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KAWASAKI DISEASE
Learning about Kawasaki Disease and
How It Affects Children
Kawasaki
disease is a
frightening and rare
condition in children.
Amount of cases reported monthly in the
duration of 10 years since 1988-1998
What is Kawasaki Disease?
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Kawasaki disease is a group of specific symptoms and physical
signs.
Kawasaki disease is associated with swelling and damage of the
blood vessels, or arteries. This swelling and damage is called
inflammation.
Kawasaki disease often affects the arteries that supply the heart
with blood. These are called the coronary arteries.
Children who get the disease are usually less than 5 years old.
It is very rare to get the disease after a child is 10 years old.
The risk of other children in the same family getting Kawasaki
disease is very low.
The risk of a child getting Kawasaki disease for the second time
is very rare.
What Causes Kawasaki Disease?
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At present, no one actually knows what causes
Kawasaki disease. Research is being done into the
possible causes.
Researchers now think that the disease may be caused
by an infection. Normally, the body's immune system
quickly recognizes germs and destroys them.
But in the case of Kawasaki disease, a poison or toxin
may be formed by the infection. This poison, or toxin,
or perhaps the infection itself, makes certain individuals
have an unusual, or abnormal reaction from the
immunity system to the infection. However, we do not
know what the infection or toxin is.
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We also do not know what makes some
individuals more likely to get this disease than
others. There is a slight chance that the brothers
and sisters of a child with Kawasaki disease may
also get the disease. But this is very rare.
Unfortunately, there is no way we know of to
prevent a child from getting the disease.
Kawasaki Disease: Symptoms and
Diagnosis
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All patients have a continuous fever lasting 5
days or more.
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4 out of 5 of the following symptoms are also
necessary before the doctor can know for sure,
if a child has this disease.
Symptoms
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Red eyes
Redness of the lips, tongue or mouth
Redness or swelling of the hands and feet
A body rash
Swelling of the glands in the neck
Kawasaki Disease Symptoms: Red
Eyes
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The below photo shows what the child’s eyes
look like with Kawasaki disease.
Kawasaki Disease Symptoms:
Changes in the Lips, Tongue and
Mouth
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Some changes which occur in the mouth and
lips may be seen in the pictures below.
These changes of the mouth and lips
include such things as:
 redness,
 drying
with cracking of the lips, and
 a red strawberry-like tongue.
Kawasaki Disease Symptoms:
Changes to the Hands and Feet
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The palms, or inside flat part of the hands, and
the soles, or bottoms of the feet may turn red in
colour. They may also appear swollen.
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About a week after the fever breaks, the skin
from the fingers and toes may peel off,
sometimes in large pieces. When this happens,
new, normal skin shows below the peeling skin.
Kawasaki Disease Symptoms: Body
Rash
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A body rash usually first appears with the fever.
The skin appears red and will feel 'bumpy' to the
touch.
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A red rash can be seen in the groin or diaper
area, particularly in young infants. This can also
peel off later.
Kawasaki Disease Symptoms:
Swelling of the Glands in the Neck
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The picture below shows a child with swollen
lymph nodes. You can sometimes feel these, just
under the skin in the neck. Usually, they are soft,
painless and about the size of a pea.
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In a child with Kawasaki disease, these lymph
nodes may become swollen or enlarged. They
become easier to feel.
What is the Treatment for a Child
with Kawasaki Disease?
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There is no single medicine, which can treat or
cure Kawasaki disease.
There are two medicines, which can
be given to reduce the effects of
Kawasaki disease
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Aspirin.
Gamma Globulin.
What are the Possible Serious
Problems for a Child with Kawasaki
Disease?
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1. Changes in the Coronary Arteries:
The most serious problems from Kawasaki
disease have to do with its effects on the heart.
During the disease, the arteries, which supply
the heart with blood, called coronary arteries,
can become inflamed and damaged
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2. Formation of Aneurysms:
Inflammation and damage to the coronary
arteries could weaken their walls and cause the
walls to develop pouches or sacs, called
aneurysms. This is just like a weak spot in a tire
or hose, that swells up with water or air.
What is an Aneurysm?
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Normally, the walls of blood vessels are smooth
and even. In Kawasaki disease, the muscular
walls of the coronary arteries may become
weakened.
The pressure of the blood flowing through the
arteries may cause these weak spots to balloonout, just like a weak spot in a tire or inner tube.
Abnormal Angiogram: Aneurysm
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This is an angiogram of a heart with abnormal
coronary arteries. The arrows point to some of
the abnormalities. Here, the blood vessels are
not smooth; they have ballooned out to form
aneurysms. This can happen to a few children
who have had Kawasaki disease.
Tests to Monitor Heart
Complications
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The following tests are used by a cardiologist to
find out what possible effects Kawasaki disease
has had on the heart and coronary arteries:
1. Echocardiography
2. Electrocardiography
3. Angiography
Long Term Effects of Kawasaki
Disease
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About 95 out of every 100 children who have
had Kawasaki disease recover completely. If no
damage in the coronary arteries is seen on the
echo tests, then complete recovery is most likely.
This means that there is little chance of future
problems.
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If small aneurysms or dilations of the coronary
artery are found, this is not serious. Small
aneurysms tend to go away in about a year or
two. Large or giant aneurysms do not tend to go
away, and may lead to clots or narrowings.
Although these children with severe coronary
damage need to be followed closely, even these
children tend to lead relatively normal lives
LINK TO CORONARY ARTERY
DISEASE
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There have been 74 reported cases of adult
coronary artery disease attributed to childhood
Kawasaki disease. The mean age at onset of
symptoms of carditis and ischaemia was 25
(range 12 to 39) years with symptoms
precipitated by exercise in 82% of these patients.
LABORATORY FINDINGS
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Laboratory findings include neutrophilia,
anaemia, thrombocytosis, elevated erythrocyte
sedimentation rate, elevated serum transaminase
levels, hypoalbuminemia and an elevated serum
alpha1-antitrypsin level.
Unlike atherosclerosis, no fatty streaks or
macrophage accumulations occur.
Other Significant Clinical and
Laboratory Findings
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Cardiovascular: On auscultation, gallop rhythm or
distant heart sounds; ECG changes (arrhythmias,
abnormal Q waves, prolonged PR and/or QT intervals,
occasionally low voltage, or ST-T wave changes); chest
X-ray abnormalities (cardiomegaly); echocardiographic
changes (pericardial effusion, coronary aneurysms, or
decreased contractility); mitral and/or aortic valvular
insufficiency; and rarely, aneurysms of peripheral
arteries (e.g., axillary), angina pectoris, or myocardial
infarction
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Gastrointestinal: Diarrhea, vomiting,
abdominal pain, hydrops of gallbladder,
paralytic ileus, mild jaundice, and mild increase
of serum transaminase levels
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Blood: Increased erythrocyte sedimentation
rate, leukocytosis with left shift, positive Creactive protein, hypoalbuminemia, and mild
anemia in acute phase of illness (thrombocytosis
in subacute phase)
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Urine: Sterile pyuria of urethral origin and
occasional proteinuria
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Skin: Perineal rash and desquamation in
subacute phase and transverse furrows of
fingernails (Beau's lines) during convalescence
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Respiratory: Cough, rhinorrhea, and
pulmonary infiltrate
Joint: Arthralgia and arthritis
Neurological: Mononuclear pleocytosis in
cerebrospinal fluid, striking irritability, and rarely,
facial palsy
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Prepared by Roshen John Group 27 of the 3rd course of
medicine Ternopil State Medical University