Does your little one have these strange flu symptoms? Let's learn about Kawasaki Disease!

Today we are going to talk about a rare, but sometimes very serious, condition that can affect young children, especially those under the age of five. It is called Kawasaki Disease. Some parents may be a little scared when they hear this name, but don't worry. If you are properly informed and get treatment on time, most of the time your child can be completely cured.

What is Kawasaki Disease?

Simply put, Kawasaki disease is an inflammation of the blood vessels in our body. Doctors also call this ``Vasculitis``. Now think about it, what happens when a blood vessel becomes inflamed? It can become weak, stretchy, and swell like a balloon. If that happens, they can burst. Sometimes, this inflammation can cause scarring inside the blood vessels, narrowing the blood vessels. Then, various parts and organs of the body do not receive enough blood, that is, nutrition. Kawasaki disease most often affects young children between the ages of 6 months and 5 years . Although it can actually affect any blood vessel in the body, we should be most concerned about the main blood vessels that supply blood to the heart, ``Coronary arteries`` . Because if these blood vessels are damaged, it can directly affect the functioning of the child's heart. But the best thing is that if the disease is recognized in time and treatment begins quickly, most children will recover completely within about two months .

How common is this disease?

Kawasaki Disease is actually a relatively rare disease . For example, in countries like the United States and Canada, it affects between 10 and 20 out of every 100,000 children under the age of 5. However, in Asian countries like Japan, Korea, and Taiwan, this number is slightly higher. There, it affects between 50 and 250 out of every 100,000 children. However, one important thing is that in developed countries like the United States and Japan, Kawasaki Disease has been identified as the leading cause of heart disease in children in later life . This means that it is very important for us to be aware of this.

What are the symptoms of Kawasaki Disease?

Now let's look at the symptoms that can indicate whether your little one has Kawasaki Disease. You should remember these one by one.

• Fever that lasts for at least five days . This is the main and first symptom.
• The child is constantly restless and crying (Irritability) .
• The eyes are red or pink , but there is no discharge from the eyes.
• Red, cracked lips, red tongue, looking like a strawberry (`Strawberry tongue`) .
• Swelling and/or redness of the hands and feet .
• Peeling skin on the fingertips, especially around the nails .
• Rash . This is most commonly seen on areas like the chest and abdomen. Sometimes it can appear on other parts of the body as well.
• Swollen lymph nodes in the neck . One or more may be swollen.
• Stomach upset , stomach ache, vomiting , diarrhea , etc.

Don't be afraid of Kawasaki disease just because you have one or two of these symptoms. But if you have a fever for more than five days and you also have one or more of the other symptoms mentioned, you should definitely see a doctor right away .

What causes Kawasaki disease?

The exact cause of Kawasaki disease is unknown . This means that it is not possible to say for sure why it occurs. But researchers are continuing to investigate. Some believe that an infection , an environmental factor , or a genetic predisposition may be the cause. Another thing is that this disease is usually seen most often in late winter and early spring . But it is not known exactly why.

Is this a contagious disease?

No. Kawasaki Disease is not a contagious disease . It is not spread through bodily fluids, touching, or sneezing. So there is nothing to worry about.

Who is at higher risk of developing Kawasaki Disease?

Some people are more likely to develop this disease. We call them 'risk groups'.

• Boys grow a little more than girls.
• Children under the age of 5 are most affected.
• Children of Asian or Pacific Islander ethnicity are more likely to develop this disease.

However, it is important to remember that Kawasaki disease can develop even in people who do not have these risk factors.

What are the possible complications of Kawasaki Disease?

The most dangerous thing about Kawasaki disease is the complications it can cause, especially those related to the heart.

• Coronary arteries of the heart become swollen, weak, and balloon-like (Aneurysms) . This is the most dangerous complication. In some severe cases, surgery such as coronary artery bypass surgery may be required.
• Blood clots form inside the coronary arteries and narrowing of the arteries .
• Coronary artery rupture . This is very rare, but very dangerous.
• Heart valve problemsThese valves control the flow of blood through the heart.
• Inflammation of the heart muscle (`Myocarditis` or ` Pericarditis` ) .
• Hepatitis .
• Inflammation of the lungs (Pneumonitis) .
• Heart infections .
• Inflammation of the pancreas (` Pancreatitis` ) .
• Heart failure .
• Heart attack . Although rare in young children, this can be caused by Kawasaki disease.

These complications can be scary to hear about. But remember, many of these complications can be prevented if treatment is started on time .

How is Kawasaki Disease diagnosed?

Doctors determine whether a child has Kawasaki disease mainly based on their symptoms and a physical exam . They look for the symptoms we discussed earlier. Sometimes a child may not show the full range of symptoms of Kawasaki disease. They may only have some of the symptoms. In that case, it is called ``Atypical or Incomplete Kawasaki Disease.'' Before making a diagnosis, doctors also look for other possible causes of the fever, that is, other diseases. They rule out all of these before confirming Kawasaki disease.

What are the three stages of Kawasaki Disease?

Kawasaki disease usually goes through three stages.

First stage (Acute Stage)

• It starts with a fever that lasts for five days or more .
• They inflict wounds on the body, especially the chest, stomach, and groin.
• Eyes become red (Pink eye).
• The lips and tongue become red, and the tongue looks like a strawberry.
• The palms and soles of the feet become red and swollen.
• The lumps on the neck are swollen.

Second Stage (Subacute Stage)

• This stage begins after the fever subsides .
• Stomach upset, vomiting, and diarrhea may occur.
• Joint pain and stomach pain may occur.
• The skin on the hands and feet begins to peel , especially on the fingertips.

Third Stage (Convalescent Stage)

• During this time , the symptoms are gradually decreasing .
• However, previous complications (especially heart-related ones) may persist, so doctors will continue to monitor the baby closely during this time.

It is difficult to tell these stages apart exactly, and sometimes they can even transition into each other.

What tests help in diagnosis?

Kawasaki Disease is a direct manifestation of this,There is no ``specific test`` . That is, you can't take a drop of blood and say, 'Oh, this is Kawasaki.'' However, when doctors suspect Kawasaki disease, they do several tests to confirm it and rule out other conditions.

• Blood tests : These check for inflammation markers, anemia, and liver function.
• Urinalysis .
• Echocardiogram : This is a very important test . Similar to an ultrasound scan of a baby in the womb, it can clearly see the condition of the baby's heart and coronary arteries, and whether there are any aneurysms. This is a painless test.
• Electrocardiogram (ECG/EKG) : This checks the electrical activity of the baby's heart, that is, the heartbeat pattern. This is also a painless test.
• Sometimes, if necessary, a CT angiogram ( a test using X-rays and a computer) or an MRA (Magnetic Resonance Angiogram) (a test using an MRI machine) may also be done.

Doctors conclude that the child has Kawasaki disease by comparing the information obtained from these tests with the child's symptoms.

How is Kawasaki Disease treated?

As soon as Kawasaki Disease is diagnosed, treatment begins by admitting the child to the hospital . It is very important to start treatment as soon as possible, as this can minimize the damage that can be done to the heart. The main treatments given are:

• Intravenous Immunoglobulin (IVIG) : This is a special medicine made from proteins found in human blood. It is given into a vein like saline. It reduces swelling in the body. Most children get better with this. However, about 10 out of 100 children may not respond well to the first dose of IVIG. If this happens, a second dose or other medicines may be needed.
• Aspirin : High doses of aspirin are given to reduce fever, reduce pain, and prevent blood clots. After the fever has subsided, if there is damage to the blood vessels in the heart, aspirin is continued at a low dose to prevent blood clots.
• IV fluids : Keep the child from becoming dehydrated.
• Other medications that reduce pain and swelling .
• Anticoagulants for children who are at risk of blood clots .
• In some severe cases, steroids or other anti-inflammatory medications may be given.
• Applying cold compresses to the body with cloths soaked in cold water can help reduce fever.

The main goals of treatment are:

• Reducing inflammation in the body.
• Preventing or reducing damage to blood vessels, especially the coronary arteries of the heart.
• Preventing blood clots in children with coronary artery problems.
• Preventing heart-related complications.

Are there any side effects of the treatment?

As with any medicine, these treatments can cause some side effects. IVIG is generally well tolerated. However, sometimes:

• Hemolytic anemia ( red blood cells die faster than normal)
• Infusion reactions - such as fever and chills.
• Chest pain.
• Difficulty breathing.
• Stomach ache.
• Pain in muscles or joints.

When you are given blood thinners (anticoagulants), the risk of bleeding is slightly higher. Therefore, even a small wound may take a while to stop bleeding.

Can Kawasaki Disease be prevented?

Unfortunately, no . Since the exact cause of Kawasaki Disease is not known, there is no way to prevent it yet.

What to expect if my child has Kawasaki Disease?

As soon as your child is suspected of having Kawasaki Disease, doctors will admit him to the hospital. It is at the hospital that the necessary tests are done and treatment begins. The child will be able to go home:

• When you can drink fluids well.
• When you can take medicine by mouth.
• When the fever has completely subsided and the signs of swelling in the body have disappeared.

After you go home, you will need to continue seeing your family doctor (primary healthcare provider), an infectious disease doctor (infectious disease doctor), and a cardiologist (cardiologist) . They will monitor your child closely, repeat blood tests, and repeat treatment until they say no further treatment is needed. The cardiologist will visit your child's home and do an echocardiogram in two weeks, and again in four to six weeks . If your child has had any problems with the coronary arteries, you may need to have an echocardiogram more often.

Is Kawasaki Disease completely curable?

Symptoms of Kawasaki disease can last for about four to six weeks . The child may feel tired and restless for up to eight weeks. Some children, about 2 or 3 out of 100, may develop Kawasaki disease again . What's more, Kawasaki disease can cause long-term damage to the coronary arteries and can lead to heart disease in adulthood.. An example is atherosclerosis. People who have aneurysms due to the disease will need to see a cardiologist for checkups every year or every few years for the rest of their lives. Sometimes, a procedure may be needed to improve blood flow. Your doctor will make sure your child doesn't develop blood clots and that the heart muscle is getting enough oxygen.

Is Kawasaki Disease dangerous?

Yes, Kawasaki disease is a serious illness . However, if the disease is recognized early and treatment is started on time, most children can make a full recovery . Heart complications, and sometimes even death, can occur between 15 and 45 days after the onset of fever. Fortunately, treatment can prevent most heart disease. If left untreated, about 25 out of 100 children will develop coronary artery aneurysms. However, if treated on time, this number drops to less than 6 out of 100. With treatment, about 50% of children with coronary artery aneurysms recover within a year or two.

How do I take care of my child?

While your child is recovering from Kawasaki Disease, there are a few things you can do:

• Make sure your child is up to date with all of their vaccinations . Be especially careful about the COVID-19, influenza, and varicella vaccines while your child is taking aspirin. There is a small risk of a rare but dangerous condition called Reye's syndrome in young children when aspirin is taken with a viral illness.
• Do not give your child live virus vaccines for 11 months after receiving IVIG . For example, measles-mumps-rubella (MMR), chickenpox (varicella), and live nasal influenza vaccines. IVIG can interfere with the body's ability to produce antibodies against these viruses.
• If there are any abnormalities in your child's echocardiogram, limit certain activities as advised by the doctor .

What time should I see the doctor?

If you notice any of these symptoms after your child returns home, be sure to see a doctor:

• If the fever comes back .
• If you have severe pain in your joints .
• If previous symptoms have reappeared and seem to be getting worse .

What questions should I ask the doctor?

Here are some questions you can ask the doctor if you find out that your child has Kawasaki disease:

• 'How serious is my child's condition?'
• 'How long do you think the baby will be in the hospital?'
• 'Are there support groups for parents of children with Kawasaki disease?'
• 'How much should I limit my child's activities?'

It's not easy to watch your little one suffer from a fever and other symptoms. But remember, researchers have found good treatments for this disease, and many children have recovered from it. To comfort your child, ask the doctor if you can bring a favorite toy or blanket to the hospital. Your love and calm voice will be a great strength to your child during this difficult time.

Final Take-Home Message

Kawasaki disease is a rare but serious disease that affects young children and can affect the heart.

• Be aware of symptoms such as fever lasting more than 5 days and accompanying red eyes, red lips/tongue, body aches, swelling of the limbs, and neck stiffness.
• If you notice these symptoms, see a doctor immediately. The most important thing is to start treatment on time.
• Many children recover completely with treatment.
• Even after recovery, the child should continue to be examined as directed by the doctor , especially by a cardiologist.

Don't be afraid, be aware. There are doctors who can provide the best treatment for your child. Your attention and quick action will be the biggest help in your child's recovery.