Kawasaki disease needs to be ruled out in young children with fever

Clusters of children and teens with Covid-19 in Europe and North America have been admitted to the intensive care unit with features similar to Kawasaki disease and toxic shock syndrome. — AFP

Kawasaki disease was first described in 1967 by a Japanese paediatrician, Dr Tomisaku Kawasaki.

The first cases outside of Japan were reported in Hawaii, United States, in 1976.

Approximately three-quarters of Kawasaki disease patients are children below the age of five, with the disease occurring more often in boys than girls.

It is the most common cause of acquired heart disease in children, as it causes inflammation of the blood vessel walls, especially in the coronary arteries that supply blood to the heart muscles.

If treated early, most children will recover within a few days.

The exact cause is still unknown, but it is not directly contagious.

Fever first

The most common symptom of Kawasaki disease is a high fever, between 38.3-39.4°C, which lasts more than four days, and has little to no response to common over-the-counter fever medications.

Other symptoms that occur within 14 days of the fever include:

  • Enlarged glands (especially at the neck)
  • Swelling of the hands or bottom of the feet, which also become reddish
  • Conjunctivitis with red, non-watery eyes
  • Red and swollen tongue
  • Non-specific rash
  • Redness of the BCG injection site
  • Peeling skin on the tips of the fingers and toes after two weeks

The symptoms appear in three stages.

Problems with the heart will occur between 10 to 14 days after the onset of the first symptoms.

Some patients may have inflamed or sore joints between the end of the fever up to around the 25th day of the disease.

The entire course of the disease may last up to eight weeks.

Hospital treatment

The diagnosis of Kawasaki disease needs to have a high degree of suspicion, i.e. the doctor must have this disease in mind when considering the diagnosis.

Your child’s paediatrician will have to decide based on the combination of symptoms and signs if your child really has this condition.

Paracetamol can be given for the fever, but your child needs to be examined to rule out Kawasaki disease.

Due to the high risk of complications, your child will likely be hospitalised while receiving initial treatment.

Treatment may include an IV (intravenous) infusion of immunoglobulin, along with other medications.

Affected patients require plenty of fluid to avoid dehydration.

Your child may also be given aspirin for a few weeks.

Risk of complications

While most children do recover completely, there are rare cases where inflammation of the blood vessels leads to weakening of the artery walls, causing bulging (aneurysm).

Other parts of the heart that can be involved are the membrane covering the heart, the heart valves and the heart muscles.

Kawasaki disease during childhood has also been linked with an increased risk of heart disease in adulthood.

Infants who get this disease face a higher risk of serious complications.

Early treatment will reduce the chances of permanent effects.

There are no official support groups for Kawasaki disease patients and their families, but there is an unofficial Malaysian support group called on Facebook.

Datuk Dr Zulkifli Ismail is a consultant paediatrician and paediatric cardiologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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