A Family Doctor's Tale - KAWASAKI DISEASE

DOC I HAVE KAWASAKI DISEASE

Kawasaki Disease is a childhood disease which was first seen in Japan which typically cause fever, swelling of the lymph nodes, and symptoms affecting the skin and mucous membranes.

It occurs mainly in children below 5 years.

One of its notable features other than high fever and skin peeling is the complication of the disease on the arterial system of the heart.

The cause of Kawasaki Disease is believed to be an infection although no causative organism has been found.

An autoimmune disease has been suggested as the cause of the Kawasaki disease.

The triad of symptoms which are common to Kawasaki Disease are:

1.Fever with headache lasting for more than 5 days

2.Swelling of one or more lymph nodes in the neck

3.blotchy red rash over the entire body with typical skin peeling in the second week of illness

Other symptoms are:
4.sore throat with sometimes tonsillar swelling

5.dry cracked and swollen lips

6.conjunctivitis

7.reddening of the palms and soles

8.swelling of the hands and feet

9.skin peeling from the tips of the fingers and toes in the second week of illness

Disease usually lasts for 2-3 weeks.

Diagnosis
1.Classical symptoms and signs as above especially high fever, lymph nodes enlargement, rash and peeling of the skin from the fingers and toes.

2.blood tests (complete blood count, ESR, blood culture).

3.X-rays of chest and neck

4.ECG or electrocardiogram of the heart

5.CT Scan of the heart

Complications of Kawasaki disease:
1.arthritis

2.myocarditis (inflammation of the heart muscles)

3.myocardial infarction (heart attack)

4.coronary artery disease

Treatment of Kawasaki disease:
Suspected cases should be treated as early as possible because of possible heart complications

1.Bed rest in isolation ward

2.Adequate fluids

3.Antipyretic medicines such as paracetamol for fever

4.Aspirin may be given (in spite of the danger of Reyes Syndrome) to prevent blockage of the coronary artery of the heart.

5.Injections of gamma globulin is the main treatment for Kawasaki disease.

6.corticosteroids is useful to reduce complications such as arthritis and myocarditis

Prognosis of Kawasaki Disease is generally good.

Most children make a full recovery after about 3 weeks.

Myocarditis and arthritis may last for 6 to 8 weeks.

Coronary artery disease improves gradually over 1 year.

In 1-2 per cent of patients serious heart complications may occur.