Kawasaki Disease in Kids

Kawasaki disease (KD) is an acquired heart disease mostly seen in children below the age of 5 years. It causes high fever, inflammation and swelling in the walls of the blood vessels. Although, most commonly seen in Japan, it occurs across countries and is a leading cause of acquired heart disease in developed countries including US.

Causes

The exact cause of Kawasaki disease in children is unknown, though experts believe it could be due to genetic changes, bacterial or viral infections, exposure to certain chemicals or other environmental factors. It is not contagious but is seen to happen in groups or clusters of the same community children.

Risk Factors that increase the odds:

Mostly affects kids below 5 years of age
Boys are more likely to get it than girls
Asians and Pacific Islanders are more prone to the disease

Kawasaki Disease Symptoms in Kids

The symptoms appear in phases over the weeks with the first sign being a high grade fever that won't go away even with usual fever medication for 5 or more days. There are many other symptoms that appear after the fever over the next few days in the first phase like:

Red rashes over the body, more commonly on the chest, legs, groin and genitals.
Blood red eyes
Red swollen mouth, tongue, throat (or strawberry tongue) and red cracked lips
Red palms and soles of the feet with swelling that later starts to peel
Enlarged lymph nodes in the neck

The symptoms of first phase may start to fade when new symptoms develop around 2 weeks after the first symptom appeared, this is the second phase and has symptoms like:

Belly pain
Diarrhoea
Vomiting
Irritability
Joint Pains
Peeling Skin on Hands and Feet

Third phase is when all the symptoms gradually start to go away which can take anywhere up to 8 weeks. The disease starts to impact the heart 10 to 15 days after the first symptom appears, that is around the time of the second phase. Seek medical attention as soon as you notice fever and any of the above symptoms in first phase.

Not all symptoms manifest in a patient, some could have as less as just 4 symptoms and it may still lead to heart issues. This is known as incomplete or atypical Kawasaki Disease, it still needs medical diagnosis and timely treatment as the regular Kawasaki Disease.

Diagnosis and Treatment

Timely diagnosis is of utmost importance as the disease progresses to impact the heart, attack the blood vessels and damage the coronary arteries that carry blood to heart muscles. The minute you notice a fever between 101 to 103 Fahrenheit that won't reduce and any of the 4 other phase 1 symptoms call your doctor and seek immediate medical attention.

The doctor will diagnose the disease with physical symptoms and will also order a few tests to rule out other diseases:

Blood and Urine Tests to rule out other diseases and also to check for Anaemia, WBC count and Inflammation
Echocardiogram (Echo) to detect any problems with the blood flow through the heart, artery issues.
Electrocardiogram (ECG) to detect any irregular heartbeats

Kawasaki Disease Treatment Plan:

Children who receive timely treatment usually have a good chance to completely recover without any long term damage to the heart or any major complications. They may need to stay in the hospital for many days to weeks before they can go home. The treatment will probably include:

Aspirin: High doses of aspirin is given at the beginning of the treatment which is gradually reduced based on how the patient responds. It helps control the fever and prevent any blood clots. The treatment continues for almost 8 weeks till all the symptoms subside.
Intravenous Immunoglobulin (IVIG): Immunoglobulin is administered intravenously to reduce the inflammation of the blood vessels. The antibodies in immunoglobulins help reduce or prevent the heart damage. Children on this treatment need to wait up to a year after to get any vaccinations as the immunoglobulins interfere with the vaccines and they may not be as effective.
Corticosteroids: In a few cases the child may not respond to IVIG and may need steroids to help.

Long term Prognosis is good for children who receive timely treatment and in most cases they recover fully and don't need lifelong follow ups. In cases where children developed complications, may need life long care and follow ups with their cardiologist.

The treatment plan mentioned here is only for educational purposes, specific plan for each patient can only be decided by their doctors and medical experts based on their patient's condition. Do not self administer any medication or use this information as a substitute for doctor's medical advice. Talk to your doctor for medical guidance and follow everything your doctor advices in your child's case.

Complications of Kawasaki Disease:

Without timely medical intervention and treatment the disease can cause some serious complications and damage to the heart, complications could include:

Aneurysms: Swelling in the heart arteries can cause a bulge in the artery wall called aneurysm which can cause clots leading to heart attack or bleeding in the body.
Arrythmias: or irregular heartbeats is a condition where the heart beats too slow or too fast or with an irregular rhythm
Myocarditis: Inflammation of the heart muscle (called as myocardium) that could change the way these muscles work and pump blood.
Inflammation of the blood vessels, coronary arteries and blood clots
Heart valve issues
Swelling of the heart muscle

When to see the Doctor?

Kawasaki Disease starts to affect the heart and cause serious complications after 10 to 14 days of the first symptom. Talk to your doctor immediately if you notice the below symptoms:

A fever of 101F to 103F that wont respond to fever medications and lasts 5 days or more
Develops other symptoms like red eyes, mouth, throat, and tongue
Red swollen hands and feet soles
Red rashes over the body especially chest, legs, groin and genitals
Swollen lymph nodes in the neck