Kawasaki disease

Although the cause is not yet fully understood, it is thought to start after an infection.

The main symptom is fever that is higher than 38°C, lasting for at least five days. The other symptoms include:

• soreness of the mouth and lips
• reddening of the tongue with raised bumps
• rashes on the body, hands and feet
• swelling of the hands and feet
• reddening of the eyes
• swollen glands in the neck
• significant discomfort and irritability in young children.

Once the fever improves, the red eyes and swollen glands will disappear. However, during the third week of illness the skin on the hands and feet may peel.

Most children make a full recovery without any problems.
Some children may develop swelling or ‘ballooning’ of the blood vessels of the heart (coronary aneurysms) which may cause other heart problems. The risk of aneurysms is reduced if children are treated within 10 days of the start of the illness.

There is no single test for Kawasaki disease so a number of tests are carried out to help to confirm the diagnosis:

• blood tests to look for signs of anaemia
• increased platelet count (cell which helps clots form in blood vessels)
• electrocardioqram (ECG) to look for abnormalities of the heart rhythm
• echocardiogram (heart scan or echo) to look for how well the heart is functioning and for changes in its blood vessels (coronary artery aneurysms).

As soon as this illness is suspected, your child will begin a course of treatment including:

• an intravenous dose of immunoglobulin (a purified human blood plasma product) given in a drip over 12 hours. This will reduce inflammation and if started within 10 days of the onset of illness, helps to prevent coronary artery damage
• aspirin given every 6-8 hours (to prevent clots forming in the coronary arteries).

Most children will respond to this treatment and their fever should improve within 48 hours.

If your child does not have any further fever after initial treatment:

• the aspirin dose will be reduced to one a day
• your child will be discharged when their general condition improves
• an echocardiogram may be repeated after 6-8 weeks. If this is normal the aspirin will be stopped
• a further echocardiogram may be done after one year.

If your child has persistent fever within the first 48 hours of treatment, your medical team will:

• give another dose of intravenous immunoglobulin
• consider adding intravenous steroid, one dose each day for three days
• consider consulting a cardiologist (heart specialist) for further advice.

If there are any signs of swelling of the coronary arteries or any signs that the heart is not functioning as well as it should.
your medical team will consult a paediatric cardiologist (children’s heart specialist) for further advice. Your child may need further tests to look at heart function and may have to have long-term treatment with aspirin.

Following discharge, you may notice that your child is tired and does not eat well for nearly two weeks. This is quite normal and most children make a full recovery.
However if your child has any of the following symptoms please contact 01206 746200:

• shallow, rapid breathing
• stomach pains
• vomiting (with or without blood)
• persistent poor feeding
• swollen hands and feet
• return of fever or other symptoms of Kawasaki disease.

It is recommended that your child has the flu vaccine he or she is on long-term aspirin treatment. Please contact your GP to discuss this. Your child will also receive a follow-up appointment in the children’s outpatient clinic in approximately 6-8 weeks. This will be to discuss your child’s progress with a member of the Paediatric team.