Kawasaki Disease: What Every Parent Needs To Know

​Kawasaki disease is a rare medical condition affecting children. There is also no known cause of the illness. The disease is so rare that there are a lot of questions surrounding it. What is Kawasaki disease? Is Kawasaki disease contagious? What are its symptoms?

In order to help parents have a better understanding of this medical condition and become more aware of this disease affects children, we put together information parents need to know about Kawasaki disease.

What is Kawasaki Disease?

​Kawasaki disease is an illness that usually affects children less than 4 years old, though older children may get it too. It can be more serious in children under the age of 1. This rare childhood illness causes inflammation of the blood vessels, resulting in fever and joint pain. 

The term was first described by Tomisaku Kawasaki, a Japanese paediatrician, in 1967. 

The mysterious illness involves the mouth, skin and lymph nodes, and mostly affects young children up to the age of 5 and a small percentage of teenagers.  

Swollen lymph node in the neck. | Photo: Kawasaki Disease Foundation

Researchers believe that it could probably be triggered by a virus infection. Though its exact cause is unknown, early diagnosis is key.

If detected early, it can be treated without any problems with intravenous (IV) gamma globulin and aspirin. However, if left untreated, it can lead to serious heart disease or other complications that can be life-threatening.

What Causes Kawasaki Disease

Although the cause of Kawasaki disease is unknown, doctors do not think that it is infectious from one person to another. Some believe that Kawasaki disease is caused by various environmental factors or that it develops following a bacterial or viral infection. It’s possible that some genes increase a child’s risk of developing Kawasaki disease.

Risk factors

Children, especially those of Asian descent, are most frequently affected by Kawasaki disease. According to the KDF, children under the age of five make up about 75% of KD cases. Although the risk factors are thought to rise within families, researchers do not think that the disease can be inherited. KD is 10 times more likely to affect siblings of KD patients.

Kawasaki Disease Symptoms

The symptoms of this disease often appear in phases. The first phase can involve a fever that lasts for at least 5 days. This phase of the disease can last for up to 2 weeks.

Important note: The following key signs and symptoms may not be present at the same time. Only a few of these symptoms actually develop in some very young infants.

The symptoms in the first phase include:

• High fever (above 101F or 38.3 degrees Celsius) – does not reduce even with medication and lasts for more than 5 days
• Swollen lymph glands in the neck
• Rash in the genital area, stomach and chest
• Dry, cracked and red lips, and a swollen tongue

A telltale symptom such as a “strawberry tongue” can sometimes appear in the early stages. 

Photo: theAsianparent reader / File photo

• Swollen red palms of hand and soles of feet
• Redness in both eyes
• Irritation and inflammation of the lips, mouth and throat

The symptoms in the second phase include:

Once a child with this disease enters the second phase, large portions of their hands and feet may begin to peel. This alarming symptom may also be accompanied by diarrhoea, vomiting, joint pain and abdominal pain.

• Joint pain
• Pain in the belly
• Diarrhoea and vomiting
• Peeling of skin on hands and feet

In rare cases, children can have:

• Unusual heart rhythms
• Inflamed heart muscles
• Damaged heart valves
• Weak or bulging artery walls

If suspected, the doctor may advise for a blood or urine test. An echocardiogram may also be ordered to evaluate the heart’s coronary arteries. Usually, no heart problems are developed if treated within the first 10 days.  

In the case of incomplete Kawasaki disease, signs and symptoms of the disease may not all be present, but appear as different combinations in different patients, said Prof Quek Swee Chye, who heads the National University Hospital’s division of paediatric cardiology. “The sequence of when the signs evolve does not follow a pattern,” he told The Straits Times in an interview.

How is Kawasaki Disease Diagnosed?

There is no specific test to rule out this condition. A doctor will take into account the child’s symptoms and eliminate out illnesses with comparable symptoms, such as:

• Scarlet fever, a bacterial illness that results in a sore throat, fever, and chills.
• juvenile rheumatoid arthritis, a persistent condition that results in inflammation and pain in the joints.
• measles
• Toxic shock condition
• juvenile idiopathic arthritis
• juvenile mercury poisoning
• medical reaction
• Rocky Mountain spotted fever, a tick-borne sickness

Additional testing may be requested by a paediatrician to determine how the condition has damaged the heart. These may consist of:

• Echocardiograph
• Blood tests
• Chest X-ray
• Electrocardiogram

Any infant or kid with a fever lasting longer than five days should be examined for the risk of Kawasaki disease. This is especially true if they are also displaying other well-known signs of the illness, such skin that is peeling.

Image Source: iStock

Possible Complications Of Kawasaki Disease 

When Kawasaki disease is discovered early, doctors can treat the symptoms. Within a few days of commencing treatment, the majority of children will feel better.

Patients may experience severe problems that impact the heart if the illness is not discovered right away, including:

• Aneurysms in the coronary arteries (or ballooning of the arteries)
• Valves leakage (often mitral valve regurgitation)
• Fluid accumulation around the heart (pericardial effusion)

The most common underlying cause of congenital cardiac disease in children is Kawasaki illness. Without appropriate treatment, Kawasaki disease can harm the heart in up to 25% of children. The most significant side effect of Kawasaki disease is aneurysms of the coronary arteries, which carry oxygen to the heart. The likelihood of coronary artery involvement drops to about 5% with effective and prompt therapy.

In general, the chance of developing coronary artery abnormalities is quite minimal if they have not materialised six to eight weeks following the commencement of the sickness.

Depending on the extent of the developing coronary aneurysm, there may be long-term coronary artery alterations that either resolve, remain unchanged, or worsen. As their massive aneurysms mend, patients with large aneurysms run the risk of getting coronary artery clots or stenosis (narrowing).

According to reports, the alterations in half of individuals with minor coronary aneurysms disappear during the first year of recovery. Unfortunately, doctors are unable to foretell a patient’s path of action.

Most children with Kawasaki disease make full recoveries, especially when they receive early diagnosis and treatment. Some people, particularly those with heart issues brought on by Kawasaki illness, may require additional testing and a visit to a cardiologist (a physician who focuses on diseases that damage the heart).

Treatments for Kawasaki Disease

To help reduce the risk of complications brought about by this medical condition, Professor Quek said appropriate treatment “using intravenous immunoglobulins and high-dose aspirin” may be provided to children with Kawasaki disease.

He noted that treatment should be initiated within 10 days of the illness and can be started as “soon as the disease is confidently diagnosed.” He also said that “some doctors would still consider giving medication beyond 10 days if there is evidence of active inflammation.”

How To Treat Kawasaki Disease Early

When a child has Kawasaki illness, doctors typically give them:

• Immunoglobulin (IVIG) administered intravenously (IV): These antibodies (proteins) aid in the defence against infections. Additionally, IVIG therapy reduces the likelihood of coronary artery aneurysms. One dose of IVIG is administered.
• oral use of a large dose of aspirin to alleviate inflammation. Until blood tests indicate that the inflammation has subsided, patients take aspirin.

The moment possible, treatment is started. When IVIG doesn’t work in some kids, doctors may prescribe steroids. Coronary aneurysms can be avoided with the aid of steroids.

For the purpose of preventing this viral infection, it is crucial for kids taking high-dose aspirin to receive their annual flu shot. This is because children who take aspirin while suffering from a viral illness run a slight chance of developing a rare disorder called Reye syndrome.

Most Kawasaki disease patients begin to improve significantly after just one immune globulin treatment, though occasionally further doses are required.

Follow-up care

Children who have had Kawasaki disease must be regularly monitored to ensure they are improving and to look out for the emergence of cardiac aneurysms. Children should be booked for an echocardiography and a check-up at 2 weeks and again at 6 to 8 weeks after their fever first started because aneurysms typically form after the first couple of weeks of illness. If any of the echocardiograms reveal abnormal findings, more regular follow-up and echocardiograms will be required.

Note: A minimum of 11 months should pass following IVIG before administering a live virus vaccine since IVIG may render the vaccines ineffective. The MMR (measles, mumps, rubella) and Varicella (chicken pox) vaccines fall under this category. An injection of the inactivated influenza (flu) vaccination is recommended for children older than 6 months.

Long-term follow-up

Children with Kawasaki disease who receive treatment and do not experience aneurysms have great long-term outcomes. They must, though, adhere to a heart-healthy diet and way of life. Every five years, cholesterol levels should be tested.

When children do develop and need particular long-term treatment and follow-up, they should be under the supervision of a paediatric cardiologist.

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Is Kawasaki Disease Contagious?

According to the United Kingdom’s National Health Service (NHS), symptoms of Kawasaki disease are similar to those of an infection, so it is likely to be caused by a bacteria or a virus. “But so far a bacterial or viral cause hasn’t been identified,” it said. 

It also noted that Kawasaki disease isn’t contagious, therefore it cannot be passed from one person to another. “This makes it unlikely that it’s caused by a virus alone,” it added.

While it is non-contagious, it can sometimes show up in clusters within a community. 

Kawasaki Disease In Singapore

According to this SingHealth website, the incidence of Kawasaki disease in Singapore is estimated at 51.4 per 100,000 children ≤ 5 years of age.”

Associate Professor Tan Teng Hong, Head and Senior Consultant, Cardiology Service, KK Women’s and Children’s Hospital (KKH), said the hospital “sees an average of 120 new cases per year of which about half are below the age of 21.”

“The younger the age group, the higher the incidence, and more than 90 per cent of our patients with Kawasaki disease are 5 years old or younger,” Prof Tan added.

Kawasaki Disease And Coronavirus

Health officials in several countries like the UK, Italy, Spain, France, Belgium and Switzerland have reported a rise in cases resembling the Kawasaki disease in kids, and all these kids were exposed to the coronavirus.

The number of such cases are gradually increasing and medical experts are investigating the link between the two. In the UK, Kawasaki disease-type of symptoms were reported in at least 12 children, and in France, about 20 children between 3 to 17 years of age were showing symptoms associated with the Kawasaki disease.

Doctors at the Necker-Enfants Malades Hospital in Paris believe that it might be a post-coronavirus infection disease, where the body’s immune system overreacts due to the infection. Although Damien Bonnet, Head of the Department of Paediatric Medical Cardiology, says that the disease mostly followed COVID-19, he also added that there is no certainty that there is a direct link between the coronavirus and the symptoms of the Kawasaki disease that were found in the children.   

The World Health Organisation is investigating the possibilities of the link between COVID-19 and Kawasaki disease. 

In Singapore, the Ministry of Health (MOH) said no children who have contracted COVID-19 has suffered from serious inflammatory symptoms

Covid-19 has infected 57 children aged 16 and younger—in Singapore—since the outbreak began in January.

MOH said none has had to be in the intensive care unit.

As of 6 May, 42 of these cases involving children have recovered.

When To Call The Doctor

Ask your doctor whether your kid may have Kawasaki disease if he or she has a fever for 4 to 5 days and any of the important signs and symptoms listed above. It can be difficult to diagnose, therefore your child might need to undergo multiple exams.

The diagnosis of Kawasaki disease cannot be made with a single, precise test. However, if Kawasaki disease is thought to be present, your doctor might request tests to check the health of your heart, such as an echocardiography, as well as collect blood and urine samples. A paediatric infectious disease, rheumatology, or cardiology expert may also be recommended by your physician if you need additional help with diagnosis and care.

Lead image photo courtesy of Kawasaki Disease Foundation. 

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