Kawasaki disease (mucocutaneous lymph node syndrome)

• What is Kawasaki Disease
• Statistics on Kawasaki Disease
• Risk Factors for Kawasaki Disease
• Progression of Kawasaki Disease
• Symptoms of Kawasaki Disease
• Clinical Examination of Kawasaki Disease
• How is Kawasaki Disease Diagnosed?
• Prognosis of Kawasaki Disease
• How is Kawasaki Disease Treated?
• Kawasaki Disease References

What is Kawasaki Disease

Kawasaki disease is currently the most common cause of acquired heart disease in children in developed countries. First described by Dr Tomisaku Kawasaki, it is a disease of unknown cause that affects the blood vessels usually in children aged less than 5 years (90-95% of Kawasaki disease patients are aged less than 10 years).

Statistics on Kawasaki Disease

Kawasaki disease has been reported throughout the world, but incidence varies from country to country. Incidence in Australia for 1994 was reported as being 3.7 cases per 100 000 children aged less than 5 years. In comparison, incidence in Japan and the United Kingdom for 2000 was reported as being 134.2 cases and 8.1 cases per 100,000 children under 5 years, respectively.

Risk Factors for Kawasaki Disease

The exact cause of Kawasaki disease remains unknown. Current evidence suggests it is triggered by infection in a genetically susceptible person. A number of infectious causes have been suggested including viruses and bacterial infections.

Progression of Kawasaki Disease

Kawasaki disease can be divided into three stages: acute, subacute and convalescent.
 

• The acute stage usually lasts seven to 14 days and is characterized by fever, eye and mouth changes, swelling and redness of the hands and feet, rash and raised lymph nodes.

 
 

• The subacute phase spans the period from the end of the fever to about day 25. During this stage, patients may have inflamed or sore joints.

 
 

• The convalescent phase begins when physical signs disappear and continues until the blood tests become normal, usually six to eight weeks after the onset of illness.

 

How is Kawasaki Disease Diagnosed?

Procedures such as ECG and echocardiography may reveal signs of myocarditis, pericarditis, arthritis, aseptic meningitis, and coronary vasculitis.

Prognosis of Kawasaki Disease

Prognosis is good with prompt diagnosis and treatment. The current mortality rate is 0.1-2%, due largely to heart involvement. A small number of children persistent arthritis or heart symptoms due to the disease. Recurrence rate is low.

How is Kawasaki Disease Treated?

Intravenous immunoglobulin is currently the treatment of choice. Given within 10 days of onset of symptoms this significantly decreases both the incidence and severity of heart complications and provides relief of symptoms. Patients with Kawasaki disease are also usually given aspirin to relieve symptoms and reduce the risk of formation of blood clots. If heart complications are present, ongoing care by a heart specialist may also be necessary.

Kawasaki Disease References

[1] Curtis N. Editorials: Kawasaki Disease. BMJ 1997;315:322-323.
[2] Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002 Pg 564-568.
[3] Maconochie I. Kawasaki disease. Archives of Disease in Childhood Education and Practice Edition 2004;89:ep3.
[4] Taubert K, Shulman S. Cardiovascular Disease: Kawasaki Disease. Am F Phys 1999.
[online @ http://www.aafp.org/afp/990600ap/3093.html] [5] Schienfeld N. Kawasaki Disease. eMedicine 2003
[online @ http://www.emedicine.com/ped/topic1236.html]