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Kawasaki Disease: Children
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Treatment for Kawasaki disease should be started as soon as possible, ideally within 10 days of the onset of illness. Usually, treatment consists of the patient receiving purified antibodies given intravenously over 12 hours, or smaller doses given over 4 days. A doctor may prescribe a high-dose aspirin to reduce the risk of coronary artery aneurysms. If a coronary aneurysm is present, high-dose aspirin may be continued for up to 8 weeks or until an echocardiogram shows improvement. A small number of children may ... need other forms of blood thinners to keep clots from forming.
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Kawasaki disease is a leading cause of acquired heart disease among children in the United States and other developed countries. Most children who contract this illness are less than two years old, and 80 percent of affected children are younger than five years of age. A generalized vasculitis of unknown etiology, Kawasaki disease can cause coronary artery abnormalities, including coronary aneurysms. From 20 to 25 percent of untreated children develop coronary artery abnormalities, which may resolve or persist. These abnormalities are of particular concern because they can lead to thrombosis, evolve into segmental stenosis or, rarely, rupture. The principal cause of death from Kawasaki disease is myocardial infarction.
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Kawasaki disease is a rare condition that causes severe fever and inflammation in young children. It primarily affects children under five years of age, and is more common in boys than in girls. The condition was first diagnosed by a Japanese doctor, Tomisaku Kawasaki, in 1967. Kawasaki disease is ... known as mucocutaneous lymph node syndrome.
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Kawasaki disease often begins with a high and persistent fever that is not very responsive to normal doses of acetaminophen or ibuprofen. The fever may persist steadily for up to two weeks and is normally accompanied by irritability. Affected children develop red eyes, red mucous membranes in the mouth, red cracked lips, a "strawberry tongue", iritis, keratic precipitates (detectable by an ophthalmologist but usually too small to be seen by the unaided eye), and swollen lymph nodes. Skin rashes occur early in the disease, and peeling of the skin in the genital area, hands, and feet (especially around the nails and on the palms and soles) may occur in later phases. Some of these symptoms may come and go during the course of the illness. If left untreated, the symptoms will eventually relent, but coronary artery aneurysms will not improve, resulting in a significant risk of death or disability due to myocardial infarction (heart attack).
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The initial treatment of Kawasaki disease is with Intravenous Gammaglobulin 2 g/kg as a single infusion over 12 hrs followed by Aspirin 30-50 mg/kg/day in 4 divided doses until afebrile for 2-3 days. Aspirin is continued for 6-8 weeks as anti-platelet therapy at a dose of 3-5 mg/kg/day once daily. If the echocardiogram is positive, treatment should be given to children within 10 days of fever onset and those beyond day 10 with clinical and laboratory signs (CRP, ESR) of ongoing inflammation 8 . Persistence or re-occurrence of fever is managed with further doses of gammaglobulin, methylprednisolone or cytotoxic drugs. Plasmapheresis and use of monoclonal antibodies to TNFα have ... been reported 7 .
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Kawasaki disease is the most common form of vasculitis that primarily affects children. The disease produces irritation and inflammation of many tissues of the body, including the hands, feet, whites of the eyes, mouth, lips, and throat. High fever and swelling of the lymph nodes in the neck ... are characteristic of this illness. The inflammation is uncomfortable, but resolves with time. However, the main threat from Kawasaki disease comes from its effect on the heart and blood vessels. Heart-related complications can be temporary or may affect the child long-term.
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