Kawasaki Disease: Signs and Symptoms, Cause, Treatment.........

I.Overview

Kawasaki disease causes inflammation in the walls of medium-sized arteries throughout the body. It primarily affects children. The inflammation tends to affect the coronary arteries, which supply blood to the heart muscle.

Kawasaki disease is sometimes called mucocutaneous lymph node syndrome because it also affects lymph nodes, skin, and the mucous membranes inside the mouth, nose and throat.

II.Sign and Symptoms

Kawasaki disease symptoms usually appear in three phases.

1st phase

Signs and symptoms of the first phase may include:

• A fever that is often is higher than 102.2 F (39 C) and lasts more than three days
• Extremely red eyes (conjunctivitis) without a thick discharge
• A rash on the main part of the body (trunk) and in the genital area
• Red, dry, cracked lips and an extremely red, swollen tongue (strawberry tongue)
• Swollen, red skin on the palms of the hands and the soles of the feet
• Swollen lymph nodes in the neck and perhaps elsewhere
• Irritability

2nd phase

In the second phase of the disease, your child may develop:

• Peeling of the skin on the hands and feet, especially the tips of the fingers and toes, often in large sheets
• Joint pain
• Diarrhea
• Vomiting
• Abdominal pain

3rd phase

In the third phase of the disease, signs and symptoms slowly go away unless complications develop. It may be as long as eight weeks before energy levels seem normal again.

When to see a doctor

If your child has a fever that lasts more than three days, contact your child's doctor, or see your child's doctor if your child has a fever along with four or more of the following signs and symptoms:

• Redness in both eyes
• A very red, swollen tongue
• Redness of the palms or soles
• Skin peeling
• A rash
• Swollen lymph nodes

Treating Kawasaki disease within 10 days of its onset may greatly reduce the chances of lasting damage.

III.Cause

No one knows what causes Kawasaki disease, but scientists don't believe the disease is contagious from person to person. A number of theories link the disease to bacteria, viruses or other environmental factors, but none has been proved. Certain genes may increase your child's susceptibility to Kawasaki disease.

IV. Risk Factors

Three things are known to increase your child's risk of developing Kawasaki disease, including:

• Age. Children under 5 years old are most at risk of Kawasaki disease.
• Sex. Boys are slightly more likely than girls are to develop Kawasaki disease.
• Ethnicity. Children of Asian or Pacific Island descent, such as Japanese or Korean, have higher rates of Kawasaki disease.

V.Complication

Kawasaki disease is a leading cause of acquired heart disease in children, but with effective treatment, only a small percentage of children have lasting damage.

Heart complications include:

• Inflammation of blood vessels (vasculitis), usually the coronary arteries, that supply blood to the heart
• Inflammation of the heart muscle (myocarditis)
• Heart valve problems

VI.Diagnosis

There's no specific test available to diagnose Kawasaki disease. Diagnosis largely is a process of ruling out diseases that cause similar signs and symptoms, including:

• Scarlet fever, which is caused by streptococcal bacteria and results in fever, rash, chills and sore throat
• Juvenile rheumatoid arthritis
• Stevens-Johnson syndrome, a disorder of the mucous membranes
• Toxic shock syndrome
• Measles

These tests may include:

• Urine tests. These tests help rule out other diseases.
• Blood tests. Besides helping to rule out other diseases, blood tests look at white blood cell count, which is likely to be elevated, and the presence of anemia and inflammation, indications of Kawasaki disease.
  Testing for a substance called B-type natriuretic peptide (BNP) that's released when the heart is under stress may be helpful in diagnosing Kawasaki disease earlier, recent research found. But, more research is needed to confirm this finding.
• Electrocardiogram. This test uses electrodes attached to the skin to measure the electrical impulses of your child's heartbeat.
• Echocardiogram. This test uses ultrasound images to show how well the heart is functioning and can help identify coronary artery abnormalities, if present.

VII.Treatment

• Gamma globulin. Infusion of an immune protein (gamma globulin) through a vein (intravenously) can lower the risk of coronary artery problems.
• Aspirin. High doses of aspirin may help treat inflammation. Aspirin can also decrease pain and joint inflammation, as well as reduce the fever. 

In some cases, a child with a coronary artery aneurysm may require:

• Anticoagulant drugs. These medications — such as aspirin, clopidogrel (Plavix), warfarin (Coumadin, Jantoven) and heparin — help prevent clots from forming.
• Coronary artery angioplasty. This procedure opens arteries that have narrowed to the point that they impede blood flow to the heart.
• Stent placement. This procedure involves implanting a device in the clogged artery to help prop it open and decrease the chance of another blockage. Stent placement may accompany angioplasty.
• Coronary artery bypass graft. This operation involves rerouting the blood around a diseased coronary artery by grafting a section of blood vessel from the leg, chest or arm to use as the alternate route.