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Kawasaki disease

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C. A. V. Nogueira, M.D. |
Kawasaki
Children   Another disease that can be easily treated, but fatal if not treated

Kawasaki disease is an inflammatory disease of blood vessels that most commonly affects infants and young children. The cause is not known, but we do know that first seven to ten days are crucial or things can get really nasty.

Kawasaki disease includes a high fever, inflammation of the mucous membranes of the mouth and throat, a reddish skin rash, and swelling of lymph nodes. But that's just for the start. Some patients may get inflammation of arteries that transport blood to heart, their walls of affected coronary arteries may become wide, and that can lead to very serious complications.

How to recognize it? The problem is it can go unnoticed and when symptoms are obvious it can be too late. So, the first thing is to pay attention to a high fever that rises and falls and lasts for up to two weeks without treatment but it can last for up to four weeks.

It is the most prominent symptom because it is not very responsive to normal treatment. Another typical characteristic are red eyes, inflammation of mucous membranes of the mouth and throat, a strawberry-red tongue, swelling of lymph nodes in the patient's neck, and a reddish rash.

If untreated, during the second or third week, skin tissue may peel from the tips of the fingers and toes and spread on the hands and feet. Unfortunately, that's not all. The patient may suffer from diarrhea, vomiting, cough, arthritis, pain, and swelling. There may be enlargement of the liver and spleen, inflammation of the brain membrane, inflammation of the middle ear...

As you can see, there are a number of symptoms that, when put together, give the right diagnosis, and every one of them alone may be a part of some other condition.

Now, the first day of fever is the first day of illness. Since the diseases progresses to involve inflammation of heart muscle and arteries that leads to heart muscle, it is important to diagnose the disease quickly and act in the first week or ten days because after that - when symptoms are already developed - the condition becomes very hard.

So, how to diagnose Kawasaki disease? Well, there is no single test to diagnose it and doctors must rule out other diseases with similar symptoms. For example, measles, Rocky Mountain spotted fever, scarlet fever, Stevens-Johnson syndrome, must be ruled out.

But as we like to say, first horses then zebras, and when it is about a sick child think children's diseases first then rule out other diseases.

So, urine tests will help rule out other diseases, blood test will show is white blood cell count elevated and is there any inflammation, electrocardiogram will see are there some irregularities with the heart rhythm, and echocardiogram will show how the heart and coronary arteries are working. Combining all those results and ruling out other disease, the doctor will know is it about Kawasaki.

When the diagnosis is established, hopefully very early, infusion of gamma globulin will be give to prevent or lower the risk of problems with coronary artery. Although aspirin is not normally given to children, high doses are used to help treat inflammation. Since aspirin and children don't go well together, that treatment must be done in a hospital.

When the first treatment is successfully done, the patient may need lower doses aspirin for six weeks, in some cases even longer. That's in the case of a coronary artery aneurysm because aspirin will help prevent clotting. But, one must be careful: if the patient develops flu or chickenpox during treatment, the aspirin therapy must be stopped or it may lead Reye's syndrome and this is very dangerous.

If diagnosed and treated on time, the sick child will see an improvement after the first gamma globulin dose. Then, the doctor will continue to follow the patient's condition, especially to be sure that the heart and arteries are not hit hard. If there is any problem the patient will be sent to another expert to fix the problem. However, early diagnosis and treatment in 99% results in a full recovery.


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