu a bana tshia mu Amerike (AAP) mikenji, tangila muanebe udi ne disama dia tshiadi mu 5 Clinical Domains eyi kunyima kua mêba 4 to ne ku 6:

1. Tshibambalu tshia 5-Domain Pediatric Fever Traffic Assessment Table

Tshitupa tshia luondapu GREEN (Low Risk , Same-Day Clinic Check if Day 5+) AMBER (Intermediate Risk , Urgent ED / Doctor Evaluation Within 2-4 Hours) RED (High Risk , BIKIJA 911 / 112 / 999 NANSHA LUYE KU ED DIAMUE)
1. Dikala dia kikoba ne dipuekesha dia mashi Dikala dia pa tshibidilu dia dikoba, mishiku, ne ludimi; bianza ne makasa bidi ne luya; capillary refill \(< 2\text{ seconds}\). Pallor (dikoba anyi tshitupa tshia mêsu tshidi katshiyi tshia pa tshibidilu) tshimanyishibua kudi muledi; bianza/makasa mashika nansha mudiku tshipupu tshikole; dikumbaja dia kapila 2 too ne ku 3 sekonde. Pale, mottled (marbled violet-blanc), ashen-grey, anyi bleu (cyanotic) kikoba, mishiku, anyi ludimi; capillary refill \(> 3\text{ seconds}\).
2. Mudimu ne nsombelu wa mitu Udi wandamuna biyampe ku bilejilu bia bantu; udi useka anyi unaya padi luya lupueka kunyima kua ibuprofen/acetaminophen; kudila kukole. Katu ujuka bipepele to (udi ujuka anu ne dikankamika dia matuku a bungi); kakuyi kuseka nansha padi luya lupueka; dipueka dia mudimu; tshiji tshikole. Kakuyi diandamuna ku bilejilu bia bantu; udi umueneka musama/mubi kudi mumanyi wa malu a bukola bua mubidi; kayi mua kujuka anyi udi upona diakamue mu tshilema; muadi mutekete, mukola, anyi udi utungunuka.
3. Kupuyakana ne dikuma dia mutshima Dipuya dia pa tshibidilu; kakuyi dikoka dia tshiadi; dikuma dia mutshima didi dipingana ku tshilelela padi luya lupueka. Dibutuka dia mishiku; tachypnea (kupuya lubilu): \(> 50\text{ breaths/min}\) (bidimu 6-12 mo) anyi \(> 40\text{ breaths/min}\) (bidimu \(> 12\text{ mo}\)); oxygen saturation \(\le 95\%\); mutshima udi wenda unyunguluka (tachycardia) nansha kunyima kua dipueka dia kapia. Kuela mbila ne mupuya wonso; disama dia tshiadi tshikole (\(> 60\text{ breaths/min}\) ku bidimu bionso); disama dia tshiadi dia pa tshibidilu anyi dikole (intercostal/subcostal retractions) anyi kuela mutu panshi.
4. Dikumbaja dia mayi ne dienda dia mashi mu mashi Ludimi lutoke ne munda mua matama; binsonji bia pa tshibidilu padi muntu udila; \(\ge 4\text{ to }6\) diapers mikole ya mâyi mu mêba 24. Mishipa miume (ludimi ludi lulamakaja); kudia bibi (\(< 50\%\) ya mayi a pa tshibidilu); dipuekesha dia mashi (\(< 3\) diapers miume mu 24 hrs). Mêsu adi muinshi, dikoba dipueka (dikoba dia mu difu didi dishala dikole), fontanelle udi muinshi anyi udi mubuele, anyi mashi adi kaayi ne tshintu bua \(> 8\text{ too ne ku }12\text{ hours}\).
5. Bitupa bia pa buabi ne bipupu bikunze Kapia \(< 4\text{ matuku}\) ne tshipupu tshia mu mishiku/tshifu; kutokesha tshipupu tshia virus nkayatshi. Kapia kakole \(\ge 5\text{ matuku onso}\); divula dipiadipia dia tshiadi anyi dia tshitupa tshia mubidi; kubenga kuambula bujitu / bulema bupiabupia (septic arthritis anyi osteomyelitis); rigors (mashika a tshikisu). Tshitupa tshia violet/tshikunze tshidi katshiyi tshitoka (petechiae/purpura); nshingu mukole; bimanyinu bia mu lungenyi anyi bipupu bia mu lungenyi; bilious green vomiting; Muana \(< 3\text{ ngondo}\) ne temp \(\ge 38.0^\circ\text{C} (100.4^\circ\text{F})\).

2. Mushindu kayi wa kuenza "Diteta dia Glass Tumbler" bua tshipupu tshia sepsis tshidi katshiyi tshitoka (Petechiae / Purpura)

Dîba dionso didi muana udi ne disama dia fièvre upeta bipeta bikunze, bia rose anyi bia violet muaba wonso pa mubidi wende (kusangisha ne mubidi, maulu, bianza, makasa, anyi munda mua mêsu a kuinshi), enza Diteta dia dikala muinshi mua muendu udi ukenka: 1. Angata dikopo dia kunua dia dikopo dimpe, ditoke, dimpe (tumbler). 2. Fina luseke lua dikopo ditoke bikole ku dikoba buludiludi pa mutu pa miaba idi ne mputa too ne padi dikoba didi dinyunguluke dilua ditoke bua difina. 3. Blanching Rash (Reassuring for Petechiae): Bikala mabala makunze ajika ne alua matoke ku bukole bua dikopo ne pashishe alua kabidi mukunze paudi ubandisha dikopo, mishipa ya mashi idi mimpe (mitamba kuikala mu exanthemes ya virus, roseola, ne disama dia Kawasaki). 4. Non-Blanching Rash (CRITICAL EMERGENCY): Bikala mabala ashala anu makunze, a rose mufiike, anyi a violet mu dikalashi ditoke padi dikoba didi dinyunguluke dilua ditoke, mashi mmapatuke mu bimanu bia kapila bidi binyanguke mu dikoba (petechiae shi \(< 2\text{ mm}\) pinpoint dots; purpura if \(> 2\text{ mm}\) bilonda bidi bu bilonda). Mu muana udi ne kapia, tshipupu tshidi katshiyi tshitoka ntshia Meningococcal Sepsis (Neisseria meningitidis) anyi Disangisha dia mashi munda mua mashi (DIC) too ne padibu baleja ne: ki mmuomu to, bikila 911 / 112 / 999 diakamue.

3. Bintu bitanu bisokoka bidi bifikisha ku disama dia tshiadi tshia matuku 5 ne kupita tshidi baminganga batangila padibu babenga Kawasaki

Shi muanebe uvua ne kapia matuku 5 anyi kupita apu ne kayi ukumbaja malu adibu balomba bua disama dia Kawasaki dijima anyi kadiyi dikumbane, lomba munganga webe bua kukonkonona malu atanu aa adi atamba kufikisha ku kapia ka bana: 1. Disama dia mu njila wa mashi didi kadiyi dimueneka / Pyelonephrite wa tshimpitshimpi (Kidney Infection): Nangananga kudi bana ba bakaji badi ne bidimu muinshi mua 2 ne bana ba balume badi kabayi batengula badi ne bidimu muinshi mua tshidimu tshimue, disama dia tshiadi ditu misangu mivule difikisha **5 to ne ku 7 matuku a luya lua bungi (\(39.5\text{ too ne ku }40.5\text{ degrees Celsius}\)) ne ZERO bimanyinu bia mashika, ZERO, ZERO, ne kanyinganyinga kakole pa kumbusha tshimvundu ne mashi adi ne mupuya mubi. Bidi bikengela tshiamu tshia kupima natshi mashi tshidi ne katetere anyi tshidi tshikuata bimpe + microscopie + culture (kueyemenyi tshibombi tshia dikoba tshidi tshilamakaja bua kuenza culture to). 2. Adenovirus anyi Epstein-Barr Virus (Infectious Mononucleosis): Adenovirus utu wenza matuku 5 too ne ku 8 a kapia kakole (\(40\text{ degrees Celsius}\)), mêsu makunzubile, ne bintu bitoka bidi bipatuka mu mishiku, bidi bifuanangana ne disama dia Strep throat ne dia Kawasaki; tshipiminu tshia PCR tshia mupuya ne plakete mibandile/ya pa tshibidilu vs. laboratoire ya Kawasaki idi yambuluisha bua kuyisunguluja, nansha mudibi bimueneka ne: tshiamu tshia mupuya tshidi ne virus tshimpe katshiena tshipangisha disama dia Kawasaki to (bu mudi virus mua kujula disama dia Kawasaki). 3. Pneumonie Lobar Occulte anyi Pneumonie Bactérienne Post-Virale ("Biphasic Fever"): Shi muanebe uvua ne mashika makese ne luya lukese munkatshi mua matuku 3, umueneka bu uvua wenda bimpe munkatshi mua mêba 24 too ne ku 48, ne pashishe mupete luya lua bungi (\(39.5+\text{ degrees Celsius}\)) ne dipuyakana dia lukasa anyi tshifu mu dituku dia 5 anyi dia 6, udi mua kuela meji ne: udi ne *bactérie*Strémononie (Strép) pneumonia*) anyi disama dia tshiadi tshia munkatsh 4. **Tshitupa tshia munda mua nshingu (Retropharyngeal anyi klzzwxh:00): Shi mwana udi na luya lua matuku 5 ne **dibenga kunyunguluka nshingu wende (nangananga dibenga kutangila mulu / dilengeja dia nshingu), dîyi dia "hot-potato" didi dipueka, diela dia mayi, ai disama dia nshingu dia ku luseke lumue, lomba dikonkonona dia lukasa dia sama dia nshingu dikole. 5. Osteomyelitis anyi Septic Arthritis**: Misangu yonso ikala utangila muanebe udi ne kapia wenda upitshi mu nzubu wa tshikebelu kayi ne bilamba, bikala muana udi ne kapia matuku 5 mu tshimpitshimpi ubenga kuimana ku dikasa dimue, utshioka, anyi udila padibu banyungulula tshiadi, dikasa anyi tshikasa, bactérie idi mua kuikala miele tshitupa tshia mufuba anyi muaba wa dikola dia mifuba ( tshianza tshia muena mudimu wa bana ne muana mutekete udi ne mabenda makunze).

Tip

Paudi ulonda disama dia buana dia matuku a bungi kumbelu, ikala ne 4-Column Paper anyi Phone Log listing: (1) Exact Time & Temperature, (2) Medication & Dose Given, (3) Wet Diaper / Urine Output Count, ne (4) Daily Photos of Eyes, Mosukin and S. Kufila tshikondo etshi kudi munganga wa tshimpitshimpi mu dituku dia 4 anyi dia 5 kudi kusungila mêba a bungi a diela meji. Ela meji bua kuangata Dilongesha dia diambuluisha dia kumpala dia bana ne CPR kudi Croix-Rouge, American Heart Association, anyi St John Ambulance.

Nkonko itubu bela misangu ya bungi

Muana udi ne tshia kuikala ne bimanyinu bionso 5 bia kale bia Kawasaki musangu umue bua kupeta disama dia Kawasaki anyi?

Tòo. Tshia kumpala, bimanyinu 5 bia kale bia disama (mêsu makunze adi kaayi ne pus, mishiku mikunze mipanduluke/ludimi lua fraise, disama dia mubidi, bianza/makasa makunze, ne tshitupa tshia mu nshingu tshidi tshiuwule) bitu bimueneka misangu ya bungi mu bulongame mu matuku a bungi pamutu pa bionso mu dituku dimue, ke bualu kayi kuangata foto ya ku telefone ya ku bianza ya bimanyinu bia kumpala kudi ne mushinga wa bungi. Tshibidi, bana batue ku 20 too ne ku 30 pa lukama (ne bapite pa tshitupa tshia bana ba muinshi mua ngondo 6) badi bapeta "Disama dia Kawasaki didi kadiyi dikumbane (didi kadiyi dia tshibidilu)," mudibu ne matuku 5 anyi kupita apu a kapia kakole ne anu bimanyinu 2 anyi 3 bia kale, kadi badi ne njiwu ya muomumue ya disama dia mishipa ya mu mikolo padibu kabayi babapeta ku diambuluisha dia mateta a mashi (CSR) ne Echogramme.

Mmunyi mundi mua kubala matuku a kapia pikala Tylenol anyi Motrin upuekesha kapia bua mêba makese?

Mu malu a bana, "Dituku dia kumpala dia luya" ndituku dia kumpala dia kalandriye didi luya lua muanebe lufika anyi lupita 38.0 degre Celsius (100.4 degre Fahrenheit). Nansha mudi dose wa acetaminophen (paracetamol) anyi ibuprofen mua kupuekesha luya bua tshitupa tshîpi mu tshitupa tshia pa tshibidilu munkatshi mua mêba 3 anyi 5 kumpala kua kupingana kabidi, bidi anu bibala bu luya lua dituku dionso. Padi muanebe ubuela mu dituku dia 4 anyi dia 5 dia disama dia luya lua dituku dionso kayi ne dimanya dimpe dia disama, udi dijinga ne dikonkonona dia munganga dia dituku dimue dimue adi.

Bua tshinyi baminganga batu bapesha bana badi ne disama dia Kawasaki aspirine padi aspirine muikale njiwu kudi bana badi ne disama dia fièvre?

Pa tshibidilu, baledi kabena ne bua kupesha muana anyi nsonga aspirine padiye ne disama dia virus (nangananga grippe anyi tshipupu) bualu didi mua kuikala ne disama dia Reye. Disama dia Kawasaki i dimue dia ku masama adi kaayi atamba kuenzeka mu malu a luondapu: bualu disama dia Kawasaki didi dienza bua bungi bua plakete mu mubidi bubandile bikole too ne ku 500 000 too ne ku 1 000 000 ku microlitre mu lumingu luibidi ne luisatu lua disama edi padi bimanu bia mishipa ya mu mikolo bisama, munganga wa muoyo wa mu lupitadi udi ufila manga a bungi bua kuenza mudimu bimpe dituku dionso (panyima pa diondapangana dia IVIG) nangananga bua kupangisha mashi adi mua kunyanga muoyo bua kuikala munda mua mijilu ya muana.

Ndishilangana kayi didi pankatshi pa disama dia Kawasaki ne MIS-C (Multisystem Inflammatory Syndrome in Children)?

Nansha mudibi bionso bibidi bidi ne disama dia tshimpitshimpi didibu bondopa mu lupitadi ne IVIG ne steroïdes, disama dia Kawasaki didi ditamba kusama bana batekete ne bana batekete badi ne bidimu muinshi mua 5, didi dikuata mijilu ya mu mikolo idi ne bunene bua munkatshi, ne didi difikisha ku bungi bua plakete (thrombocytose). MIS-C udi wenzeka mbingu 2 anyi 6 kunyima kua disama dia SARS-CoV-2 (COVID-19), udi utamba kunyanga bana bakulumpe ba mu kalasa ne bansonga (ba bidimu 5 too ne ku 13), pabuipi ne misangu yonso udi ukebesha disama dikole dia mu difu, disama dia nsukadi, anyi disama dia munda (mu bilumbu 85 pa lukama), misangu ya bungi udi ukebesha disama dia mutshima dikole (yomodia dipanga dia mudimu ne tshipupu tshia tension mukese), ne bidi bifikisha ku dipueka dia bungi bua plakete (thrombocytopenie) ne dipueka dia bungi bua lymphocytes mu mateta a mashi.

Miaba mifumina

  • Tshisumbu tshia bena Amerika tshia muoyo (AHA, McCrindle ne bakuabu. & Jone et al.): Dimanyisha dia malu a sianse bua bena mudimu ba malu a bukola bua mubidi: Dimanya, diondapa ne dilama dia disama dia Kawasaki (Complete and Incomplete Kawasaki Algorithms, IVIG Dosing, and Coronary Artery Z-Score Surveillance).
  • Tshilongelu tshia bena Amerike tshia malu a bana (AAP, Mukanda mukunze): Disama dia Kawasaki ne disama dia mubidi wa bungi mu bana (MIS-C): Bimanyinu bia disama, bikondo bia dipingaja dia tshiamu tshia dikuba natshi bantu kunyima kua IVIG, ne dikuba dia disama dia Reye.
  • Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne a dilama dia bantu (NICE, Royaume-Uni, Mikenji NG143): Kapia mu bana ba muinshi mua bidimu 5: Dikonkonona ne dilombola dia kumpala (Traffic Light System and Kawasaki Disease Recognition).
  • Tshisumbu tshia bena Japon tshia dienda dia mikanda (JCS) Kasumbu ka mudimu kasangisha: Mibelu ya kujingulula ne ya kulombola disama dia muoyo mu disama dia Kawasaki.

Malu adi apetangana