Monthly Archives: February 2015

Kawasaki disease

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Kawasaki disease is a leading cause of acquired heart disease in children, but with effective treatment, only a small percentage of children have lasting damage.

Kawasaki Disease is also called as “Mucocutaneous lymph node syndrome” as it affects lymph nodes, skin, mucus membranes inside mouth, nose and throat. It causes inflammation of medium sized arteries wall in body; involvement of coronaries (blood supply to heart) being most dangerous.

KD awareness

Symptoms and Signs:

Various Symptoms are

Fever > 5days, along with characteristic features like

  • Rashes all over the body
  • Redness of the eyes (specially involvement of white area of eye ball) without discharge
  • Redness of tongue (strawberry tongue), red and congested throat along with red, dry, cracked lips.
  • Swelling of neck, Lymph nodes enlargement of neck ( one sided > both sided)
  • Redness of palms and soles (erythema) along with swelling

symptoms of Kawasaki disease

Other nonspecific features like Irritability, vomiting, diarrhea, pain abdomen, joint pain, jaundice can also be there.

Typical feature of “Peeling of skin on hands and feet” occurs in 2nd to 3rd week of illness.

peeling of skin

Cause of disease: Unknown but it is more common in boys in less than 5 years of age and seen more common in Asian. As the name suggest it is most commonly seen in Japanese or Korean but it is also seen in Indian population.

Treating Kawasaki disease within 10 days of its onset may greatly reduce the chances of lasting damage.

Most severe complications is damage to 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 forming and blocking the artery, which could lead to a heart attack or cause life-threatening internal bleeding.

KD sign

Diagnosis:

Kawasaki disease can look similar to other common childhood viral and bacterial illnesses. No specific test, diagnosis is on clinical basis and test are done to support the diagnosis and rule out other illnesses with similar features like Measles, Steven Johnson syndrome, Juvenile rheumatoid arthritis, other viral illnesses.

Tests:

  • Blood test: CBC, CRP, ESR, to look for elevated neutrophils and other inflammatory markers, relative anemia, low albumin, raised bilirubin and liver enzymes, dyselectrolemia etc.
  • Urine test: may show few pus cells (sterile pyuria)
  • ECHO: to look for dilatation of coronary arteries and other suggestive features.

 

Treatment:

To reduce the risk of complications, your child’s doctor will want to begin treatment for Kawasaki disease as soon as possible after the appearance of signs and symptoms, preferably while your child still has a fever. The goals of initial treatment are to lower fever and inflammation and prevent heart damage.

  • IVIG (Gamma globulin). 2mg/kg over 10-12 hours should be given when diagnosis is made. Mostly given between 5- 7 days and within 10 days. It can lower the risk of coronary artery problems.
  • High doses of aspirin may help treat inflammation. Aspirin can also decrease pain and joint inflammation, as well as reduce the fever. Kawasaki treatment is a rare exception to the rule against aspirin use in children.
  • Important to give Flu shot to prevent flu infection as child is on aspirin.
  • Pediatric Cardiologist opinion should be taken.

Within 2 days significant improvement is seen in fever.

Untreated cases can lead to more serious complications, such as aneurysm

  KD image

To summaries:

summary of KD

Regards

Dr Rahul Varma