Question:
Describe about the differential diagnosis, physical exam findings, most concerning diagnosis and additional diagnostic tests.Answer:
Differential Diagnosis
The differential diagnosis for the patient is ‘Kawasaki Disease'. After reviewing the symptoms, laboratory culture reports, age and vitals of the child and physical examination of the child, it can be estimated that the child is suffering from Kawasaki Disease.
Physical Exam Findings
Kawasaki disease starts in a febrile mode characterized by persistent and high fever, which continues over two weeks. With the progress of few days, antipyretics and antibiotics decrease responding.
Conjunctival inflammation is the second symptom of the disease and often it is bilateral and bulbar. It is the symptom accompanied by fever.
The third symptom of the disease is swollen red lips with occasional bleeding and cracking. The oropharynx mucosa becomes red with the appearance of strawberry tongue.
The fourth symptom includes the erythema of the peripheral extremities like palms and soles. This advances to become painful with striking demarcation.
The fifth symptom involves the cutaneous manifestations characterized by non-specific erythematous rash. Initially the rash is found on the trunk of the body, which spreads over time.
The sixth symptom is myocarditis and pericarditis. An increased heart rate and a decreased blood pressure characterize this.
Since the positive physical examinations of the child were found to be similar with the characteristic symptoms of the disease, so it was anticipated to be Kawasaki Disease that the child is suffering from (Kawasaki, 2014).
Most Concerning Diagnosis
Cardiac complications have been the most concerning diagnosis of Kawasaki disease. Mostly this disease acquires heart diseases in children. Myocardial infarction occurs due to formation of blood clot in aneurysm of coronary artery or rupture of the large aneurysm of coronary artery. This can lead to death, mostly after two to twelve weeks of the onset of the disease. During the healing process of the vessel wall, the coronary artery becomes narrow. Thus the heart fails to receive enough oxygen and blood due to obstruction, which further leads to the tissue death of the heart muscle (Eleftheriou et al., 2014).
Additional Diagnostic Tests
For the diagnosis of Kawasaki disease, no specific test is available. Therefore, the diagnosis process essentially involves ruling out of the diseases with similar symptoms and signs.
Since cardiac complications are the most concerning diagnosis of Kawasaki disease, therefore the additional diagnosis tests should include those, which are concerned with the cardiac functioning. These include Electrocardiogram, Echocardiogram and Chest X-Ray.
Electrocardiogram – Since Kawasaki disease causes complications of the heart rhythm, the child’s heartbeat has to be measured. This involves the attachment of electrodes to the skin for measuring the heartbeats.
Echocardiogram – This test is done to identify the functioning of the coronary arteries. Ultrasound images are used to detect the functioning of the heart.
Chest X-Ray – This is done to find out if the heart is affected by Kawasaki disease. Pictures inside the chest show the heart and the preliminary observations can be made.
Caregiver Information
The primary goal of Kawasaki disease treatment is the prevention of coronary artery disease and to get rid of the associated symptoms. The essential treatment regimen includes complete doses of intravenous immunoglobulin (IVIG).
Since the patients are admitted to the hospital for IVIG administration, the caregivers need to monitor closely the control of fever. However, focus should be on the monitoring of the cardiovascular functioning. Myocardial dysfunction or heart failure becomes unlikely when the fever gets resolved (Saguil et al., 2015).
References
Eleftheriou, D., Levin, M., Shingadia, D., Tulloh, R., Klein, N. J., & Brogan, P. A. (2014). Management of Kawasaki disease. Archives of disease in childhood, 99(1), 74-83.
Kawasaki, T. (2014). Kawasaki disease. International Journal of Rheumatic Diseases, 17(5), 597-600.
Saguil, A., Fargo, M., & Grogan, S. (2015). Diagnosis and management of Kawasaki disease. American Family Physician, 91(6), 365.
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