Kawasaki disease—sudden death as the first presenting symptom

1992 ◽  
Vol 2 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Louis Tsun-cheung Chow ◽  
Wing-hing Chow ◽  
Christopher Chun-hing Tse ◽  
Eric Hon-man Wong ◽  
Koon-sang Wong ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Sudden Death ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Underlying Disease ◽  
Postmortem Examination ◽  
Arterial Aneurysm ◽  
True Nature ◽  
Clinical Signs And Symptoms ◽  
High Index Of Suspicion

SummaryTwo patients are described with sudden death as the first presenting symptom of Kawasaki disease. The first patient died of cardiac tamponade as a result of rupture of a coronary arterial aneurysm at the age of three months and nineteen days. The second patient, one and half years old, developed acute myocardial infarction secondary to coronary arterial aneurysm and thrombosis. The true nature of their underlying disease was realized only after postmortem examination. Their clinical signs and symptoms of Kawasaki disease might be so mild as to escape recognition. A high index of suspicion should be exercised by the clinician in order not to miss this condition, especially in places where Kawasaki disease is uncommon.

Pathology of the Heart in Kawasaki Disease

PEDIATRICS ◽  
1978 ◽  
Vol 61 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Hisayoshi Fujiwara ◽  
Yoshihiro Hamashima
Keyword(s):  
Kawasaki Disease ◽  
Clinical Signs ◽  
Stage Iv ◽  
Signs And Symptoms ◽  
Conduction System ◽  
Coagulation Necrosis ◽  
Duration Of Illness ◽  
Cardiac Lesions ◽  
The Media ◽  
Clinical Signs And Symptoms

Pathologic studies were done on 20 hearts of patients who had typical clinical signs and symptoms of Kawasaki disease. The cardiac lesions were classified according to the duration of illness at the time of death. Stage I (zero to nine days) was characterized by acute perivasculitis and vasculitis of the microvessels (arterioles, capillaries, and venules) and small arteries, and acute perivasculitis and endartenitis of the three major coronary arteries (MCAs). Penicarditis, myocarditis, inflammation of the atrioventricular conduction system, and endocarditis with valvulitis were also present. Stage II (12 to 25 days) was characterized by panvasculitis of the MCAs and aneurysm with thrombus in the stems. Myocarditis, coagulation necrosis, lesion of the conduction system, pericarditis, and endocarditis with valvulitis were also present. In stage III (28 to 31 days), granulation of the MCAs and disappearance of inflammation in the microvessels were noted. Patients in stage IV (40 days to 4 years) had scarring with severe stenosis in the MCAs. Fibrosis of the myocardium, coagulation necrosis, lesions of the conduction system, and endocardial fibroelastosis were also present. The features observed revealed Kawasaki disease to be acute and inflammatory. The angiitis begins in the microvessels and fibrinoid necrosis of the media is rare. The disease is one with a pathologic pattern previously unknown.

Laboratory Diagnostics in Septic Disseminated Intravascular Coagulation

2009 ◽  
Vol 03 (01) ◽  
pp. 19
Author(s):  
Giuseppe Lippi ◽  
Gian Cesare Guidi ◽  
◽  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Coagulation Factors ◽  
Underlying Disease ◽  
Laboratory Diagnostics ◽  
Diagnostic Efficiency ◽  
Intravascular Coagulation ◽  
Diagnostic Algorithms ◽  
Clinical Signs And Symptoms

The diagnosis of septic disseminated intravascular coagulation (DIC) relies on clinical signs and symptoms, identification of the underlying disease and results of laboratory testing. Since no single test result alone can definitely establish or rule out the diagnosis, the laboratory diagnostics of septic DIC encompass a combination of tests for which simple diagnostic algorithms are now available. Global tests of haemostasis provide evidence of activation of blood coagulation and, ultimately, consumption of coagulation factors, but their diagnostic efficiency is as yet questionable. Fibrinolytic markers, namely D-dimer, reflect the extent of activation of both coagulation and fibrinolysis, so a normal value can be used in a ruling-out strategy. Decreased levels of the natural inhibitors are frequently observed in patients with septic DIC, but antithrombin and protein C measurements are not incorporated in any of the widely used diagnostic algorithms. Among the inflammatory biomarkers, procalcitonin is currently regarded as the gold standard to differentiate the type of infection and guide antibiotic therapy, but its clinical usefulness in identifying and predicting the outcome of patients with septic DIC is still circumstantial.

scholarly journals Giant posterior gastric perforation in a 40 years old male: a case report

2021 ◽  
Vol 8 (6) ◽  
pp. 1907
Author(s):  
Raheel Hussan Naqvi ◽  
Khushwant Singh ◽  
Rahul Singh
Keyword(s):  
Gastric Perforation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The Body ◽  
Clinical Entity ◽  
Delayed Presentation ◽  
Relative Paucity ◽  
Life Saving ◽  
Clinical Signs And Symptoms ◽  
High Index Of Suspicion

Posterior perforation of gastric ulcer is a rare clinical entity and has a propensity for delayed presentation and missed diagnosis. By virtue of their location, posterior gastric perforations may rupture into the retroperitoneum which leads to abscess formation and development of adhesions and consequently, leads to a delay in the onset of symptoms. Alternatively, ulcers located in the fundus or the body of the stomach may perforate into the lesser sac, which results in sealing off the perforation and less dramatic clinical signs and symptoms. This delay in presentation contributes to higher morbidity, higher infection rates and higher mortality. Thus, it is essential to have a high index of suspicion for this condition, particularly in patients with a protracted clinical presentation and classical risk factors so that timely, life-saving intervention is possible. We report a case of giant posterior gastric perforation with benign histopathology in a 40-years-old male. This case is being presented due to the rarity of this clinical entity and the relative paucity of literature on the same.

scholarly journals Bacterias anaerobias del suelo responsables de la muerte súbita bovina en sabanas tropicales: investigaciones realizadas en Colombia

2008 ◽  
Vol 9 (1) ◽  
pp. 102
Author(s):  
Diego Ortiz ◽  
Luis Carlos Villamil
Keyword(s):  
Sudden Death ◽  
Clostridium Botulinum ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clostridium Tetani ◽  
Cattle Feeding ◽  
Type C ◽  
Clinical Signs And Symptoms ◽  
Clostridium Chauvoei ◽  
Alternative Solutions

<p>El estudio de las clostridiosis en Colombia debe ser una prioridad para nuestras autoridades sanitarias debido al impacto sanitario que causan estas bacterias en la salud animal. Así mismo, la agudeza de los signos y síntomas clínicos de estas patologías, y el hecho que afectan animales en buenas condiciones de carne, hacen que tengan fuerte impacto económico. Se presenta una revisión de las principales investigaciones realizadas sobre clostridiosis en los últimos años, algunas publicadas en literatura científica y otras en literatura gris. Se hace énfasis en la muerte súbita bovina, condición que incluye varias patologías entre las que se destacan el botulismo bovino producido por las neurotoxinas tipo C y D de <em>Clostridium botulinum</em>, el carbón sintomático (pierna negra) causado por <em>Clostridium chauvoei </em>y en menor proporción el tétanos, causado por el <em>Clostridium tetani</em>. Se reportan algunos avances en la estandarización de metodologías de diagnóstico en laboratorio y en campo, lo mismo que resultados de estudios epidemiológicos desarrollados en zonas afectadas por estas enfermedades. Finalmente, se presenta una visión prospectiva sobre la investigación en los clostridios y las clostridiosis, lo mismo que algunas propuestas de solución a la problemática discutida.</p><p><strong> </strong></p><p><strong>Anaerobic soil bacteria causing sudden death in cattle feeding on tropical savannahs: research in Colombia </strong></p><p>The study of the clostridiosis in Colombia must be a priority for sanitary authorities due to the sanitary and economic impact caused by these bacteria. Disease clinical signs and symptoms, and effect on animals in good meat condition suppose a high financial impact. This article reviews major research in clostridiosis in recent years, published in scientific and gray literature. Emphasis is made on bovine sudden death, which includes a number of diseases among them botulism produced by neurotoxins type C and D of <em>Clostridium botulinum</em>; black leg caused by <em>Clostridium chauvoei </em>and to a lesser extent tetanus, caused by <em>Clostridium tetani</em>. Some progress in standardization of laboratory and field methodologies is reported, as well epidemiology in areas affected by these diseases. We conclude with a prospective proposal of research in clostridia and clostridiosis, as well as some ideas on alternative solutions to the problems discussed. </p>

Cardiac Tamponade Physiology Secondary to Tense Ascites

Cardiology ◽  
2016 ◽  
Vol 134 (4) ◽  
pp. 423-425 ◽  
Author(s):  
Saad Ahmad ◽  
Hina K. Jamali ◽  
Fahad Waqar ◽  
David M. Harris
Keyword(s):  
Liver Disease ◽  
Cardiac Tamponade ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Abdominal Pressure ◽  
Inferior Wall ◽  
Extrinsic Compression ◽  
Life Threatening ◽  
Clinical Signs And Symptoms ◽  
High Index Of Suspicion

Cardiac tamponade is a common and often life-threatening process, which is typically associated with a pericardial effusion or, in rare cases, with a large pleural effusion. Theoretically, as reported in only a single prior case, it can be caused by extrinsic compression from tense ascites. We present a case in which dynamic inferior wall collapse was secondary to increased abdominal pressure from tense ascites. This phenomenon may be more common than previously diagnosed, especially in patients with liver disease. These patients often develop frequent ascites and present with clinical signs and symptoms similar to cardiac tamponade (tachycardia, hypotension and dyspnea). Presently, no formal practice guidelines exist regarding cardiac imaging for these patients. A high index of suspicion is required for timely diagnosis and management.

Serotonin toxicity

2011 ◽  
Vol 28 (2) ◽  
pp. i-iv ◽  
Author(s):  
Sobia Nasim ◽  
Faraz Jabbar ◽  
Asfar Afridi ◽  
Brendan D Kelly
Keyword(s):  
Differential Diagnosis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Causal Agent ◽  
Vital Functions ◽  
Threatening Condition ◽  
Life Threatening ◽  
Clinical Signs And Symptoms ◽  
High Index Of Suspicion ◽  
Serotonin Toxicity

Serotonin toxicity is a potentially life-threatening condition associated with a range of psychotropic medications, co-administration of specific combinations of agents and overdose of certain drugs. It is associated with a wide diversity of clinical signs and symptoms, including cognitive, autonomic and somatic effects, as well as serious complications, including possible death. Diagnosis is often challenging and requires a high index of suspicion. Differential diagnosis includes syndromes such as neuroleptic malignant syndrome. Management depends on the causal agent and urgency of clinical presentation. Treatment may involve discontinuing the causal agent and providing supportive measures, or emergency intervention to preserve vital functions (airway, breathing, circulation), amongst other measures. Further research is needed to clarify the incidence of serotonin toxicity, issues related to differential diagnosis, optimal management of the condition, and treatment of mood problems following serotonin toxicity.

scholarly journals Plasmodium falciparum infection among neonates in the North Central Region of Nigeria

2013 ◽  
Vol 7 (05) ◽  
pp. 365-371 ◽  
Author(s):  
Caroline Amuche Okoli ◽  
Seline Nneaku Okolo ◽  
John Chibunkem Collins
Keyword(s):  
Plasmodium Falciparum ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Malaria Parasitaemia ◽  
Cross Sectional ◽  
The North ◽  
Clinical Signs And Symptoms ◽  
High Index Of Suspicion

Introduction: This cross-sectional study investigated the rate of congenital and neonatal malaria infections in patients attending our hospital. Methodology: Thick and thin blood films of 288 neonates admitted in the Special Care Baby Unit of Jos University Teaching Hospital, Nigeria, were examined microscopically for malaria parasites. Babies’ and mothers’ demographic and clinical data were analyzed. Results: Of 288 blood samples examined, 160 (55.6%) were from males, 115 (39.9%) were from babies 0 to 7 days old, and 173 (60.1%) were from babies 8 to 28 days old. In total, 91 (31.6%) babies had malaria parasitaemia, of whom 49 (53.8%) were males. Malaria was significantly higher in babies 8 to 28 days old (p<0.001) and was independent of gender (p=0.692). Prevalence rates for congenital and neonatal malaria were 6.9% and 24.7% respectively. Clinical presentations on admission included fever, cough, pallor, jaundice, and inability to suck. A total of 145 (50.3%) babies had symptoms of malaria, of whom 56 (61.5%) had malaria parasitaemia. Symptoms of malaria were present in 35 (12.2%) babies of 59 (20.5%) mothers who had symptoms of malaria during pregnancy. Ten (11.0%) of these neonates had malaria parasitaemia, of whom 4 (0.4%) were 0 to -7days old. Plasmodium falciparum was the only specie identified. No mortality was recorded against malaria-infected babies. Conclusion: High prevalence of malaria in these neonates calls for high index of suspicion. Inclusion of malaria parasite test in the routine battery of tests for babies presenting with clinical signs and symptoms of neonatal infections is recommended.

scholarly journals Kawasaki Disease Shock Syndrome in Japan and Comparison With Multisystem Inflammatory Syndrome in Children in European countries

2021 ◽  
Vol 9 ◽  
Author(s):  
Junko Suzuki ◽  
Kota Abe ◽  
Takuya Matsui ◽  
Takafumi Honda ◽  
Kumi Yasukawa ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Good Prognosis ◽  
European Countries ◽  
Cardiovascular Agents ◽  
Clinical Signs And Symptoms ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome in children (MIS-C) is a severe Kawasaki-like illness that was first linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in European countries in the spring of 2020 and has been suggested to have overlap with Kawasaki disease shock syndrome (KDSS). There are few reports of MIS-C from Asia. This observational study aimed to identify the clinical features in children presenting with KDSS in Japan over a 5-year period and to summarize similarities and differences between KDSS and MIS-C. We retrospectively collected data on patient characteristics, clinical signs and symptoms, treatment, and prognosis including coronary artery abnormalities (CAAs), which were compared with data of patients with KDSS worldwide and patients with MIS-C from a review. KDSS was identified in 6 (1.1%) of 552 patients with Kawasaki disease (KD) treated at a single institution in Japan between 2015 and 2020 (1 in 2020). In patients with KDSS in Japan or worldwide vs. patients with MIS-C, KDSS was more likely to have a diagnosis of complete KD (100, 70 vs. 6.3%), a higher incidence of CAAs (50, 65 vs. 11%), and a greater requirement for vasoactive agonists (67, 67 vs. 43%) because of circulatory shock (100, 50 vs. 26%). Both KDSS and MIS-C had good prognosis (mortality 0, 6.7 vs. 1.7%). Although KDSS in Japan and MIS-C show some overlap in clinical symptoms, they are unlikely to be the same disease entity. KDSS is more likely to have a cardiovascular phenotype with CAAs and requires treatment with cardiovascular agents.

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