By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

KAWASAKI’S DISEASE IS TREATABLE AND NOT COMMUNICABLE

Question: I run a day care center, and a 2-year-old boy was just diagnosed with Kawasaki’s Disease. Should I be concerned that the other children will catch this? The parents tell me that this can lead to heart trouble. Could you give me more information about this illness, please?

Answer: Kawasaki’s Disease (KD) is a disorder limited almost exclusively to children. It is very uncommon after the age of 14. It is more common in boys than girls, and the most frequent victims are boys under 2 1/2. KD is more common in children of Asian and African descent and occurs most often in the winter and spring.

KD was first described in Japan in 1967 by the pediatrician Dr. Tomisaku Kawasaki. It is also known as Mucocutaneous Lymph Node Syndrome.

We don’t know exactly what causes this serious illness, but there is no concrete evidence that it is spread from person to person. So it’s not considered a communicable disease, and you don’t need to be concerned on this score.

This disease is not diagnosed by a single blood test. Instead the doctor must rely on observation and physical examination. The first thing he or she looks for is a high, spiking fever. Then, in addition to the fever, four out of the following five symptoms must be present:

• Changes in the hands and feet –- swelling and redness followed by peeling of fingertips and toes after fever improves;
• Diffuse red rash covering most of the body, usually appearing five days after start of the fever (90 percent of cases);
• Red eyes (infection in both eyes, without pus)
• Mouth changes, such as a red tongue (strawberry tongue) and dry cracked lips; and
• Enlarged lymph glands in the neck, usually on only one side (50-70 percent of cases).

In making his or her diagnosis, the doctor must differentiate KD from other diseases with somewhat similar symptoms. These include scarlet fever, Steven’s-Johnson syndrome and parvovirus infection. A number of blood tests may need to be done to rule out these disorders as the cause of the symptoms.

Children who are diagnosed with KD usually require hospitalization because of possible serious consequences, such as inflammation and swelling of the coronary arteries around the heart. These blood vessels can dilate to the point that aneurysms form.

Prompt treatment in the hospital, IV hydration, corticosteroids, gamma globulin, and aspirin can reduce the likelihood of cardiac complications and shorten the duration of illness. These children should have an echocardiogram early in the illness and be followed by a pediatric cardiologist if it is abnormal.

The good news is that most children, if diagnosed and treated promptly, make a full recovery from this serious illness.
Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.