What is Kawasaki disease in children?

Many people have not heard of Kawasaki disease, nor do they understand its causes and symptoms. In fact, Kawasaki disease is also a lymph node syndrome. For patients with Kawasaki disease, if it is not treated in time, it will cause capillary lesions and trigger related diseases. When parents find that their children have persistent high fever, red spots on the body and other symptoms, they should consider that the child may have Kawasaki disease.

Kawasaki disease in children

Kawasaki disease is a vasculitis syndrome also known as mucocutaneous lymph node syndrome. The biggest harm of Kawasaki disease is damage to the coronary arteries. It is the main cause of coronary artery disease in children and a potential risk factor for coronary heart disease in adulthood. Kawasaki disease, also known as mucocutaneous lymphadenopathy, invades small and medium-sized blood vessels throughout the body and causes vasculitis.

Diagnostic criteria include

A persistent high fever (39-40°C) for more than five days is necessary for a diagnosis of Kawasaki disease.

In the acute phase, redness and swelling appear on the extremities of the hands and feet. During the second to fourth week, peeling may occur on the soles of the hands and feet, fingertips, and around the anus.

Erythema multiforme, various macules may appear all over the body.

Bilateral conjunctivitis with conjunctival hyperemia, redness, and usually no discharge.

Changes in the oral mucosa, such as strawberry tongue, congestion of the oral and pharyngeal mucosa, redness, swelling, cracking and even bleeding lips.

Acute non-suppurative cervical lymphadenopathy, unilateral or bilateral, with a diameter of more than 1.5 cm.

According to the diagnostic criteria for Kawasaki disease established by the American Heart Association in 1993, at least four of the above (ii)-(vi) requirements must be met, plus a high fever that persists for more than five days, and other diseases that can cause similar symptoms can be ruled out, in order to be correctly diagnosed with Kawasaki disease. Other common clinical manifestations include: redness, swelling and even scabs may appear at the site where the BCG vaccine is injected; blood tests may show anemia, leukocyte and thrombocytosis, increased inflammatory index (ESR, CRP), and sterile pyuria. These findings increase the likelihood of Kawasaki disease.

Comorbidities include

Invasion of the cardiovascular system is often the main cause of death in patients with Kawasaki disease. In the acute phase, it may cause myocarditis, pericarditis, leading to heart failure or arrhythmia. 15-20% of Kawasaki disease patients may develop coronary artery aneurysms 1 to 3 weeks after onset (average about 10 days). More than 50% of coronary artery aneurysms will disappear within 1 to 2 years, especially the common small and medium-sized coronary artery aneurysms with a diameter of less than 8 mm. As for giant coronary artery aneurysms with a diameter of more than 8mm, they often fail to completely disappear upon subsequent follow-up and are prone to blood clots, causing acute myocardial infarction or coronary artery aneurysm rupture, both of which may cause sudden death (the sudden death rate accounts for about 2% of all patients). Myocardial infarction often occurs within 6 to 8 weeks of onset. In the future, after the coronary artery dilatation heals, scar tissue may cause coronary artery stenosis or calcification, leading to myocardial hypoxia.

Joint pain or arthritis occurs within two weeks of onset, and some reports suggest that symptoms may persist for up to four months.

Gallbladder edema may occur within two weeks of the onset of the disease and usually requires no specific treatment.

Intestinal pseudo-obstruction.

Aseptic meningitis.

Increased liver function index, jaundice, diarrhea, decreased serum albumin, etc. Aside from the cardiovascular system, the effects on other organs and tissues are temporary and should gradually disappear.

Kawasaki disease is common in children under five years old. The incidence rate in Taiwan is about one in ten thousand children under five years old, and the chance of boys getting it is about 1.5 times that of girls. Kawasaki disease was first reported by Japanese doctor Tomisaku Kawasaki in 1967. After more than 30 years of research, its cause is still unknown. It may be related to infection or immune response.