Download Raising awareness about Kawasaki disease

Raising awareness about Kawasaki disease
Associate Professor David Burgner, Paediatric Infectious Diseases Specialist and co-chair of the
International Kawasaki Disease Consortium
Kawasaki disease is a relatively rare condition in Australia; there is probably a case diagnosed
every 2 days or so. But it is also an extremely important disease for families and doctors to think
about and recognise, as early treatment can usually prevent the potentially life-threatening damage
to the coronary arteries that supply blood to the heart. In contrast to Northern Asian countries,
where Kawasaki disease is much more common - it is thought to affect 1 in every 150 Japanese
children – General Practitioners and Emergency Department Doctors may never have seen a case of
Kawasaki disease and indeed may never do so in their working lives. The important thing is that
they – and to a lesser extent parents - are aware of the possibility and seek the help of a doctor who
is familiar with the condition.
Kawasaki disease is characterised by fever. However all young children will have a number of
infections that cause fever, so when should Kawasaki disease be suspected? Most other infections
are caused by viruses and significant fever (greater than 38.5 oC) will last only a few days. In
Kawasaki disease the fever lasts much longer –about 2 weeks if no treatment is given – and usually
doesn’t respond to paracetamol (Panadol) or to antibiotics. It’s therefore important to have a
thermometer to measure the temperature – the back of your hand is not accurate enough to measure
temperature, no matter what your grandmother told you!
Kawasaki disease typically causes other features, including red eyes (without pus or discharge),
rash, red lips (sometimes described as if the child has put red lipstick on their lips), red ‘strawberry’
tongue, red throat, swollen and painful hands and feet and less commonly a swollen gland in the
neck. These features usually come on one after the other and may have disappeared once the family
seek medical advice. They also vary form child to child – often the rash is mild and fleeting, but
sometimes it is very obvious and bright red. So it is important for families to try to keep a record of
the features (and take photos of them if possible – use your mobile phone camera) and tell the
doctor about them. Not all children have all the features of Kawasaki disease, but most children
have some of the features at some time, in addition to fever. One of the most striking features of
Kawasaki disease is that the child is almost always described as being particularly cross and
irritable, often very clingy and very difficult to conjure a smile out of. This is much more marked
than when the child has a cold of the ‘flu’ and is very typical of Kawasaki disease.
Most children with fever do not have Kawasaki disease. However any child, particularly those who
are pre-school, who has a fever that carries on for more than about 4 days and has some of the other
features and is irritable, should be seen by a doctor familiar with Kawasaki disease. Most
paediatricians have seen children with Kawasaki disease and paediatric infectious diseases
specialists are contactable through all major children’s hospitals to discuss possible cases with local
doctors. It is usually better for specialists to discuss cases with other doctors rather than talking
directly with parents.
By adopting a sensible approach to children with fever that continues for more than a few days and
watching them closely for other features of Kawasaki disease, families can assist doctors in being
alert to the rare but important possibility of Kawasaki disease. Diagnosis and treatment within about
10 days of fever onset will prevent coronary artery damage in 90-95% of cases and most cases
make a full recovery.
More information is available from the Australian Kawasaki Disease Foundation website
www.kdfoundation.org.au and the sister US organisation www.kdfoundation.org