Has your little one's fever not subsided for more than five days? Are there red spots all over their body? Are their eyes red and their lips chapped? How scared do we get as parents at times like this? Even if you think it's just a normal fever or a cold, sometimes it can be something more serious. Today, we're going to talk about a rare condition that affects young children that needs to be diagnosed and treated quickly. That's Kawasaki Disease.
What is Kawasaki Disease?
Simply put, Kawasaki disease is a condition in which the blood vessels (blood vessels) in our body become inflamed, that is, they become swollen and red. In medicine, we call this vasculitis . Think of the blood vessels throughout our body as pipes that carry water. What happens if these pipes become inflamed from the inside? Blood flow is impeded, and the walls of those pipes can also become weak.
Although this disease can affect any blood vessel in the body, as doctors, we are most concerned about the coronary arteries, which supply blood to the heart. Because the heart is the engine of our body. The main vessels that supply blood to that engine are called coronary arteries. If these become inflamed or weak, the functioning of the heart can be seriously damaged.
This disease is most common in children between the ages of 6 months and 5 years . However, the best thing is that if the disease is diagnosed at the right time and proper treatment is started, most children will recover completely within about two months. Therefore, it is important not to panic and be aware of the symptoms.
How common is this disease?
Kawasaki disease is a very rare disease. In countries like the United States and Canada, it affects between 10 and 20 out of 100,000 children under the age of 5. However, in Asian countries like Japan and Korea, this number is slightly higher. The most important thing is that Kawasaki disease has become the leading cause of acquired heart disease in children in developed countries.
What are the symptoms of this disease? How do we recognize it?
As a parent, you should be very careful about this. Because these symptoms can be somewhat similar to those of a common viral flu. But it is when these symptoms come together that you should pay special attention.
The most important symptom is a high fever that lasts for 5 days or more. This fever may not be completely reduced by ordinary medicines such as paracetamol.
Let's look at the other main features in this way to make them easier to remember.
| Symptom | Description (what you see) |
|---|---|
| Fever lasting more than 5 days | This is the main and most obvious symptom. The fever may be higher than 101°F (38.3°C). |
| Redness of the eyes | The whites of the eyes turn pink or red, but there is no discharge of mucus or pus from the eyes. |
| Changes in the mouth, lips, and tongue | The lips become bright red, cracked, and dry. The tongue becomes strawberry-red and may have small bumps (Strawberry tongue). The throat may also become red. |
| Changes in hands and feet | The child's palms and soles become red and swollen. This swelling may make it difficult for the child to walk or hold things with their hands. |
| Skin rash | Red rashes often appear on the chest, abdomen, and groin. These can resemble measles. |
| Swollen lymph nodes in the neck | A swollen lymph node (nodule) on one side of the neck, usually larger than 1.5 centimeters. |
| Skin peeling | 2-3 weeks after the onset of the disease, the skin begins to peel off from the fingertips and toes. |
| Excessive restlessness | The child is crying more than usual and seems to be unwell. |
Some children do not show all of these symptoms at once. If only a few symptoms are shown, we call it incomplete Kawasaki disease . However, it is very important to take your child to a doctor right away, even if they have one or two of these symptoms along with a fever.
Why does this disease occur? Is it contagious?
In fact, doctors have not yet found a definitive cause for Kawasaki disease, but there are several theories.
- A reaction to an infection: Some researchers believe that when a virus or bacteria enters the body, our immune system overreacts to it, causing damage to blood vessels.
- Environmental factors: This disease is more commonly reported at certain times of the year, especially in late winter and early spring.
- Genetic predisposition: It is believed that children who carry certain genes may be more prone to developing this disease.
The most important thing is that Kawasaki disease is not contagious. This means that if your child has this disease, there is no need to worry about spreading it to other children at home or at school.
Who is at higher risk?
- Male children are at slightly higher risk than female children.
- Children under 5 years of age.
- For children of Asian or Pacific Islander descent.
What complications can make Kawasaki disease dangerous?
This is the part we need to pay the most attention to. If left untreated or treated late, the complications that can occur, especially those related to the heart, can be dangerous.
- Coronary artery aneurysms: This is the most serious and dangerous complication. An aneurysm is a bulge in a blood vessel wall that has become weakened due to inflammation. These can become bulging and sometimes rupture.
- Heart attack: If a blood clot forms inside an aneurysm and blocks the flow of blood to the heart, a heart attack can occur.
- Myocarditis: Inflammation of the heart muscle.
- Heart valve problems: Heart valves can become damaged and not open or close properly.
- Heart failure: The inability of the heart to pump enough blood to the body as a whole.
Hearing about these complications may scare you. But remember, most of these complications can be prevented if treatment is started within the first 10 days of the onset of symptoms. That's why we say that if you have a fever and the symptoms mentioned above, see a doctor without delay.
How does the doctor diagnose this disease exactly?
There is no single blood test or scan that can confirm Kawasaki disease. The doctor makes the diagnosis by carefully examining the child's symptoms. We call this a clinical diagnosis .
The doctor will diagnose Kawasaki disease by examining the child, looking at how many days the fever has been present, what other symptoms are present, and making sure that there are no other diseases that can cause the symptoms (e.g. measles, scarlet fever).
Three stages of the disease
Kawasaki disease usually progresses through three stages.
1. Stage 1 - Acute: This is the first two weeks or so. The main symptoms such as fever, rash, red eyes, and changes in the mouth are all present during this time. The child becomes extremely restless during this stage.
2. Stage 2 - Subacute: Lasts two to four weeks. By this time, the fever has subsided. However, symptoms such as stomach aches, diarrhea, and joint pain may occur. Most importantly, the skin on the fingertips and toes begins to peel off during this time. The risk of developing coronary artery aneurysms is highest during this stage.
3. Stage 3 - Convalescent: This can last for a month or two. All symptoms gradually disappear. However, the child may feel a little tired. It takes time for the damage to the blood vessels to heal.
What tests are performed?
Even if the disease cannot be confirmed, the doctor may order several tests to determine the severity of the disease and to rule out other conditions.
- Blood tests: Look for things like CRP and ESR, which indicate the level of inflammation in the body.
- Urinalysis
- Echocardiogram: This is the most important test. This is an ultrasound scan. It can clearly see the function of the heart, the condition of the valves, and especially whether the coronary arteries have been damaged or aneurysms have formed.
- Electrocardiogram (EKG): This helps to look at the electrical activity (rhythm) of the heart.
How is it treated?
As soon as Kawasaki disease is suspected, the child is admitted to the hospital. Treatment begins in the hospital. There are four main goals of treatment:
1. Reducing fever and inflammation in the body.
2. Prevent or reduce damage to blood vessels, especially the coronary arteries.
3. Preventing heart complications.
4. Preventing blood clots.
Two main treatment methods are used:
- Intravenous Immunoglobulin (IVIG): This is the main treatment. Simply put, it is a substance that contains antibodies taken from healthy people. It is given to the child intravenously (IV) like saline. It works by controlling the body's overactive immune response and reducing damage to blood vessels. Giving this treatment within the first 10 days can reduce the risk of heart complications from 25% to less than 5%.
- Aspirin: We don't usually give aspirin to children with viral fevers. However, in Kawasaki disease, aspirin is given initially in high doses to reduce fever and inflammation, and then in low doses to prevent blood clotting for several weeks.
In addition to these treatments, the child is also given things like saline to prevent dehydration, and medication for pain and swelling.
What happens after you go home from the hospital?
Once the child's fever is completely gone and he is able to take oral fluids and medication, he can be sent home from the hospital. But the work is not over after he returns home. The child needs to be closely monitored.
You will need to continue to have follow-up visits with your pediatrician and cardiologist.
- You will go home and have an echocardiogram in a week or two, and again in 4-6 weeks to see how your heart is doing.
- If there has been any damage to the coronary arteries, you will need to be under medical supervision for a long time, and may even need to have periodic tests throughout your life.
Is Kawasaki disease completely curable?
Most children recover completely. Symptoms may last for about 4-6 weeks. The child may feel tired and restless for about two months. Very rarely (about 2-3%) the disease can recur.
After treatment, about 50% of the damage to the arteries will heal within a year or two. However, if the damage is severe, such as an aneurysm, it can be a lifelong problem.
What can you do as a parent?
We understand the stress and sadness you feel when a child is sick. But your strength is your child's greatest strength.
- Follow your doctor's instructions exactly: Take your medications exactly as prescribed. Don't miss any follow-up appointments.
- Be careful about vaccinations: It's important to protect your child from viral diseases like chickenpox and influenza while taking aspirin. Aspirin and some viruses can cause a rare but dangerous condition called Reye's syndrome. So talk to your doctor to make sure your child's vaccinations are up to date.
- Be aware of live virus vaccines: Live virus vaccines, such as measles-mumps-rubella (MMR) and chickenpox (varicella), are not given for 11 months after receiving IVIG treatment. This is because IVIG treatment may prevent the body from making adequate antibodies to these vaccines.
- Limiting activities: If your child's heart has been affected, your doctor may advise you to limit strenuous sports and running activities for a while. Follow these instructions carefully.
- Comfort your child: While your child is in the hospital, give them a favorite toy or book. Your voice and your caress will bring great comfort to your child during this difficult time.
Take-Home Message
- If your child has a fever that lasts for more than 5 days and is accompanied by symptoms such as red eyes, chapped lips, rashes, and swollen limbs, do not assume it is just a normal fever and seek medical advice immediately.
- Kawasaki disease is not contagious . Don't be unnecessarily afraid of it.
- By diagnosing the disease early and starting treatment within the first 10 days of the onset of symptoms, much of the serious damage to the heart can be prevented.
- Even after treatment, it is essential for the child's long-term well-being to follow up with the doctor's instructions and tests as prescribed.
- Although this disease is rare, remember that most children make a full recovery with treatment, and stay positive and strong.
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