What happens in the vessels
In Kawasaki disease, immune cells attack the walls of medium-sized arteries. Inflammation destroys the muscle and elastic layer of the vessel, causing the wall to lose strength and stretch under blood pressure. The most vulnerable are the coronary arteries that supply the heart muscle. In places where they expand, blood flow slows down and blood clots form more easily. Inflammation also affects the mucous membranes, skin and lymph nodes, which gives a characteristic set of external signs. The disease is not contagious and cannot be transmitted from child to child.
- Systemic vasculitis of medium-sized arteries
- Predominant damage to the coronary arteries
- Risk of dilation and aneurysms of heart vessels
- Involvement of mucous membranes, skin and lymph nodes
- Children under five years of age are more likely to get sick
- The disease is not transmitted from person to person
Symptoms
The first and obligatory sign is fever: the temperature is high, does not respond well to antipyretics and lasts for at least five days. The remaining manifestations appear during the first week, but not necessarily at the same time, and some of them may have already passed by the time of the visit to the doctor. That is why it is important to tell your pediatrician about all the symptoms that you had before. A characteristic feature is the child’s pronounced irritability, stronger than with a regular viral infection. In the second or third week, peeling of the skin on the tips of the fingers and toes appears.
- Fever for five days or longer
- Redness of the conjunctiva of both eyes without purulent discharge
- Bright chapped lips and crimson tongue
- Various rashes on the trunk without blisters
- Swelling and redness of the palms and soles
- Peeling of the skin of the fingers in the second or third week
- Enlarged cervical lymph node on one side
- Severe irritability and tearfulness
Heart complications
Dilatation of the coronary arteries is detected in some children already in the acute period, more often in the second or third week of illness. Small dilations often return to normal over time, but large aneurysms can persist and pose a risk of thrombosis and poor nutrition of the heart muscle in the future. In addition, in the acute period, inflammation of the heart muscle and valves, and fluid accumulation in the pericardial cavity are possible. This is why echocardiography is done at diagnosis and repeated several weeks later, even if the first test was normal.
- Dilatation and aneurysms of the coronary arteries
- Myocarditis and decreased cardiac contractility
- Mitral valve insufficiency
- Effusion in the pericardial cavity
- Thrombosis in the area of the aneurysm
- Heart rhythm disturbances
Diagnostics
There is no specific test to confirm Kawasaki disease. The diagnosis is clinical: the doctor assesses the duration of the fever and the presence of characteristic signs, while simultaneously excluding infections with a similar picture. The tests show severe inflammation, increased ESR and C-reactive protein, anemia, and from the second week - a sharp increase in the number of platelets. White blood cells without bacteria may appear in the urine. Echocardiography is mandatory: it evaluates the coronary arteries and heart function. There is an incomplete form, in which there are fewer signs, and it is more common in children under one year of age.
- Assessment of fever duration and clinical criteria
- Complete blood count with platelets
- ESR and C-reactive protein
- Liver enzymes and albumin
- General urine test
- Echocardiography at debut and again
- ECG and consultation with a pediatric cardiologist
- Exclusion of scarlet fever, measles, infectious mononucleosis
Treatment and observation
Treatment is carried out in a hospital. The basis of therapy is intravenous immunoglobulin, which is administered once, preferably in the first ten days of illness: this significantly reduces the incidence of coronary artery damage. Additionally, acetylsalicylic acid is used in doses determined by the doctor; This is one of the few cases when the drug is prescribed to children, and you cannot do it yourself. If there is no effect, repeated administration of immunoglobulin or other drugs is used. After discharge, the child is observed by a cardiologist, and routine vaccinations with live vaccines are postponed for the period indicated by the doctor.
- Hospitalization and intravenous immunoglobulin
- Acetylsalicylic acid strictly as prescribed by the doctor
- Repeated administration of immunoglobulin if fever persists
- Follow-up echocardiography after a few weeks
- Long-term observation of a cardiologist for aneurysms
- Delaying live vaccines after immunoglobulin as directed by a physician
- Monitoring blood tests over time
