KAWASAKI DISEASE: CLINICAL GUIDELINES
Kawasaki disease causes swelling
(inflammation) in the walls of medium-sized arteries throughout the body. It
primarily affects children. The inflammation tends to affect the coronary
arteries, which supply blood to the heart muscle. Kawasaki disease is sometimes called
mucocutaneous lymph node syndrome because it also affects glands that swell
during an infection (lymph nodes), skin, and the mucous membranes inside the
mouth, nose and throat.
Signs of Kawasaki disease, such as a
high fever and peeling skin, can be frightening. The good news is that Kawasaki
disease is usually treatable, and most children recover from Kawasaki disease
without serious problems.
SYMPTOMS
Kawasaki disease signs and symptoms
usually appear in three phases.
1st phase
Signs and symptoms of the first phase
may include:
· A fever that is often is higher than 102.2 F (39 C)
and lasts more than three days
· Extremely red eyes without a thick discharge
· A rash on the main part of the body and in the
genital area
· Red, dry, cracked lips and an extremely red,
swollen tongue
· Swollen, red skin on the palms of the hands and the
soles of the feet
· Swollen lymph nodes in the neck and perhaps
elsewhere
· Irritability
2nd phase
In the second phase of the disease,
your child may develop:
· Peeling of the skin on the hands and feet,
especially the tips of the fingers and toes, often in large sheets
· Joint pain
· Diarrhea
· Vomiting
· Abdominal pain
3rd phase
In the third phase of the disease,
signs and symptoms slowly go away unless complications develop. It may be as
long as eight weeks before energy levels seem normal again.
WHEN TO SEE A DOCTOR
If your child has a fever that lasts
more than three days, contact your child's doctor. Also, see your child's
doctor if your child has a fever along with four or more of the following signs
and symptoms:
· Redness in both eyes
· A very red, swollen tongue
· Redness of the palms or soles
· Skin peeling
· A rash
· Swollen lymph nodes
Treating Kawasaki disease within 10
days of when it began may greatly reduce the chances of lasting damage.
HOW
IS KAWASAKI DISEASE DIAGNOSED
Kawasaki disease symptoms can look
similar to those of other childhood viral and bacterial illnesses. Doctors
usually diagnose it by asking about the symptoms (such as a long-lasting fever)
and doing an exam.
If Kawasaki disease looks likely, the
doctor:
· will order tests to check the heart, such as
an echocardiogram
· might test blood and urine (pee) samples to rule
out other conditions, such as scarlet fever, measles, Rocky
Mountain spotted fever, or juvenile rheumatoid arthritis
Risk factors
Three things are known to increase your
child's risk of developing Kawasaki disease.
· Age. Children
under 5 years old are most at risk of Kawasaki disease.
· Sex. Boys
are slightly more likely than girls are to develop Kawasaki disease.
· Ethnicity. Children
of Asian or Pacific Island descent, such as Japanese or Korean, have higher
rates of Kawasaki disease.
COMPLICATIONS
Kawasaki disease is a leading cause of
acquired heart disease in children. However, with effective treatment, only a
few children have lasting damage.
Heart complications include:
· Inflammation of blood vessels, usually the coronary
arteries, that supply blood to the heart
· Inflammation of the heart muscle
· Heart valve problems
Any of these complications can damage
your child's heart. Inflammation of the coronary arteries can lead to weakening
and bulging of the artery wall (aneurysm). Aneurysms increase the risk of blood
clots, which could lead to a heart attack or cause life-threatening internal
bleeding.
For a very small percentage of children
who develop coronary artery problems, Kawasaki disease can cause death, even
with treatment.
MONITORING HEART PROBLEMS
If your child has any signs of heart
problems, the doctor may recommend follow-up tests to check your child's heart
health at regular intervals, often at six to eight weeks after the illness
began, and then again after six months.
If heart problems continue, you may be
referred to a doctor who specializes in treating heart disease in children
(pediatric cardiologist). Treatment for heart complications related to Kawasaki
disease depends on what type of heart condition is present. If a coronary
artery aneurysm ruptures, treatment may include anticoagulant drugs, stent
placement, or bypass surgery.
WAIT TO VACCINATE
If your child was given gamma globulin,
it's a good idea to wait at least 11 months to get the chickenpox or measles
vaccine, because gamma globulin can affect how well these vaccinations work
You should always call your child’s pediatrician if you have any concerns or questions about their health.
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