Kawasaki Disease

Overview

Kawasaki disease is a rare condition affecting children under the age of 5, causing inflammation in their blood vessels. Symptoms include high fever, rash, swollen hands and feet, and red eyes. If left untreated, it can lead to serious heart complications like coronary artery dilation, blood clots and heart infections. While the exact cause is unknown, early diagnosis and treatment can help an affected child recover within two months, significantly reducing the risk of lasting heart problems.

What is Kawasaki Disease?

Kawasaki disease (or Kawasaki syndrome) is a rare condition that causes inflamed blood vessels to weaken and stretch out, raising the risk of narrowing or tearing of blood vessels. It limits the amount of blood to pass through to nourish organs and tissues.

This disease is common in children between 6 months to 5 years of age, affecting their arteries. Leaving the disease untreated can cause complications such as coronary artery dilation. However, on-time treatment can help a child recover within 2 months.

Types of Kawasaki Disease

The 2 forms of Kawasaki disease are outlined below:

Complete KD: Individuals experience fever that lasts for at least 5 days, along with 4 or 5 principle symptoms. These symptoms include polymorphous rash, extremity changes, changes in the oropharynx, acute unilateral nonpurulent cervical lymphadenopathy (with lymph node diameter exceeding 1.5 cm) and painless bulbar conjunctival injection.

Incomplete KD: The fever lasts for more than 5 days in the patient as they exhibit 2 - 3 principle clinical signs. It is common in children younger than 6 months or older than 5 years.

Symptoms of Kawasaki Disease

An affected individual may have a fever (102.2 degrees Fahrenheit or more) for over 5 days. Other symptoms that a child can experience include irritability, rash in the genital area or other main body parts, upset stomach, swollen lymph nodes, inflammation and redness on feet and hands, pink or red eyes without discharge, and peeling of skin starting around the nails.
A child may also exhibit symptoms such as vomiting, joint pain and belly discomfort.

Kawasaki disease symptoms can be similar to those of multisystem inflammatory syndrome, which happens in children with COVID-19. This disease can cause severe complications, leading to the swelling of certain parts of the heart and blood vessels. This causes the heart to function abnormally, resulting in aneurysms and coronary artery dilation.

Other complications include hepatitis, blood clots, heart infection, hemolytic anaemia, pancreatitis and heart attack.

Causes of Kawasaki Disease

The causes of Kawasaki disease are unknown to this date. However, medical researchers are speculating that the disease can be caused by genetics, environmental factors and infections. Additionally, KD occurs mainly in the late winter and early spring, reporting more cases of children of Asian descent.

The disease is not contagious, implying it cannot spread through person-to-person contact. However, individuals younger than the age of 5, assigned male at birth, and of Asian descent or Pacific Islander are at risk of developing the condition.

Diagnosis of Kawasaki Disease

A medical professional asks about the child’s symptoms to rule out diseases with similar signs and symptoms. A child may have incomplete or atypical Kawasaki disease if they exhibit some of the symptoms.

A paediatrician may order additional tests to examine the heart function. These tests may include an echocardiogram (ECG), electrocardiogram (EKG), blood tests, CT angiogram, urinalysis, magnetic resonance angiogram (MRA) and chest X-ray.

Symptoms escalate over time through 3 stages of Kawasaki disease. Here is the breakdown of the stages:

• Stage 1 (Acute): Symptoms include high fever for more than five days, pink eye, swelling of lymph nodes, red lips and tongue, red skin on feet and hands, and rash around groin or trunk.
• Stage 2 (Subacute): Starts after the fever goes down, and causes diarrhoea, peeling skin on feet and hands, joint and belly pain, and upset stomach.
• Stage 3 (Convalescent): Symptoms progressively fade away, however, the complications persist.

Treatment for Kawasaki Disease

Kawasaki disease treatment plan aims at reducing inflammation, preventing heart complications and blood clots, or damage to arteries. A doctor may recommend intravenous immunoglobulin (infusion of antibodies) over 12 hours within 10 days of the high fever and aspirin for the next four days as the first-line KD treatment.

Other treatment options include cold compresses, medications for swelling and pain and fluids by IV (for hydration). Anticoagulants or blood thinners are given to patients at risk for blood clots, while steroids reduce inflammation in serious cases.

Prevention of Kawasaki Disease

Kawasaki disease cannot be prevented as its exact causes are unknown. However, early diagnosis and treatment can reduce the risk of developing heart complications. While a child may make a full recovery from the disease within 6 - 8 weeks, complications can continue if the disease is left untreated. One must ensure that the affected child’s vaccinations are up to date, such as influenza, COVID-19, measles-mumps-rubella and varicella, while taking a daily dosage of aspirin.

Myths and Facts Related to Kawasaki Disease

Here is a breakdown of the myths and facts about Kawasaki disease:

Myth 1: Kawasaki disease is contagious
Fact: Kawasaki disease is an inflammatory condition that affects blood vessels, primarily in children, while its causes are still unknown, it is not contagious and cannot be spread from one person to another.

Myth 2: Only Japanese children get Kawasaki disease
Fact: While Kawasaki disease was first identified in Japan and is more common among Asian children, it can affect children of all ethnicities and backgrounds worldwide.

Myth 3: Kawasaki disease can always cause long-term heart problems
Fact: An early diagnosis and treatment with intravenous immunoglobulin (IVIG) can reduce the risk of heart complications significantly.

Myth 4: Kawasaki disease will never recur once treated
Fact: In rare cases, some children may experience Kawasaki disease more than once. However, this recurrence is uncommon and happens in less than 3% of cases.