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Kawasaki disease is a rare form of blood vessels inflammation (vasculitis) in children. Inflammation within the walls of small to medium-sized blood vessels responsible for transporting blood throughout the body can result in these vessels becoming vulnerable to weakening and expansion. This increased vulnerability may lead to the risk of vessel tearing or narrowing. It impacts all of the body’s arteries, but the primary focus of concern lies with the coronary arteries, which are responsible for providing blood to the heart. This may result in heart problems among children.
Kawasaki disease in children can cause high fevers, swollen hands and feet with peeling skin, as well as red eyes and tongues. It was also known as mucocutaneous lymph node syndrome due to its ability to induce inflammation in both lymph nodes and the mucous membranes found in the mouth, nose, eyes, and throat.
Kawasaki disease happens most often in children 6 months to 5 years of age. Most children recover without serious complications in about two months if treated within 10 days of the start of the disease. Medications are often used to treat Kawasaki disease.
Symptoms
Symptoms of the Kawasaki disease may not manifest at the same time. A child typically needs a fever for five or more days and at least four of the following symptoms to be diagnosed with Kawasaki disease.
Symptoms of Kawasaki disease include:
- A rash occurring on the main part of the body or within the genital area
- Swollen lymph node in the neck
- Eyes that are red or pink with no significant discharge
- Lips that are red, dry, and cracked, along with a notably swollen, red tongue.
- Skin on the palms of the hands and the soles of the feet exhibiting pronounced redness and swelling, followed by subsequent peeling of the skin on the fingers and toes.
Some cases of Kawasaki may include these signs and symptoms:
- Stomach pain
- Diarrhea
- Vomiting
- Irritability
- Aching joints
Incomplete Kawasaki disease may occur if a child had a high fever for five or more days but fewer than four of the other signs and symptoms. Children with incomplete Kawasaki disease is still required of treatment within 10 days of the onset of symptoms because they still run the risk of suffering from coronary artery damage.
Children who exhibit these symptoms may also undergo COVID-19 testing, as Kawasaki disease can present similar symptoms to the multisystem inflammatory syndrome in children with COVID-19 worldwide.
If the child experiences a recurrent fever, severe joint pain, or worsening of previous symptoms, contact a healthcare provider for proper diagnosis and treatment.
If Kawasaki disease is treated within 10 days of the onset, there may be a significant reduction in the possibility of long-term damage to the coronary arteries feeding the heart muscle. Complications impacting the heart can reach a severity level that may result in fatality between 15 and 45 days after the onset of a fever.
Causes
The precise cause of Kawasaki disease remains elusive. Scientists are actively exploring potential factors that might play a role in the development of Kawasaki disease, including infections, environmental factors, and genetic influences. Some hypotheses suggest that Kawasaki disease may arise from a combination of environmental factors or develop in the wake of a bacterial or viral infection.
Risk factors
Several factors may contribute to one’s risk of acquiring Kawasaki disease. More cases also happen in late winter and early spring in North America. The risk factors include:
- Age: The risk of acquiring Kawasaki disease is higher among kids under 5 years old.
- Sex: Kawasaki disease is more likely to affect boys than girls.
- Ethnicity: Kawasaki disease is more common in children of Asian or Pacific Island ancestry, including Japanese or Korean children.
Diagnosis
There is no specific test that can confirm Kawasaki disease. In cases where a child exhibits only a subset of the symptoms, it may indicate an atypical or incomplete presentation of Kawasaki disease.
Other illnesses with similar signs and symptoms must be ruled out, such as scarlet fever, juvenile rheumatoid arthritis, Stevens-Johnson syndrome, toxic shock syndrome, mumps, and tick-borne diseases such as Rocky Mountain spotted fever.
Several tests may be required to confirm the diagnosis, such as:
- Physical examination: The diagnosis usually involves assessing the signs and symptoms and performing a physical examination.
- Blood tests: Anemia, high white blood cell count, and inflammation are indications of Kawasaki disease. Blood tests are often required to assess the blood cell count and rule out other disorders.
- Electrocardiogram: Heart rhythm issues might result from Kawasaki disease. An EKG is a noninvasive examination for assessing the heartbeat rhythm in the child’s heart. To measure the electrical impulses of the heartbeat, electrodes are affixed to the skin.
- Echocardiogram: This test involves utilizing an ultrasound device on the chest’s surface to detect issues with coronary arteries as well as observe how efficient the heart and artery’s function.
Treatment
The primary objective of the initial treatment for Kawasaki disease is to accomplish several key goals: reduce fever, decrease inflammation, mitigate the risk of arterial damage, prevent blood clots in individuals with coronary artery issues, and forestall any cardiac-related complications. To prevent lasting complications, it is crucial to initiate Kawasaki disease treatment as early as feasible, preferably while the child is still having a fever.
Common treatment options for Kawasaki disease include:
- Gamma globulin: Gamma globulin, an immune protein, can reduce the incidence of coronary artery issues when administered intravenously. It aids in reducing inflammation in the vessels. 10% of kids may not respond to the initial IVIG treatment and require a second dose or additional drugs.
Aspirin: Aspirin is often prescribed to reduce fever, pain, and joint inflammation. If taken at higher doses, may significantly reduce inflammation. Once the fever has subsided for 48 hours, it is likely that the aspirin dosage will be reduced.
Kawasaki disease treatment is an exception to the usual rule of not giving aspirin to children. This is because aspirin can lead to a rare and dangerous condition called Reye’s syndrome in children recovering from chickenpox or the flu. Aspirin should only be administered to kids with Kawasaki disease when a doctor is present to supervise the administration, which is usually done in a hospital setting at the initial treatment of the condition.
After the initial course of treatment: Kawasaki disease lasts approximately 12 days without therapy. Heart problems, however, could persist for a longer time.
After the initial gamma globulin treatment, the child may begin to improve with treatment.
The kid may need to take low-dose aspirin for at least six weeks after the fever has subsided and may be longer if coronary artery aneurysm developed. It may also be necessary to halt aspirin use in kids who contract the flu or chicken pox while receiving treatment.
Monitoring of cardiac issues: Depending on the type of cardiac issue present, Kawasaki disease-related heart complications are treated differently. Normally, the healthcare provider may advise follow-up tests to evaluate the child’s heart health periodically, typically at 6 to 8 weeks after the sickness started and then again at six months if there are any indications of heart issues.
Delay vaccination: Gamma globulin administration can influence the efficacy of specific vaccines. Healthcare providers should be informed if a child has a history of Kawasaki disease. Typically, it is recommended to wait at least 11 months before administering a live vaccine, such as those for chickenpox or measles, to children who have undergone gamma globulin treatment for Kawasaki disease.
