Kawasaki Disease - Mostly Associated with Heart Problem

Kawasaki is a rare disease seen mostly in Japanese and Korean descent children, and more so in Boys than in Girls. Recently Kawasaki Disease is seen in the United States and the rate is increasing. Kawasaki disease is predominantly a disease of young children, with 80% of patients younger than 5 years of age.

In the year 1967 Doctor Tomisaku Kawasaki in Japan described about this disease. Kawasaki disease is also known as lymph node syndrome, mucocutaneous node disease, and infantile polyarteritis and Kawasaki syndrome. It affects many organs, including the skin and mucous membranes, lymph nodes, blood vessel walls, and the heart.

The cause of Kawasaki disease is not known, but the medical world suspects primarily on immunological causes for the disease. Evidence increasingly points to an infectious etiology.

Symptoms
Kawasaki disease is mostly associated with heart problem. Kawasaki disease can cause vasculitic changes (inflammation of blood vessels) in the coronary arteries and subsequent coronary artery aneurysms. These aneurysms can lead to myocardial infarction (heart attack) even in young children.

Some basic symptoms presented by Kawasaki disease is:

1) Strawberry tongue, white coating on the tongue or prominent red bumps (papillae) on the back of the tongue.
2) High temperatures between 102 deg cent to 104 deg cent.
3) Swollen hands and feet
4) Red eyes like conjunctivitis without pus or drainage
5) sore, irritated throat
6) swollen palms of the hands and soles of the feet with a purple-red color
7) swollen lymph nodes
8) a rash on the stomach, chest, and genitals
9) Tachycardia (rapid heart beat)
10) Peeling (desquamation) palms and soles (later in the illness); peeling may begin around the nails
11) Irritability
12) Joint pains

Diagnosis
Kawasaki disease can be clinically examined and then some test has to be done like CBC Complete blood count, Electrocardiogram may show evidence of ventricular dysfunction or, occasionally, arrhythmia due to myocarditis. Ultrasound and CAT scan to done.

It generally remains for 5 to 6 days and still persists with erythema of the lips or oral cavity or cracking of the lips; (2) rash on the trunk; (3) swelling or erythema of the hands or feet; (4) red eyes (conjunctival injection) (5) swollen lymph node in the neck of at least 15 millimeters.

Treatment
Children with Kawasaki disease should be immediately admitted to good hospital with experienced doctors who have previous experience in treating this disease. It is required that pediatric cardiology and pediatric infectious disease specialists should be consulted.

It is very important for the treatment be started as soon as the diagnosis is made to prevent damage to the coronary arteries.
Standard treatment Intravenous immunoglobulin (IVIG) of high dose to be administered and if required second dosage to be given within 7 days of treatment, if fever doesn't come down.

Salicylate therapy, particularly aspirin, remains an important part of the treatment (though questioned by some) but salicylates alone are not as effective as Intravenous immunoglobulin.

Aspirin therapy is started at high doses until the fever subsides, and then is continued at a low dose when the patient returns home, usually for 2 months to prevent blood clots from forming. Except for Kawasaki disease and a few other indications, aspirin is otherwise normally not recommended for children due to its association with Reye's syndrome.

Corticosteroids have also been used, especially when other treatments fail or symptoms recur, but in a randomized controlled trial, the addition of corticosteroid to immune globulin and aspirin did not improve outcome.