It was first introduced in 1967 by Japanese pediatrician Dr. Kawasaki disease, diagnosed by Tomisaku Kawasaki, is one of the diseases especially seen in young children. Although this disease, also called Kawasaki syndrome, is rare in children, it can have important consequences. In Kawasaki disease, which causes serious heart diseases if not treated, children can grow and develop in their normal course with early diagnosis and appropriate treatment methods.
What is Kawasaki Disease?
Kawasaki; It is a disease that can cause enlargement of medium-sized vessels, especially the coronary arteries that feed the heart, and inflammation in the vessel walls, also known as vasculitis.
This disease, which is common all over the world, especially in Japan, is mostly seen in young children under the age of 5. The disease can also occur in children younger than 3 months and older than 5 years, although it is rare. Although the disease is encountered in every period of the year, more cases are reported in the winter and spring seasons.
According to statistics, the cause of the disease, which is more common in boys, is not known exactly. Genetic predisposition is also effective in the disease, where exposure to infections is seen as an important cause. In particular, viruses and bacteria are thought to have an important role in the inflammation of blood vessels. In this sense, Kawasaki can be triggered by viruses and bacteria.
Although its cause is known to be related to some factors, Kawasaki is not a preventable disease. It cannot be predicted that the mentioned factors may cause the disease. Although rare, the disease can recur.
Kawasaki Disease Symptoms
Kawasaki disease can cause undesirable results within an average of 2 weeks with rapidly progressive complaints. Not all symptoms occur in every child. Cardiac complications, especially seen in the later stages of the disease, occur in very few children who are treated. In children younger than one year, it is difficult to diagnose because of the vague symptoms. In this case, diagnosis and treatment are delayed and enlargement of the heart vessels (aneurysm) may be seen more frequently.
The first stage of the disease, which progresses in three stages, is characterized by high fever. In addition to high fever above 39°C in the first 3-day period;
- Irritation and redness of the throat, mouth and lips,
- redness in the eyes,
- Rash, redness and peeling on the trunk, groin and leg skin,
- enlargement of lymph nodes,
- A more red and swollen tongue than normal
- Redness and swelling are seen on the hands and feet.
In addition to these symptoms, in infancy tuberculosis Some of the children who have been given the vaccine (BCG) also have redness at the vaccination site. In the first 3-5 days when symptoms appear, children are quite restless. Children whose high fever does not decrease during this period should be treated.
After this period, the following symptoms are observed:
- Diarrhea and vomiting,
- headache and stomachache,
- Swelling and pain in the joints,
- Peeling on the tips of the fingers and toes.
In the final stage of the disease, the symptoms may disappear. However, if not treated, cardiac complications can be seen in children. These complications are the most important and serious symptoms of the disease. Although arrhythmias and inflammations in various layers can be seen in the heart, the greatest damage caused by the disease is enlargement of the heart vessels (coronary aneurysm).
The Relationship Between Kawasaki Disease and Coronavirus
The disease that causes quarantine practices all over the world brings with it the question of what is Coronavirus. Coronavirus, which emerged in Wuhan, China in December 2019 and affected different countries in a short time, is an infectious respiratory disease. There are different subtypes of Coronavirus, which is a group of viruses. SARS, which emerged in 2003, and MERS, which appeared in 2012, are viruses in the Coronavirus group. The virus, which is thought to be caused by exotic animals consumed in China, is called Novel Coronavirus or Covid-19.
Among the countries with the highest number of new coronavirus cases are Italy, England and the United States. It has been reported that there has been an increase in the number of pediatric patients presenting with some signs of Kawasaki disease during this period, especially in northern Italy and some parts of England. Among the findings seen in children are high fever and coronary artery aneurysm. The increase in these symptoms, especially in children younger than 9 years old, has led to the suspicion that there is a relationship between the Novel Coronavirus and Kawasaki disease.
Research on the relationship between Kawasaki disease and Coronavirus, which is also on the agenda of the World Health Organization (WHO) and the British National Health Agency (NHS), continues.
Is Kawasaki Disease Contagious?
Especially recently, considering that the disease may be related to the Coronavirus, most people are researching what is Kawasaki syndrome. Information about the definition, symptoms and treatment methods of the disease also raises the question of whether Kawasaki is contagious.
Kawasaki disease is not a contagious disease. There is no possibility of the spread of the disease, especially in institutions such as kindergartens or nurseries where children under the age of 5 are collectively located.
How Is Kawasaki Disease Treated?
In order to make a diagnosis of Kawasaki, the symptoms that occur in children must be observed. Diagnosis can only be made by a specialist doctor based on clinical findings. Especially in the first stage of the disease, accompanying high fever for a few days, redness of the eyes, skin rash, enlarged lymph nodes in the neck, irritation in the mouth and throat, and redness, swelling and peeling in the arms and legs are the symptoms that physicians focus on during the diagnosis. Children with four of these five symptoms are diagnosed with Kawasaki disease.
Apart from these clinical symptoms, there is no test to diagnose the disease definitively, but some tests are used. Findings such as CRP and sedimentation level above normal, abnormal increase in leukocyte count and liver enzyme level, anemia and increased platelet count are measured by laboratory tests and help physicians in diagnosis.
Treatment of Kawasaki disease is started immediately after diagnosis. Although symptoms resolve spontaneously in most cases, failure to seek medical treatment can have serious consequences in some patients. If early treatment is not started in rapidly progressing disease, the possibility of cardiac complications is high. Generally, children are kept under surveillance and treatment despite the possibility of cardiac problems in health institutions.
In the treatment of the disease, primarily aspirin and high-dose intravenous immunoglobulin are administered. Intravenous immunoglobulin, also known as antibody, refers to pure plasma obtained from the fluid region of human blood. It is aimed to reduce inflammation and rapidly progressing symptoms of the disease by administering aspirin and especially intravenous immunoglobulin, which is frequently used in infection treatments. At the same time, this treatment method is applied in order to minimize the possibility of coronary vasodilation seen in the last stage of the disease.
For most patients, this treatment is sufficient. However, since some children do not respond to intravenous immunoglobulin therapy, alternative treatment methods are being used. Intravenous corticosteroid administration is one of these methods. Corticosteroids are frequently used, especially in coronary artery aneurysms. This treatment method, also known as cortisone among the people, helps to reduce inflammation.
High fever regresses in most patients 24 to 48 hours after the start of treatment. At this point, the dose of aspirin administered to patients is reduced. One of the most important reasons for continuing to administer aspirin even at low doses during treatment is to prevent blood clot formation in the inflamed coronary artery. After the regression of the enlargement of the heart vessels, the drug treatment is terminated.
Although intravenous immunoglobulin and aspirin are an effective treatment method in Kawasaki disease, the application has some side effects. In some patients, allergic reactions, headaches and muscle aches and, although very rarely, inflammation of the meninges can be seen. At the same time, routine childhood vaccinations should be postponed following intravenous immunoglobulin therapy.
Does Kawasaki Disease Recur?
Kawasaki disease, the cause of which is not known exactly, but thought to occur due to some factors, can recur, albeit rarely. In some cases, a second attack may occur, even if the disease completely heals after appropriate treatment.