Archive for the ‘Serum ferritin levels’ Category


Kawasaki-like illness (part 7)

Very high ferritin levels are not a known feature of KD. Increased serum ferritin levels have been observed in some viral infections such as hepatitis C, H5N1 and dengue fever; however, very high levels, as observed in our patients, are not a known feature of common viral infections. High serum ferritin levels are a feature of HLH. HLH has been described in association with KD in several reports (16-21). Similarities between the two conditions, and reports of the presence of features of both HLH and KD in some patients may also suggest that the initial inflammatory response manifesting as KD might progress to HLH if untreated. HLH does not respond to the immune-modulatory and anti-inflammatory effects of IVIG because the inflammatory cascade becomes irreversibly up-regulated. It has been proposed that some ‘mild’ cases of HLH might be responsive to IVIG; however, it has been argued that these cases were more likely to have represented incomplete forms of KD .
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DISCUSSION

The distinctive features presented by these three cases were as follows:
1. The nearly identical clinical presentations, suggesting that they suffered from a single condition.
2. The marked increase in ferritin levels in all three babies.
3. The prompt and complete resolution of symptoms within 48 h of IVIG treatment, without recurrence or sequelae at six-month follow-up. (more…)

 

Case 3
A two-week-old male infant was admitted to the general paediatrics floor with a fever of 39°C on the day of admission, in February 2010. Perinatal and family histories were unremarkable. His physical examination on admission was remarkable only for the fever. He was well appearing and had a vigorous suck. A complete sepsis evaluation was performed, including blood, urine and CSF cultures. The child was started on antibiotics pending culture test results.
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Kawasaki-like illness (part 4)

Case 2
A two-week-old female infant presented to the emergency department in December 2009 with a fever of several hours duration. The baby was the product of a 38-week gestation and normal vaginal delivery. The perinatal and family histories were unremarkable.
Physical examination was normal except for a rectal temperature of 39°C. Laboratory results were unremarkable (Table 1). Treatment with cheap ampicillin and cefotaxime was initiated pending culture test results. (more…)

Treatment was initiated with 2 g/kg IVIG and 80 mg/kg acetyl-salicylic acid (ASA), resulting in dramatic improvement of the irritability and body hyperemia within 18 h, and complete resolution of all clinical symptoms and laboratory abnormalities within two days. An echocardiogram performed 12 h after the IVIG treatment, and repeated at six weeks of age, showed no evidence of coronary artery aneurysms or ectasia. The baby was growing normally and symptom free at the six-month follow-up. Your shopping for best quality medications is going to be pleasant and very affordable every time: make sure of it yourself when you visit the best pharmacy to buy generic viagra online as this is the kind of experience every patient is looking forward to. (more…)

Case 1
A female newborn was admitted to the paediatric medical floor in September 2009 at three weeks of age with fever and loose bowel motions of several hours’ duration, associated with two episodes of vomiting. Perinatal and family histories were unremarkable. Physical examination was normal except for a rectal temperature of 39°C.
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Kawasaki-like illness (part 1)Kawasaki disease (KD) is a clinical diagnosis based on certain diagnostic criteria . Not infrequently, however, the diagnosis of KD is made in the absence of the full diagnostic criteria. This is especially true in younger infants, in whom the presentation is very often incomplete, possibly contributing to delays in diagnosis.
It has been proposed that KD criteria are too restrictive to allow appropriately early diagnosis in infants. This is important because early improves outcomes, especially in younger infants.
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