How to recognize Kawasaki disease in your child
Doctors in the United States are seeing an increase in Kawasaki disease, a mysterious condition that mainly affects children under the age of five. The disease is the most common cause of acquired heart disease in children worldwide, but is often unrecognized or misdiagnosed.
Kawasaki disease is rare, but the number of cases is increasing in the United States. Here are the important things you need to know about Kawasaki disease.
What causes it?
Nobody knows. Kawasaki disease, also known as KD, is one of the most important pediatric mysteries. Some scientists believe it results from environmental exposure or occurs after a bacterial or viral infection. Certain genes appear to make some children more susceptible to it.
Whatever the cause, there was a lull in case numbers in the United States during the pandemic, suggesting that masking and social distancing measures could have helped protect children from exposure. Cases are now increasing, indicating that many children are being exposed to the mysterious cause of the disease for the first time.
What to look for
Kawasaki disease is characterized by a high fever that persists more than five days, a swollen lymph node in the neck and everything red: swollen red hands and feet, red ‘strawberry tongue’, red cracked lips and other red rashes. Patients often eventually experience peeling skin on the hands and feet. One of the telltale signs of Kawasaki disease is very bloodshot eyes.
There is no test to diagnose Kawasaki disease, and doctors must rule out a range of diseases that have similar symptoms, including tick-borne diseases, juvenile rheumatoid arthritis, scarlet fever, Stevens-Johnson syndrome, toxic shock syndrome and even measles . The condition is also very similar to multisystem inflammatory syndrome in children, or MIS-C, which can occur as a result of a Covid infection.
Some children who visit the emergency room and test positive for viral illnesses such as RSV or the flu – but also meet the criteria for Kawasaki disease – end up having an echocardiogram that shows enlargement of their coronary arteries. For this reason, it is important not to dismiss Kawasaki disease even if another respiratory diagnosis is confirmed.
The risks
Without treatment, the acute phase of Kawasaki disease can last for weeks and then resolve on its own. But the condition can cause swelling of the blood vessels, including the arteries that send blood to the heart, as well as damage to the heart muscle and valves, even long after the acute symptoms have resolved.
Undetected, inflamed heart arteries can develop aneurysms or bulges in the artery walls, which in turn can lead to a risk of blood clots and heart attacks.
About 25 percent of Kawasaki disease patients who do not receive treatment for the condition will develop aneurysms in the coronary arteries, which can lead to heart attacks and death even years later.
Your child has KD. What now?
The good news is that as long as Kawasaki disease is detected and treated within a few days, the results are usually positive. Patients are admitted to the hospital and given a large infusion of intravenous immunoglobulin, or IVIG, a mixture of antibodies, to quickly calm the inflammatory response.
Together with high doses of aspirin, the infusions can lower fever, reduce swelling and prevent heart damage. After the inflammation has subsided, an echocardiogram can confirm that the heart still looks healthy.
If you think your child might have Kawasaki disease, ask for a consultation with a Kawasaki disease specialist. For this condition, time is of the essence.
Could I have had Kawasaki disease as a child?
Many adults who had Kawasaki disease during childhood may not know they have the disease. Many were left untreated or misdiagnosed with another condition that caused a rash. Some of these people do not know they have any heart damage until a tragedy occurs during adulthood.
If you think you have had a missed case of Kawasaki disease, make sure you see a cardiologist who is familiar with the disease as soon as possible. Doctors often order a simple test called a coronary calcium score to check for damage.