Kawasaki's Disease in Older Children
Disease May Be Misdiagnosed as a Younger Child's Disease
Jan 3, 2009
This very rare condition causes the walls of small and medium sized arteries to become inflamed; including the arteries in the heart, causing an acquired heart disease. The disease has also been called mucotaneous lymph node syndrome because it also affects the lymph nodes and the mucosal membranes in the nose, mouth and throat. This acquired heart disease can cause sudden death in some patients. It is commonly found in young children (Ages 2 to 5). There is no real known cause of the disease; some people think it may be caused by bacteria, viruses or environmentally influenced (pollutants and chemicals). There is no evidence suggesting that the disease is inherited but there may be a genetic predisposition since the disease can be found in higher rates among Asians. The disease however is not contagious. Kawasaki disease was first identified by a Japanese doctor, Tomisaki Kawasaki in 1967. This disease can not be prevented but the symptoms can be treated.
Symptoms of the Kawasaki Disease
The first symptom is usually an extremely high fever (over 104 F) that lasts up to two weeks. The child exhibits red eyes, a rash on the body (trunk and genital area), red and cracked swollen lips, swollen red tongue, swollen red skin on hands and soles of feet, sore throat and swollen lymph nodes. After the swelling, the skin peels and joints become painful. The child also experiences diarrhea, vomiting and pain in the abdomen after which the disease symptoms usually disappear. Since the disease affects the coronary arteries, cardiac complications are normally the main concern. The affected vessels may develop coronary artery aneurysms which can lead to a heart attack and sudden death.
Diagnosis of Kawasaki Disease
There is no specific test to diagnose the disease but diagnosis is usually made by the patient displaying the disease's classic symptoms such as five or more days of the extremely high fever, the red and swollen cracking lips, rash on the body, swelling of the hands and feet, the extremely red eyes and the swollen lymph nodes. A doctor may order a chest x-ray, blood count, echocardiogram and a urinalysis. Children are usually hospitalized and treated quickly to prevent damage to the coronary arteries. Once the disease is diagnosed, an IV of gamma globulin (IVIG) is given at extremely high doses and after 24 hours the fever usually improves. Aspirin in high doses is also given for its anti-inflammatory effect.
Prognosis
If treatment is started early enough the patient is expected to recover but if left untreated the risk of coronary artery aneurysms increases. It is expected that children who have suffered from the disease have regular echocardiograms to ensure that the heart is not affected by the disease. Most children recover without any residual side effects, however in some cases there may be some skin problems and abnormal lipid profiles. Patients who suffered from coronary artery aneurysms as a result of Kawasaki's disease can be treated by echocardiography and angiography and recover within a couple of years. Aneurysms may however lead to an abnormal narrowing of the arteries which eventually which leads to larger aneurysms.
Kawasaki Disease in Older Children
Kawasaki disease (KD) has always been associated with younger children (under 5 years old), but according to a recent study that appeared in the journal Pediatrics in 1998 KD was found to be more common in older children than reported. The study was conducted in a hospital in British Columbia over a 12 year period (1984 to 1996) where 133 patients diagnosed with KD were studied. They researchers found a larger number of older children (over 8 years old) than had been previously anticipated. The older group had a higher rate of coronary abnormalities than the younger group. The researchers couldn’t say whether this was because of the rate of the diagnosis of disease. KD is usually misdiagnosed in older children, which means the coronary symptoms have a chance to develop and worsen.
References
Freeman AF, Shulman ST. Kawasaki disease: Summary of the American Heart Association guidelines. Am Fam Physician. 2006 Oct 1;74(7):1141-8.
Tarek Momenah, Shubhayan Sanatani, Jim Potts, George G. S. Sandor, Derek G. Human and Michael W. H. Patterson. Kawasaki Disease in the Older Child Pediatrics,1998 July 1; 102(1):1-5.
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