Kawasaki disease is uncommon and presumed to be infectious. The first cases were noted in Japan in the late 1960s. The disease is named after the Japanese doctor who first described the illness. Even though it remains uncommon, doctors are particularly concerned about Kawasaki disease because it has become a leading cause of coronary artery disease in children. In fact, if not recognized and properly treated, it can cause inflammation and abnormalities of the coronary arteries.
Most often, Kawasaki disease affects youngsters between the ages of 1 and 8 years, with the highest number of cases in children between 18 and 24 months of age. About 80% of children who develop Kawasaki disease are younger than 5 years. Most cases occur during the winter and spring months.
The cause of Kawasaki disease is not known, nor is it clear how the illness is spread. Person-to-person transmission has not been found. Its various clinical features suggest it is an infectious disease.
Signs and Symptoms
The first sign of illness with Kawasaki disease is a high, spiking fever, with a temperature usually above 102.2°F (39°C) that lasts at least 5 days. In addition, 4 of the following 5 signs and symptoms must be present for a diagnosis of Kawasaki disease to be made:
Eye redness and irritation (conjunctival injection) without eye discharge
Inflammation and redness of the mouth, tongue, lips, and throat
Reddening and swelling of the palms and soles with subsequent peeling of the skin around the nails (peeling occurs in the second week of illness)
Swollen glands in the neck, with one being more than 0.5 inches in diameter Other characteristics sometimes associated with Kawasaki disease include irritability, stomach pain, diarrhea, and vomiting.
The signs and symptoms of Kawasaki disease may be less specific in infants younger than 12 months, making an accurate diagnosis more difficult. The diagnosis of Kawasaki disease may be considered in this age group even when all the symptoms are not present.
When to Call Your Pediatrician
Prompt treatment of Kawasaki disease is important. If your child has many of these symptoms, particularly a fever that lasts for longer than 5 days, contact your pediatrician.
How Is the Diagnosis Made?
There is no diagnostic test available for Kawasaki disease. Your pediatrician will make the diagnosis based on your child’s signs and symptoms and by excluding illnesses that have some of the same symptoms, such as measles, streptococcal infections, toxic shock syndrome, juvenile rheumatoid arthritis, and certain reactions to medicines. The doctor may order blood tests that can rule out other infectious diseases. Your pediatrician may also perform echocardiography, an ultrasound of the heart, to monitor the coronary arteries.
If Kawasaki disease is diagnosed in your child, your doctor may recommend hospitalization to receive medicines to reduce inflammation. In most cases, this treatment will include intravenous immune globulin (purified human antibodies), given along with aspirin. Although parents are usually advised to avoid giving aspirin to children because it may put youngsters at risk for Reye syndrome, doctors agree that the benefits outweigh the risks for Kawasaki disease. Thus, aspirin use is usually recommended for these youngsters. However, you should never give your child aspirin for any condition without first consulting with your pediatrician.
What Is the Prognosis?
With proper treatment, most children recover fully from Kawasaki disease in a few weeks. If untreated, however, about 20% will develop abnormalities of the coronary arteries, including aneurysms (the enlargement or bulging of blood vessels). Even with proper treatment, some children may still develop heart disease. The children at greatest risk are young and male and have signs of heart involvement early in the illness.
There are no known preventive measures against Kawasaki disease at this time.