KAWASAKI KAWASAKI DISEASEDISEASELearning about Kawasaki Learning about Kawasaki

Disease and How It Affects Disease and How It Affects ChildrenChildren

Kawasaki disease is a Kawasaki disease is a frightening and rare frightening and rare condition in childrencondition in children..

Amount of cases reported Amount of cases reported monthly in the duration of 10 monthly in the duration of 10

years since 1988-1998years since 1988-1998

What is Kawasaki What is Kawasaki Disease?Disease?

Kawasaki disease is a group of specific symptoms and Kawasaki disease is a group of specific symptoms and physical signs. physical signs.

Kawasaki disease is associated with swelling and damage Kawasaki disease is associated with swelling and damage of the blood vessels, or arteries. This swelling and of the blood vessels, or arteries. This swelling and damage is called inflammation. damage is called inflammation.

Kawasaki disease often affects the arteries that supply Kawasaki disease often affects the arteries that supply the heart with blood. These are called the coronary the heart with blood. These are called the coronary arteries. arteries.

Children who get the disease are usually less than 5 Children who get the disease are usually less than 5 years old. years old.

It is very rare to get the disease after a child is 10 years It is very rare to get the disease after a child is 10 years old. old.

The risk of other children in the same family getting The risk of other children in the same family getting Kawasaki disease is very low. Kawasaki disease is very low.

The risk of a child getting Kawasaki disease for the The risk of a child getting Kawasaki disease for the second time is very rare. second time is very rare.

What Causes Kawasaki What Causes Kawasaki Disease?Disease?

At present, no one actually knows what causes At present, no one actually knows what causes Kawasaki disease. Research is being done into Kawasaki disease. Research is being done into the possible causes.the possible causes.

Researchers now think that the disease may be Researchers now think that the disease may be caused by an infection. Normally, the body's caused by an infection. Normally, the body's immune system quickly recognizes germs and immune system quickly recognizes germs and destroys them.destroys them.

But in the case of Kawasaki disease, a poison or But in the case of Kawasaki disease, a poison or toxin may be formed by the infection. This toxin may be formed by the infection. This poison, or toxin, or perhaps the infection itself, poison, or toxin, or perhaps the infection itself, makes certain individuals have an unusual, or makes certain individuals have an unusual, or abnormal reaction from the immunity system to abnormal reaction from the immunity system to the infection. However, we do not know what the infection. However, we do not know what the infection or toxin is.the infection or toxin is.

We also do not know what makes We also do not know what makes some individuals more likely to get some individuals more likely to get this disease than others. There is a this disease than others. There is a slight chance that the brothers and slight chance that the brothers and sisters of a child with Kawasaki sisters of a child with Kawasaki disease may also get the disease. But disease may also get the disease. But this is very rare. Unfortunately, there this is very rare. Unfortunately, there is no way we know of to prevent a is no way we know of to prevent a child from getting the disease.child from getting the disease.

Kawasaki Disease: Kawasaki Disease: Symptoms and DiagnosisSymptoms and Diagnosis

All patients have a continuous fever All patients have a continuous fever lasting 5 days or more. lasting 5 days or more.

4 out of 5 of the following symptoms 4 out of 5 of the following symptoms are also necessary before the doctor are also necessary before the doctor can know for sure, if a child has this can know for sure, if a child has this disease. disease.

Symptoms Symptoms Red eyesRed eyes Redness of the lips, tongue or moutRedness of the lips, tongue or mout

hh Redness or swelling of the hands aRedness or swelling of the hands a

nd feetnd feet A body rashA body rash Swelling of the glands in the neckSwelling of the glands in the neck

Kawasaki Disease Kawasaki Disease Symptoms: Red EyesSymptoms: Red Eyes

The below photo shows what the The below photo shows what the child’s eyes look like with Kawasaki child’s eyes look like with Kawasaki disease.disease.

Kawasaki Disease Kawasaki Disease Symptoms: Changes in the Symptoms: Changes in the Lips, Tongue and MouthLips, Tongue and Mouth

Some changes which occur in the Some changes which occur in the mouth and lips may be seen in the mouth and lips may be seen in the pictures below. pictures below.

These changes of the These changes of the mouth and lips include mouth and lips include

such things as:such things as:

redness, redness, drying with cracking of the drying with cracking of the

lips, and lips, and a red strawberry-like tongue.a red strawberry-like tongue.

Kawasaki Disease Kawasaki Disease Symptoms: Changes to the Symptoms: Changes to the

Hands and FeetHands and Feet The palms, or inside flat part of the The palms, or inside flat part of the

hands, and the soles, or bottoms of hands, and the soles, or bottoms of the feet may turn red in colour. They the feet may turn red in colour. They may also appear swollen. may also appear swollen.

About a week after the fever breaks, About a week after the fever breaks, the skin from the fingers and toes the skin from the fingers and toes may peel off, sometimes in large may peel off, sometimes in large pieces. When this happens, new, pieces. When this happens, new, normal skin shows below the peeling normal skin shows below the peeling skin.skin.

Kawasaki Disease Kawasaki Disease Symptoms: Body RashSymptoms: Body Rash

A body rash usually first appears A body rash usually first appears with the fever. The skin appears red with the fever. The skin appears red and will feel 'bumpy' to the touch. and will feel 'bumpy' to the touch.

A red rash can be seen in the groin A red rash can be seen in the groin or diaper area, particularly in young or diaper area, particularly in young infants. This can also peel off later. infants. This can also peel off later.

Kawasaki Disease Kawasaki Disease Symptoms: Swelling of the Symptoms: Swelling of the

Glands in the NeckGlands in the Neck The picture below shows a child with The picture below shows a child with

swollen lymph nodes. You can swollen lymph nodes. You can sometimes feel these, just under the sometimes feel these, just under the skin in the neck. Usually, they are skin in the neck. Usually, they are soft, painless and about the size of a soft, painless and about the size of a pea. pea.

In a child with Kawasaki disease, In a child with Kawasaki disease, these lymph nodes may become these lymph nodes may become swollen or enlarged. They become swollen or enlarged. They become easier to feel. easier to feel.

What is the Treatment for a What is the Treatment for a Child with Kawasaki Child with Kawasaki

Disease?Disease?

There is no single medicine, which There is no single medicine, which can treat or cure Kawasaki disease.can treat or cure Kawasaki disease.

There are two medicines, There are two medicines, which can be given to which can be given to reduce the effects of reduce the effects of Kawasaki diseaseKawasaki disease

AspirinAspirin.. Gamma GlobulinGamma Globulin. .

What are the Possible What are the Possible Serious Problems for a Serious Problems for a Child with Kawasaki Child with Kawasaki

Disease?Disease? 1. Changes in the Coronary Arteries:1. Changes in the Coronary Arteries: The most serious problems from The most serious problems from

Kawasaki disease have to do with its Kawasaki disease have to do with its effects on the heart. During the effects on the heart. During the disease, the arteries, which supply disease, the arteries, which supply the heart with blood, called coronary the heart with blood, called coronary arteries, can become inflamed and arteries, can become inflamed and damaged damaged

2. Formation of Aneurysms:2. Formation of Aneurysms: Inflammation and damage to the Inflammation and damage to the

coronary arteries could weaken their coronary arteries could weaken their walls and cause the walls to develop walls and cause the walls to develop pouches or sacs, called aneurysms. pouches or sacs, called aneurysms. This is just like a weak spot in a tire This is just like a weak spot in a tire or hose, that swells up with water or or hose, that swells up with water or air. air.

What is an Aneurysm?What is an Aneurysm? Normally, the walls of blood vessels Normally, the walls of blood vessels

are smooth and even. In Kawasaki are smooth and even. In Kawasaki disease, the muscular walls of the disease, the muscular walls of the coronary arteries may become coronary arteries may become weakened.weakened.

The pressure of the blood flowing The pressure of the blood flowing through the arteries may cause these through the arteries may cause these weak spots to balloon-out, just like a weak spots to balloon-out, just like a weak spot in a tire or inner tube. weak spot in a tire or inner tube.

Abnormal Angiogram: Abnormal Angiogram: AneurysmAneurysm

This is an angiogram of a heart with This is an angiogram of a heart with abnormal coronary arteries. The abnormal coronary arteries. The arrows point to some of the arrows point to some of the abnormalities. Here, the blood abnormalities. Here, the blood vessels are not smooth; they have vessels are not smooth; they have ballooned out to form aneurysms. ballooned out to form aneurysms. This can happen to a few children This can happen to a few children who have had Kawasaki disease.who have had Kawasaki disease.

Tests to Monitor Heart Tests to Monitor Heart ComplicationsComplications

The following tests are used by a The following tests are used by a cardiologist to find out what possible cardiologist to find out what possible effects Kawasaki disease has had on effects Kawasaki disease has had on the heart and coronary arteries:the heart and coronary arteries:

1. Echocardiography1. Echocardiography 2. Electrocardiography2. Electrocardiography 3. Angiography3. Angiography

Long Term Effects of Long Term Effects of Kawasaki DiseaseKawasaki Disease

About 95 out of every 100 children About 95 out of every 100 children who have had Kawasaki disease who have had Kawasaki disease recover completely. If no damage in recover completely. If no damage in the coronary arteries is seen on the the coronary arteries is seen on the echo tests, then complete recovery is echo tests, then complete recovery is most likely. This means that there is most likely. This means that there is little chance of future problems.little chance of future problems.

If small aneurysms or dilations of the If small aneurysms or dilations of the coronary artery are found, this is not coronary artery are found, this is not serious. Small aneurysms tend to go serious. Small aneurysms tend to go away in about a year or two. Large or away in about a year or two. Large or giant aneurysms do not tend to go away, giant aneurysms do not tend to go away, and may lead to clots or narrowings. and may lead to clots or narrowings. Although these children with severe Although these children with severe coronary damage need to be followed coronary damage need to be followed closely, even these children tend to lead closely, even these children tend to lead relatively normal lives relatively normal lives

LINK TO CORONARY LINK TO CORONARY ARTERY DISEASEARTERY DISEASE

There have been 74 reported cases There have been 74 reported cases of adult coronary artery disease of adult coronary artery disease attributed to childhood Kawasaki attributed to childhood Kawasaki disease. The mean age at onset of disease. The mean age at onset of symptoms of carditis and ischaemia symptoms of carditis and ischaemia was 25 (range 12 to 39) years with was 25 (range 12 to 39) years with symptoms precipitated by exercise symptoms precipitated by exercise in 82% of these patients.in 82% of these patients.

LABORATORY FINDINGSLABORATORY FINDINGS Laboratory findings include Laboratory findings include

neutrophilia, anaemia, thrombocytosis, neutrophilia, anaemia, thrombocytosis, elevated erythrocyte sedimentation elevated erythrocyte sedimentation rate, elevated serum transaminase rate, elevated serum transaminase levels, hypoalbuminemia and an levels, hypoalbuminemia and an elevated serum alpha1-antitrypsin elevated serum alpha1-antitrypsin level. level.

Unlike atherosclerosis, no fatty streaks Unlike atherosclerosis, no fatty streaks or macrophage accumulations occur. or macrophage accumulations occur.

Other Significant Clinical Other Significant Clinical and Laboratory Findingsand Laboratory Findings

CardiovascularCardiovascular: On auscultation, gallop : On auscultation, gallop rhythm or distant heart sounds; ECG changes rhythm or distant heart sounds; ECG changes (arrhythmias, abnormal Q waves, prolonged PR (arrhythmias, abnormal Q waves, prolonged PR and/or QT intervals, occasionally low voltage, or and/or QT intervals, occasionally low voltage, or ST-T wave changes); chest X-ray abnormalities ST-T wave changes); chest X-ray abnormalities (cardiomegaly); echocardiographic changes (cardiomegaly); echocardiographic changes (pericardial effusion, coronary aneurysms, or (pericardial effusion, coronary aneurysms, or decreased contractility); mitral and/or aortic decreased contractility); mitral and/or aortic valvular insufficiency; and rarely, aneurysms of valvular insufficiency; and rarely, aneurysms of peripheral arteries (e.g., axillary), angina peripheral arteries (e.g., axillary), angina pectoris, or myocardial infarction pectoris, or myocardial infarction

GastrointestinalGastrointestinal: Diarrhea, : Diarrhea, vomiting, abdominal pain, hydrops of vomiting, abdominal pain, hydrops of gallbladder, paralytic ileus, mild gallbladder, paralytic ileus, mild jaundice, and mild increase of serum jaundice, and mild increase of serum transaminase levelstransaminase levels

Blood:Blood: Increased erythrocyte Increased erythrocyte sedimentation rate, leukocytosis sedimentation rate, leukocytosis with left shift, positive C-reactive with left shift, positive C-reactive protein, hypoalbuminemia, and mild protein, hypoalbuminemia, and mild anemia in acute phase of illness anemia in acute phase of illness (thrombocytosis in subacute phase)(thrombocytosis in subacute phase)

Urine:Urine: Sterile pyuria of urethral Sterile pyuria of urethral origin and occasional proteinuriaorigin and occasional proteinuria

Skin:Skin: Perineal rash and Perineal rash and desquamation in subacute phase and desquamation in subacute phase and transverse furrows of fingernails transverse furrows of fingernails (Beau's lines) during convalescence(Beau's lines) during convalescence

Respiratory:Respiratory: Cough, rhinorrhea, Cough, rhinorrhea, and pulmonary infiltrateand pulmonary infiltrate

Joint:Joint: Arthralgia and arthritis Arthralgia and arthritis Neurological:Neurological: Mononuclear Mononuclear

pleocytosis in cerebrospinal fluid, pleocytosis in cerebrospinal fluid, striking irritability, and rarely, facial striking irritability, and rarely, facial palsypalsy

Prepared by Roshen John Group 27 of the Prepared by Roshen John Group 27 of the 33rdrd course of medicine Ternopil State course of medicine Ternopil State Medical University Medical University