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What is Kawasaki disease (KD)?
Kawasaki disease is an illness that young children can get (usually children younger than 5 years of age).
KD is an acute, self-limited, febrile illness of childhood, characterized by systemic inflammation of the medium-sized arteries, most notably the coronary arteries, and in multiple organs and tissues.
KD leads to the development of coronary artery aneurysms in up to 25% of untreated cases and is now the leading cause of acquired heart disease in children in the developed world.
6 Interesting Facts of Kawasaki disease
1.KD is the most common vasculitis and cause of acquired heart disease in children.
2. Consider KD in any child under the age of 5 years presenting with prolonged high fevers and conjunctivitis.
3. Consider KD in the differential diagnosis of any infant under the age of 6 months with fever for >7 days without a source.
4. When considering KD, a careful history is essential. Some manifestations of KD may be transient, but still count in considering which of the principal clinical features are present toward fulfilling the diagnostic criteria.
5. Incomplete KD not meeting full diagnostic criteria does exist.
6. Intravenous immunoglobulin (IVIG) and aspirin are the gold standard first-line therapies for KD.
How soon will my child be over Kawasaki disease?
It usually takes a few weeks for a child to get over KD. You’ll have to keep your child home from school or day care until he or she feels strong enough to return.
What are the symptoms?
Children who have KD have a fever (sometimes as high as 104°F) for 5 days or longer. Usually, they also have at least 4 of the following symptoms:
Some children who have KD also have diarrhea, vomiting and stomach pain. Kawasaki disease might make your child very irritable and cross.
- A red, patchy rash that may cover the whole body
- Swollen lymph nodes in the neck
- Swollen and red hands and feet and, later in the illness, peeling skin on the fingers and toes
- Changes in the lips and mouth, such as red, cracked lips, a very red tongue and redness in the mouth and the back of the throat
- Red, bloodshot eyes
What causes Kawasaki disease?
No one knows what causes Kawasaki disease. Some doctors think it may be caused by a virus or bacteria. The illness can last from 2 weeks to a few months.
A subset of patients who meet diagnostic criteria for MIS-C also meet the criteria for Kawasaki disease, partial Kawasaki disease, or Kawasaki disease shock syndrome. Patients in this subset commonly have features that are atypical in Kawasaki disease
- Kawasaki diagnosis is established by fever lasting 5 or more days and at least 4 of the following criteria:
- Polymorphous rash (excluding bullous or vesicular eruptions)
- Conjunctival injection
- Oropharyngeal mucous membrane changes
- Extremity changes
- Lymphadenopathy
- Features common to MIS-C but not typical for classic Kawasaki disease:
- Abdominal pain is often a predominant feature and severity exceeds that seen in classic Kawasaki disease
- Thrombocytopenia, anemia, and lymphopenia
- Elevated levels of ferritin, troponin, proBNP, and D-dimer
How does my doctor know my child has Kawasaki disease?
Your doctor has given your child an exam and asked about his or her symptoms. There isn’t a special test for Kawasaki disease, but your doctor may do some tests to see if another illness could be causing the symptoms.
Children who have this condition have a fever (sometimes as high as 104°F) for 5 days or longer. Usually, they also have at least 4 of the following symptoms:
Some children who have Kawasaki disease also have diarrhea, vomiting and stomach pain. Kawasaki disease might make your child very irritable and cross.
- A red, patchy rash that may cover the whole body
- Swollen lymph nodes in the neck
- Swollen and red hands and feet and, later in the illness, peeling skin on the fingers and toes
- Changes in the lips and mouth, such as red, cracked lips, a very red tongue and redness in the mouth and the back of the throat
- Red, bloodshot eyes
What are the diagnostic criteria for Kawasaki disease ?
Fever or a history of fever is almost always present in patients with KD. Exceptions include very young infants in whom fever may be low grade or unrecognized or patients diagnosed late in the illness (and whose parents did not recognize fever during the acute phase).
Fever is a necessary component in the clinical diagnostic criteria for KD. It is usually high grade (>38.5°C), unresponsive to antibiotics, poorly responsive to antipyretics, and lasts an average of 1–3 weeks.
The diagnostic criteria for KD are:
- • Fever for >5 a consecutive days, with four of the following five criteria:
- 1. Conjunctivitis (>90%): bilateral bulbar nonexudative conjunctivitis, often with limbic sparinga If all of the clinical criteria are present, the diagnosis may be made on Day 4 of fever. With a classic presentation, experienced clinicians may make the diagnosis at Day 3 of fever.
- 2. Oral changes (90%): erythema, fissuring, cracking, or bleeding of lips; diffuse oropharyngeal erythema without exudate; and/or “strawberry” tongue
- 3. Cervical lymphadenopathy (25%–70%): (least common finding), one or more enlarged (>1.5 cm) nodes in the anterior cervical triangle, usually unilateral and sometimes painful; can be confused with bacterial cervical lymphadenitis
- 4. Rash (70%–90%): erythematous rash, usually a diffuse maculopapular eruption; erythroderma, erythema multiforme-like, urticarial, scarlatiniform, and micropustular eruptions are also seen; bullous, vesicular, and petechial rashes not seen in KD patients; rash typically involves the trunk and extremities and there may be accentuation in the groin (50%)
- 5. Extremity changes (60%–85%): (last manifestation to occur), erythema of palms and soles and firm sometimes painful edema of the hands and feet; desquamation of the fingers and toes begins in the periungual area usually 2–3 weeks after fever onset; desquamation may also involve the palms and soles.
In many patients, the presence of the clinical criteria may appear sequentially over time. In some patients, one or more of the clinical criteria may have been present and resolved prior to the diagnosis of KD being considered. A history of any of the clinical criteria listed above count as diagnostic criteria even if not present at the time the diagnosis is considered.
How is this disease treated?
Your doctor will prescribe medicines to make your child feel better and to prevent the problems Kawasaki disease can cause.
Your doctor might also give your child a medicine called immunoglobulin to help prevent heart problems. Immunoglobulin is given intravenously (through your child’s veins) for several hours. It has to be given in the hospital.
Your doctor may give your child high doses of aspirin to lower the fever. Aspirin also helps with the rash and the joint pain. It can keep your child’s blood from making clots.
After the fever goes down, your doctor might give your child a lower dose of aspirin for several weeks to reduce the chance of heart problems. (However, if your child gets the flu or chickenpox during this time, you’ll have to stop giving your child aspirin for a while. When children take aspirin during the flu or chickenpox, they might get another illness called Reye’s syndrome. For this reason, don’t give your child aspirin unless your doctor tells you to.)
Complications
How serious is this disease?
It can make you a little scared to find out your child has Kawasaki disease. Your child won’t feel well, and the rash and other signs of Kawasaki disease may look scary. Just remember that most children who have Kawasaki disease get well with no problems.
However, Kawasaki disease can cause heart problems in 1 out of every 50 children affected by the disease. If your child gets heart problems from Kawasaki disease, your doctor will talk with you about any special care your child needs.
Kawasaki disease can also cause problems like swelling in your child’s joints, but these problems usually go away without special treatment. It helps if your doctor finds out about the Kawasaki disease at an early stage and starts treatment soon. Early treatment means your child probably won’t get lasting heart problems or joint problems.
Questions
- Could my child have the flu or a cold instead?
- What is the best thing I can do to make my child more comfortable while he/she has Kawasaki disease?
- Should I keep my other children away from my child while he/she has Kawasaki disease?
- What medicines can help my child?
- Is it safe to give my child aspirin?
- When should I call if my child gets worse?
- My child is complaining about his/her joints hurting. What should I do?
- My child has a rash. Can I use an ointment to make him/her feel better?
- Should I tell my child’s school/daycare provider that he/she has Kawasaki disease?
- Could I get Kawasaki disease from my child?
Sources
Kawasaki Disease by KA Taubert, ST Shulman( 06/01/99,http://www.aafp.org/afp/990600ap/3093.html )
