From the Guidelines
Kawasaki disease is a rare inflammatory condition primarily affecting children under 5 years old, and its symptoms include persistent high fever lasting at least five days, red eyes without discharge, rash on the trunk and genital area, red swollen lips and tongue, swollen and red hands and feet with later peeling of skin, and swollen lymph nodes in the neck, and treatment should begin as soon as possible after diagnosis, ideally within 10 days of fever onset, with intravenous immunoglobulin (IVIG) and high-dose aspirin. The main symptoms of Kawasaki disease are:
- Persistent high fever lasting at least five days
- Red eyes without discharge
- Rash on the trunk and genital area
- Red swollen lips and tongue (often called "strawberry tongue")
- Swollen and red hands and feet with later peeling of skin
- Swollen lymph nodes in the neck The standard treatment consists of intravenous immunoglobulin (IVIG) given as a single infusion of 2g/kg over 10-12 hours, along with high-dose aspirin (80-100mg/kg/day divided into four doses) during the acute phase, as recommended by the American Heart Association 1. Once the fever resolves, aspirin is typically reduced to a low dose (3-5mg/kg/day) and continued for 6-8 weeks to prevent blood clots, as the inflammation can affect coronary arteries. If the child doesn't respond to the initial IVIG treatment within 36 hours, a second dose may be given or corticosteroids added, as suggested by the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association 1. Prompt treatment is crucial because Kawasaki disease can cause coronary artery aneurysms if left untreated, which may lead to heart problems later in life, with a risk of coronary artery abnormalities developing in about 15 to 25 percent of untreated children, as reported by the American Heart Association 1. Regular cardiac follow-up with echocardiograms is necessary to monitor for heart complications, as recommended by the American Family Physician 1.
From the Research
Symptoms of Kawasaki Disease
- Fever greater than or equal to 102 degrees F for more than or equal to 5 days 2
- Bilateral bulbar conjunctivitis/conjunctival suffusion 2
- Erythematous rash 2
- Cervical adenopathy 2
- Pharyngeal erythema 2
- Swelling of the dorsum of the hands/feet 2
- Conjunctivitis, rash, lymphadenopathy, mucositis, edema of hands and feet 3
- High fever lasting more than five days, conjunctivitis, stomatitis, edema of hands or feet erythema of the palms and soles, epidermic desquamation of the fingers and toes, polymorphic rush and cervical lymphadenopathy 4
Treatment of Kawasaki Disease
- Hospitalization of the child and subsequent administration of high doses of aspirin and intravenous immunoglobulin 5
- Intravenous infusion of immunoglobulin and aspirin 4
- Addition of methylprednisolone to a combination of aspirin and intravenous immunoglobulins and biological agents like anakinra, etanercept, infliximab, and immunosuppressants like cyclosporine to prevent the occurrence of coronary artery aneurysms 3
- Oral prednisolone 2 mg/kg/day plus standard of care therapy IVIG (2 g/kg) and aspirin (40 mg/kg/day) 6