This condition was discovered by Dr. Kawasaki of Japan in 1967. It is also known as Kawasaki syndrome, mucocutaneous lymph node syndrome, or infantile polyarteritis. It is a rare condition in children less than 5 years of age. The cause is yet unknown but it is believed to be caused by infection. It usually affects the heart, blood vessels, lymph nodes, and mucous membranes. There is still no tests available to diagnose this condition. Diagnosis is based on a diagnostic criteria based on the symptoms manifested by the patient. The acute phase is characterized by high-grade spiking fever of 1 to 2 weeks duration. The fever is accompanied by painless reddening of the bulbar conjunctiva, redness of the mucous membranes, red cracking lips, red tongue with raised bumps (strawberry tongue), and swelling and redness of the hands and feet. Five days after the appearance of fever, the rash appears in the trunk and extremities. There is also the appearance of enlarged lymph nodes in the neck area. This is usually firm and slightly tender but on one side only. The rash can easily be mistaken for measles. Since there is no diagnostic exam available to diagnose this condition, a high degree of suspicion is needed. Using the diagnostic criteria for Kawasaki disease,the presence of fever plus at least four of the other symptoms means the presence of this condition in a child. After 1 to 2 weeks of onset desquamation of fingers and toes is noted. The skin surrounding the fingernails and toe nails peel. During this time the child is no longer febrile but there can be pain and inflammation of the joints. Treatment is started as soon as diagnosed. Gamma globulin is given intravenously in high doses (2g/kg body weight as single dose or 400 mg/kg body weight given for 3 days). This is accompanied by giving oral acetylsalicylic acid. These are given to reduce inflammation and prevent damage to the heart and coronary arteries. Complications involves the coronary arteries and the heart. These vessels can be inflamed which can lead to aneurysm (dilated area of a blood vessel because of weakening of its walls). This together with the heart complication will lead to heart attack at a very young age or later in life. The major cause of death in these patients is myocardial infarction. Screening in the form of echocardiography is therefore important at least every year to note the presence of heart problem. |
