Kawasaki Disease: Symptoms & Diagnosis

Kawasaki disease is characterized by inflammation of the walls of mid-size blood vessels. It has been noted, as affecting children from the age of 5 years and younger, with males being targeted more often than females.

Children of Japanese decent are affected more often than any other ethnic group. Although there have been cases reported in Hawaii and the United States, it still remains to be classed, as a rare autoimmune disorder. Statistics have shown that 9-19 American children under the age of 5 per every 100,000 have been diagnosed with Kawasaki disease. American children under the age of 18 years have been hospitalized with Kawasaki, as well (CDC).

Etiology

Kawasaki was discovered by Dr. Tomisaku Kawaski, a pediatrician from Japan in 1967. He later published several journals about the disorder. An English version was written in 1974 that describes the etiology of the disorder. The cause is unknown, but many medical experts seem to think that it  may be linked to the presence of a viral infection.

Stages & Symptoms

The stages of the disorder are classed by the presence and severity of the symptoms and time lapse from onset to diminish of the symptoms.

  • Acutefebrile Stage – lasts 7-14 days, with febrile temperatures of 102-104° Fahrenheit. The temperatures are unaffected by antipyretics (fever reducing medications) and antibiotics. If the disease is not treated, the symptoms may potentially last up to 4 weeks.
  • Symptoms during this stage may include uveitis or inflammation of the uvea (inner layer of the eye). Myocarditis or inflammation of the myocardium (inner layer of the heart wall). Redness and rash of the perianal area, chest and stomach. The hands and feet will become reddened and edematous (this normally develops near the end of the stage). Tongue will become red, edematous, and the lips will crack. Nausea and vomiting may also be noted. Liver, kidney, and gastrointestinal dysfunctions may be noted, as well. One or more lymph nodes may become inflamed and swollen to a diameter of 1.5 cm.
  • Subacute Stage – lasts up to the 4th or 6th week of the onset of symptoms, at which time the temperatures and fevers begin to dissipate. The skin on the fingers will begin to peel.The platelet count may be <1 million/uL, which increases the risk of thrombocytosis or blood clots. Coronary aneurysms have been noted, as being at their highest during this stage and may lead to death, if untreated.
  • Convalescent Phase – normally begins at the 3 month mark of the onset of symptoms. Most symptoms will have been alleviated and blood work findings will begin to return to baseline normal. Beau lines or grooves across the nail bed will appear. Cardiac anomalies may be ascertainable and small coronary artery aneurysms will correct themselves, but larger ones may lead to grow larger in size and cause myocardial infarction (heart attack).
  • Chronic Phase – this stage is marked by cardiac complications, in children that have suffered with the formation of aortic aneurysms (blood filled bulge within the atrial wall of the heart). This may end up rupturing during adulthood and can be life threatening.

Diagnosis

Diagnosis will begin with a complete physical and checkup. Kawasaki disease is normally diagnosed by a fever lasting more than 5 days and 4 of the symptoms must be present, as well.

Echocardiogram, blood and urine testing are also ordered to rule out other factors including juvenile rheumatoid arthritis, scarlet fever, and Rocky Mountain spotted fever.

Treatment

  • Antipyretics (fever reducing medications)
  • Antibiotics
  • Intravenous Gamma Globulin (blood antibodies)
  • Aspirin (blood thinner)
  • Analgesics (pain medications)
  • Antiemetic (reduce vomiting)