13457 Kawasaki Disease

Overview

Kawasaki disease is a rare illness that causes inflammation (swelling) in the walls of some blood vessels in the body. It most often affects young children. The inflammation can involve the heart's blood vessels, which is why prompt medical care is very important. With early treatment, most children recover fully.

No, Kawasaki disease is uncommon. In the UK, around 8 in every 100,000 children develop it each year. It is more common in boys than in girls.

It mostly affects children under 5, but it can occur in older children and, very rarely, in adults. Children of East Asian descent are more likely to get it, but it can affect any child.

Symptoms

Common symptoms

• A fever that lasts 5 days or longer
• A rash anywhere on the body, often on the chest or back
• Red, bloodshot eyes without a thick discharge
• Bright red, swollen lips and a strawberry-like tongue
• Red, swollen hands and feet with peeling skin at the fingertips
• Swollen lymph nodes in the neck

Symptoms in children

• The same symptoms as above. A child may be very irritable and in pain.
• A high fever lasting more than 5 days is often the first sign.
• The peeling of skin on hands and feet usually happens in the second week.

Symptoms in older adults

• Kawasaki disease is extremely rare in older adults. If an adult develops these symptoms, another condition is much more likely.
• An older adult with new rash, red eyes, and fever should see a doctor to rule out other causes.

Causes

Main causes

• The exact cause is unknown. Doctors believe it may be an abnormal immune response to an infection or virus.
• It is likely that a combination of genes and an infection trigger the body's immune system to attack its own blood vessels by mistake.

Risk factors

• Being under 5 years old
• Being male
• Having a family member who has had Kawasaki disease
• Being of East Asian descent

When to see a doctor

See a doctor urgently if:

• If your child has a fever lasting more than 5 days
• If your child has a fever plus two or more of the other symptoms listed above
• If you notice peeling skin on your child's fingers or toes

Book a routine appointment if:

• If your child has had a fever for a few days and you are worried, even if it has not been 5 days yet.
• If your child has red eyes or a rash that is not going away.

Diagnosis

There is no single test for Kawasaki disease. A doctor will diagnose it by looking at your child's symptoms, doing a physical exam, and ruling out other illnesses that can look similar, such as measles, scarlet fever, or certain viral infections.

Tests that may be done

• Blood tests to check for signs of inflammation (such as high white blood cell count or high CRP)
• Urine tests
• An echocardiogram (an ultrasound of the heart) to check the heart's blood vessels
• Sometimes an electrocardiogram (ECG) to check the heart's rhythm

What to expect at your appointment

Your child may need to stay in the hospital at first, so doctors can watch them closely and start treatment quickly. Tests will be repeated over the next few weeks to make sure the heart is healthy.

Treatment

Kawasaki disease is treated in the hospital. The goal of treatment is to reduce inflammation, protect the heart, and prevent damage to the coronary arteries (the blood vessels that supply the heart). Treatment works best when started within 10 days of the fever beginning.

Self-care at home

• Give your child plenty of fluids to keep them well hydrated.
• Encourage rest, but let them play gently if they feel well enough.
• Keep follow-up appointments so the doctor can check your child's heart.
• Give pain or fever relief only as recommended by your child's doctor.

Medical treatments

Standard treatment includes medicines given through a drip (intravenously) to reduce inflammation. This is often combined with other medicines that help prevent blood clots and further inflammation. Your child will be monitored in the hospital, and the treatment plan will be tailored to their needs. Doctors may continue some medicines at home for a few weeks or months, with regular heart check-ups.

When is surgery considered?

In rare cases, if a coronary artery becomes very narrowed or blocked, a child may need a procedure to restore normal blood flow in the heart. This is uncommon and only considered after full assessment by a specialist heart team.

Living with this condition

Most children recover completely within a few weeks and can return to normal activities once they feel better. Your child may be tired for a while, so rest and gradual return to play is fine. Keep any follow-up appointments with the doctor.

Lifestyle tips

• Help your child stay active after recovery, but let their energy levels guide them.
• Maintain a healthy routine with good sleep and regular meals.
• If your child takes any medicines for a while, give them exactly as prescribed.

Diet and exercise

There is no special diet for Kawasaki disease. A normal, healthy diet with plenty of fruits, vegetables, and water supports recovery. After recovery, regular exercise such as playing, running, and cycling is safe and good for the heart for most children.

Mental health and emotional wellbeing

A hospital stay and illness can be stressful for a child and for parents. It is normal to feel worried or anxious. Talk to your child in simple, reassuring words. Let them know they are safe and that the treatment is helping. If you or your child feel very anxious or low, speak to your GP or health visitor.

Prevention

There is no known way to prevent Kawasaki disease. Because the cause is still not fully understood, there are no special precautions to take. The best thing you can do is recognize the symptoms early and seek medical help promptly.

Vaccines

There is no vaccine to prevent Kawasaki disease. Ensuring your child's routine vaccinations are up to date is still important for protecting against other illnesses.

Screening programmes

There is no routine screening for Kawasaki disease in healthy children. Children who have had Kawasaki disease will have follow-up heart checks to make sure their blood vessels are healthy.

Complications

If left untreated

• Damage to the coronary arteries, including bulging or narrowing of the blood vessel walls (called aneurysms)
• Inflammation of the heart muscle (myocarditis)
• Problems with heart valves
• Blood clots that can block blood flow to the heart (heart attack)

Long-term outlook

With early treatment, the outlook is excellent. More than 8 out of 10 children who are treated in time recover completely and have no lasting heart problems. A small number of children may need long-term follow-up, but most grow up healthy and active. Even with a delayed diagnosis, modern treatment can still help, though the risk of heart complications is higher.

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