www.womanthismonth.com 49 January 2013 | Is high fever just what it seems to be or is it the first sign of Kawasaki disease, the poorly understood illness found in children aged below five years? Parents fret about meningitis, malaria, jaundice and dengue. Very few have heard of Kawasaki disease and most doctors have never seen a case. This is an imperative diagnosis that must not be missed in a child suffering from fever because treatment within the first 10 days of illness may prevent acute and long-term coronary artery damage, which on rare occasions can be fatal. Diagnostic obscurity arises because many of the early clinical features of the disease mimic other more common self-limiting febrile illnesses. To make an early finding, doctors should have a high index of suspicion in an irritable child with five or more days of fever, irrespective of other clinical features. What is it? Kawasaki disease is a serious illness characterised by causing blood vessels throughout the body to become inflamed and swollen, which can lead to complications in the coronary arteries (the blood vessels that supply the heart with oxygen). Inflammation affects the blood vessels of many tissues in the body including the hands, feet, whites of the eyes, mouth, lips, throat, lymph nodes and skin. It is therefore also known as mucocutaneous lymph node syndrome. About 72 per cent of patients are under five years of age; children over eight are rarely affected. The condition was also shown to be one-and-a-half times more common in boys than in girls. It is very rare for more than one child in a family to develop this disease. The majority of cases had been diagnosed in winter and early spring. Nevertheless, it has been concluded that it is not contagious. It can, however, occur in all racial and ethnic groups; mostly seen in Japanese and Korean children. The cause of Kawasaki disease remains unknown, although an agent like a virus is suspected. Without treatment, about 25 per cent of affected children can develop heart disease involving the coronary arteries, resulting in those vessels’ enlargement (dilation or aneurysm formation). Up to five per cent of the affected experience heart complications. In about one per cent of cases, the complications can be fatal. Because of this, the condition has become the leading cause of acquired heart disease, when the heart’s blood supply is blocked or interrupted. Timely diagnosis, hospitalisation and treatment which usually include intravenous gamma globulin (a solution of antibodies) and a high dose of Aspirin are highly effective in preventing coronary complications. Kawasaki disease cannot be prevented, but if it is diagnosed and treated promptly, most children will make a full recovery within six to eight weeks. Less than two per cent of children die from this syndrome. If it is recognised and treated within the first 10 days, they have a less than four per cent risk of coronary artery damage. For feedback, comments or questions contact Dr Jinan Darwish via email at: [email protected] • Fever that lasts for five or more days • Rash, often worse in the groin area • Red, bloodshot eyes, without drainage or crusting • Bright red, swollen, cracked lips • “Strawberry” tongue, which appears with shiny bright red spots after the top coating sloughs off • Swollen hands and feet and redness of the palms and soles of the feet • Swollen lymph nodes in the neck • Understandably, children with these symptoms are extremely uncomfortable and irritable. Early symptoms include: Column Kawasaki Disease
RkJQdWJsaXNoZXIy Mjk0MTkxMQ==