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by Safer DA

Kawasaki Disease

(Kawasaki Syndrome; Mucocutaneous Lymph Node Syndrome)

Definition

Kawasaki disease is an illness that affects young children. It causes irritation and swelling of the skin, mouth, and lymph nodes. More serious illness can also lead to swelling in the coronary arteries. These arteries supply oxygen to the heart. The swelling can cause serious heart problems like a weakening of blood vessel walls ( aneurysm ) and heart attack.
Coronary Arteries
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Causes

The cause of Kawasaki disease is unknown. Some believe it is an infectious agent like a virus. However, Kawasaki does not seem to be contagious. It does not spread through households like the flu.

Risk Factors

Kawasaki disease is most common in children less than five year old. It is rare in adults. Children of Asian ethnicity also seem to be more likely to get Kawasaki disease.
Outbreaks of the disease are more common during the winter and early spring months.

Symptoms

Early symptoms in the first 2 weeks may include:
  • High fever—lasting for at least 5 days and usually greater than 102 degrees Fahrenheit (38.8 degrees Celsius)
  • Irritability
  • Red or bloodshot whites of the eyes due to conjunctivitis
  • Rash
  • Soreness and swelling of the mouth, lips, and throat
  • Strawberry tongue—white/yellow coating and bright red bumps on tongue
  • Swollen hands and feet that may look red
  • Swollen lymph nodes (organs of the immune system) in the neck
Later symptoms (within 2 weeks of the start of the fever) may include:
  • Peeling of skin on hands and feet
  • Joint problems
  • Diarrhea, vomiting, or abdominal pain

Diagnosis

There is no specific test to diagnose Kawasaki disease. You will be asked about your child’s symptoms and medical history. A physical exam will be done.
Your child's bodily fluids may be tested. This can be done with:
  • Blood tests
  • Urine tests
Images may be taken of your child's heart. This can be done with an echocardiogram.
The electrical activity of your child's heart may be measured. This can be done with an electrocardiogram (EKG).

Treatment

Kawasaki will go away on its own. However, treatment can help to limit the damage the illness does. The sooner Kawasaki disease is treated, the better the outcome. Treatment is especially important to reduce risk of damage to the heart.
Talk with your doctor about the best treatment plan for your child. Treatment options include the following:

Intravenous Gamma Globulin

Gamma globulin naturally occurs in the body. It is a protein that helps your body fight infections. This treatment provides a concentrated dose of gamma globulin. It is passed into your bloodstream through an IV.
This treatment may decrease the risk of heart complications. It is most effective when given early in the illness, ideally the first 10 days.

Aspirin

High doses of aspirin may also be advised. Aspirin may help to manage symptoms by:
  • Preventing the formation of blood clots
  • Reducing fever
  • Easing joint swelling
  • Treating rashes
Note : If your child is given aspirin therapy and develops symptoms of a viral infection, especially chickenpox , call the doctor about stopping aspirin therapy. Aspirin has been associated with Reye's syndrome , a potentially fatal condition.

Other Medications

Steroid or joint inflammation medication may also be recommended. They may be used if inflammation cannot be controlled with other treatments.
If heart complications develop, they will need to be treated. Specific treatment will depend on the specific problem.
If heart complications develop, they will need to be treated. Specific treatment will depend on the specific problem.

Prevention

There is no known way to prevent Kawasaki disease.

RESOURCES

American Heart Association http://www.heart.org

Kawasaki Disease Foundation http://www.kdfoundation.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

References

Kawasaki disease. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/CardiovascularConditionsofChildhood/Kawasaki-Disease%5FUCM%5F308777%5FArticle.jsp. Updated March 22, 2013. Accessed November 3, 2014.

Kawasaki disease. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/kawasaki-disease.html. Updated April 2014. Accessed November 3, 2014.

Kawasaki diseases. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/heart/kawasaki.html. Updated September 2014. Accessed on November 3, 2014.

Kawasaki diseases. Cincinnati Children's Hospital website. Available at: http://www.cincinnatichildrens.org/health/k/kawasaki. Updated January 2013. Accessed November 3, 2014.

Kawasaki disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 9, 2014. Accessed November 3, 2014.

Newburger JW, Takahashi M, et al. AHA scientific statement: diagnosis, treatment, and long-term management of Kawasaki Disease. Circulation. 2004;110:2747-2771.

Taubert KA, Shulman ST. Cardiovascular medicine: Kawasaki disease. Am Fam Physician. 1999;59(11).

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