Kawasaki syndrome

Article Abstract:

Kawasaki disease, also called mucocutaneous lymph node syndrome, affects young children. The symptoms include signs of diffuse inflammation affecting many organs of the body, fever, rash, inflammation of the conjunctiva of the eyes, and inflammation of the mucous membranes. These symptoms are common with many infections, and the diagnosis of Kawasaki disease must carefully exclude several common infections. Kawasaki disease itself is also suspected to be caused by some infection, but a causative agent has never been identified. In addition to the symptoms, which are suggestive of infection, the sporadic occurrence of the disease in the population is occasionally interrupted by outbreaks. At most times, the incidence of Kawasaki disease in the United States is about 4.5 to 8.5 cases per 100,000 children each year. During an outbreak, this incidence may rise to 150 cases. While this pattern of outbreaks is strongly suggestive of infection, there are no recorded instances of the transmission of Kawasaki disease from one child to another. Kawasaki disease may cause inflammation of the coronary arteries of the heart, and this may lead to heart attacks in some children. Heart attacks among victims of Kawasaki disease are not common, but may affect as many as 2 percent of the cases. The heart attacks often occur as long as one year after the acute illness and perhaps as long as several years later. One fifth of the first heart attacks are likely to be fatal. Kawasaki disease is treated with aspirin and human immunoglobulin. The aspirin serves to ease the symptoms of inflammation. The function of the immunoglobulin is not certain, but it is suspected that harm may be coming from some of the patient's own immunoglobulin, or antibodies, bound to some unknown foreign molecule, and the immunoglobulin from outside may simply interfere with the patient's antibodies. In the June 6, 1991 issue of The New England Journal of Medicine, researchers present evidence that the conventional treatment of Kawasaki disease, which included immunoglobulin injections over a four-day period, is inferior to a method involving one large single dose of immunoglobulin. Not only is the single-dose method superior in outcome for the patient, but also reduces the time of the necessary hospital stay as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Immunoglobulins, editorial, Kawasaki disease, Kawasaki syndrome

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Handwashing and nosocomial infections

Article Abstract:

Hospital health care workers may often neglect to wash their hands, despite the danger of spreading nosocomial infections to their patients. Nosocomial infections are infections acquired in the hospital, and are often transmitted on the hands of health care workers. A research study of hand washing by health care workers in the intensive care units (ICU) of one hospital found that only 30% to 48% washed their hands. The Centers for Disease Control's (CDC) guidelines state that health care workers should wear gloves because compliance with hand washing rules is so poor. Health care workers may be no better at following rules about wearing gloves. The CDC's guidelines only require precautions when treating patients with certain infections or infections that are resistant to treatment. Body-substance isolation (BSI) is a new system that requires workers to wear gloves while in contact with mucous membranes or the body substances of certain patients. This system is expensive, and its effectiveness is questionable. Other infection-control experts recommend washing with soap or an antimicrobial agent.

Editorial, Prevention, Nosocomial infections, Cross infection, Hand washing, Handwashing

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