KD was first described in Japan in the 1960s by Dr Kawasaki. This disease involves inflammation of the medium-sized arteries in the body. The arteries of primary concern are the coronary arteries that supply blood to the heart muscles. These arteries can potentially be weakened by the inflammation, causing them to dilate (bulging of the vessel). This dilation increases the risk of heart attacks, rupture or sudden death in the long term.
KD affects children primarily under the age of five and is seen across all ethnic groups, though it is more common among children of Japanese and Korean descent. Early recognition and treatment can lead to full recovery within a few days. However, untreated KD can lead to serious heart-related complications.
What causes it
The cause of KD remains unclear, it is thought to be initiated by a viral infection.
Signs & Symptoms
Kawasaki Disease (KD) is a childhood illness that causes inflammation of the medium blood vessels in the body. It is characterised by a persistent fever over 38°C (100.4°F) for at least 4-5 days, accompanied by several other clinical features such as:
Eye redness without discharge
A rash
Red, dry, cracked lips and/or strawberry tongue
Redness and swelling of the hands and feet
Enlarged lymph nodes of the neck
Redness and swelling of the BCG vaccination scar
Not all the symptoms may be present in every child.
Diagnosis and Treatment Options
Diagnosing KD involves assessing for the clinical features and excluding other conditions, as no single test exists for its diagnosis.
A diagnosis generally requires a fever of at least 4-5 days, along with at least 4 of the following symptoms:
Eye redness without discharge
A rash
Red, dry, cracked lips and/or strawberry tongue
Redness and swelling of the hands and feet
Enlarged lymph nodes of the neck
Blood and urine tests may be conducted, alongside an echocardiogram, to examine the coronary arteries. Treatment includes an intravenous immunoglobulin (IVIg) infusion (a blood-derived product) and oral aspirin, which mitigate the inflammation and lessen the likelihood of long-term coronary artery damage. In more severe cases, steroids may also be given.
Symptoms typically subside within two days after treatment initiation. If treated within 10 days of symptom onset, heart complications are unlikely to occur.
Delaying treatment (beyond 12 to 14 days) elevates the risk of severe complications, including inflammation of blood vessels and potential coronary artery involvement, which is particularly dangerous as these arteries supply blood to the heart.
Care Tips
The child can go home once the fever has resolved and the clinical features have improved. Peeling of the fingers and toes may be noticed after discharge in the second to third week of KD and can be left alone.
Echocardiograms will be repeated by a Cardiologist at the outpatient clinic to assess your child’s coronary arteries. In most cases, aspirin is usually continued for a few weeks following KD diagnosis.
Vaccination
Following the intravenous immunoglobulin (IVIg) infusion, live vaccines (e.g. measles, mumps and rubella (MMR) and varicella vaccines) should be avoided for 11 months post-infusion. Inactivated vaccines can be taken as per routine schedule.
