Childhood exanthems. Old and new

Coronary Artery Dilation in Children with Febrile Exanthematous Illness without Criteria for Kawasaki Disease

Background

Coronary dilatation is the most important complication of Kawasaki disease (KD) and, in addition to some clinical characteristics, is common to KD and febrile exanthematous illnesses (FEIs).

Objective

To assess whether children with FEI, who do not meet the criteria for KD, have changes in coronary arteries dimensions.

Methods

Echocardiography was performed within the first two weeks of the disease in patients < 10 years with fever and exanthema without other KD criteria. To make a comparison with KD patients, we reviewed the echocardiograms and medical records of patients with a diagnosis of KD of the last five years. Coronary ectasia was assessed using Z scores of coronary arteries. The means of the dimensions of the coronary arteries were compared with a z test and a level of significance of 0.05 was adopted.

Results

A total of 34 patients were included, 22 (64.7%) with FEI, and 12(35.2%) with a diagnosis of KD. Using the Z scores of coronary artery, a dilation of any of the coronary artery branches was observed in six (27.2%) patients with FEI.

Conclusions

An important percentage of patients with FEI has coronary artery dilation.

Annular lesions in Kawasaki disease: a cause of confusion

We present three cases of Kawasaki disease in which an annular eruption was the predominant cutaneous finding. The provisional diagnosis was Stevens-Johnson syndrome. However, the annular lesions were not typical of Stevens-Johnson syndrome: the lips were crusted without mucosal ulceration and the conjunctivitis was non-purulent without corneal erosions. Dermatologists are often involved in the initial assessment of this multisystem disease and should be aware of the variety of cutaneous manifestations, as rapid treatment is known to decrease morbidity and mortality.

A Case of Vitiligo after Kawasaki's Disease

Vitiligo is a common skin disease, but its pathogenesis has not been fully determined, though an autoimmune etiology is considered likely. Kawasaki disease (KD) is an acute multisystem vasculitis of childhood associated with coronary arteriopathy, and is diagnosed based on clinical criteria. Furthermore, vitiligo has been associated with several other diseases, but no report has been issued about the relationship between vitiligo and Kawasaki's disease. The author's report the case of an 8-year-old male child that presented with depigmented lesions, which developed from the desquamative skin lesions of Kawasaki's disease.

[Incidence and clinical characteristics of maculopapular exanthemas of viral aetiology]

OBJECTIVE

To estimate the incidence of maculo-papular viral exanthemas and to describe the epidemiological and clinical patterns.

DESIGN

Observational descriptive study with a sample design.

PARTICIPANTS AND SETTING

154 practitioners from the Castilla y León Sentinel Network with a surveilled population of 23 237 people-year under 15 years old, notified in 2002 the cases of diseases by means of a standard form with the variables and inclusion and exclusion criteria.

MAIN MEASUREMENTS

It was included the maculo-papular exanthemas associated to a presumable systemic virus disease in patients under 15 years old. It was excluded the infectious mononucleose, the chickenpox, and other non viral infections or exanthemas.

RESULTS

368 cases were notified which represent a incidence rate of 158.37 cases per 10 000 (95% CI, 142.31-174.42). The incidence was maximum under four years old, more than 350 per 10 000, decreasing significantly in children over this age. Erythema infectiousum presented the highest rate, followed by exanthema subitum. The exanthemas caused by measles or rubella were insignificants.

CONCLUSIONS

Childhood exanthematous diseases of presumable viral etiology have an important incidence in primary care, although the majorities are banal and self-limited diseases. Clinical characteristics supported the suspicion diagnosis, which was consistent with the observed epidemiological description and expected presentations of each disease. Although serological analysis could diminish the uncertainly on notification and control of diseases submited to especial programs of vaccination and eradication, they would not improve substantially the diagnosis and treatment of these patients.

Pediatric exanthems

Many childhood diseases have cutaneous manifestations such as exanthems. More than 50 agents (viral, bacterial, or rickettsial) that cause exanthems in children have been identified. This article describes a systematic approach for evaluating 12 common exanthems. Diagnosis is made by correlating the location, morphology, and timing of the eruption with associated constitutional signs and symptoms.

New aspects of exanthematous diseases of childhood

The childhood exanthems include a spectrum of common and uncommon disorders caused by a variety of pathogens. In this article, timely issues relating to immunization for measles and varicella are discussed. Recently reported exanthematous illnesses, including papular-purpuric gloves and socks syndrome, unilateral laterothoracic exanthem, and eruptive pseudo-angiomatosis, are described. The current research and debate about bacterial toxins as the cause of Kawasaki syndrome are presented.

Histiocytoses

Childhood histiocytoses are a rare and diverse group of histiocytic disorders. This review will focus on clinical, pathological and immunopathological features of these syndromes. The pathogenesis of Langerhans' cell histiocytosis or class I histiocytosis, a proliferative disorder of the Langerhans' cell, remains enigmatic. Approaches to treatment are as varied as the clinical presentations, ranging from a fatal leukaemia-like disorder to solitary lytic lesions of bone. Recent findings indicate that Langerhans' cell histiocytosis is a clonal histiocytic disease. The two major class II histiocytoses are familial erythrophagocytic lymphohistiocytosis and the reactive haemophagocytic syndromes. The clinicopathological similarities between these two entities suggest that they share a common immunological feature in which uncontrolled cytokine release from activated T-cells leads macrophages to a haemophagocytosing state.