KAWASAKIS DISEASE

Kawasaki's Disease History Kawasaki syndrome (KS), also known as Kawasaki disease, is an acute febrile illness of unknown etiology that primarily affects children younger than 5 years of age. KS was first described in Japan by Tomisaku Kawasaki in 1967, and the first cases outside of Japan were reported in Hawaii in 1976. KS occurs worldwide, with the highest incidence in Japan, and it most often affects boys and younger children. KS may have a winter-spring seasonality, and community-wide outbreaks have been reported occasionally. In the continental United States, population-based and hospitalization studies have estimated an incidence of KS ranging from 9 to 19 per 100,000 children younger than 5 years of age. Approximately 4248 hospitalizations with KS, of which 3277 (77%) were for children under 5 years of age, were estimated among children younger than 18 years of age in the United States in the year 2000. In 2006, the number of hospitalizations with KS was 5523 (standard error [SE] 289) and the percentage of children under 5 years of age remained the same. OTHER NAME OF KAWASAKIS DISEASE Mucocutaneous lymph node syndrome; Infantile polyarteritis DEFINITION Mucocutaneous lymph node syndrome is the original name for Kawasaki's disease. The original name was quite descriptive because the disease is characterized by the typical changes in the mucous membranes that line the lips and mouth and by the enlarged and tender lymph nodes. Kawasaki's disease is also sometimes referred to as Kawasaki disease. Kawasaki disease is a rare condition in children that involves inflammation of the blood vessels. CAUSES, INCIDENCE, AND RISK FACTORS Kawasaki disease occurs most frequently in Japan, where the disease was first discovered. In the United States, after congenital heart defects, Kawasaki disease is the leading cause of heart disease in children. Most of these patients are younger than age 5. The disease occurs more often in boys than in girls. Kawasaki disease is a poorly understood illness. The cause has not been determined. It may be an autoimmune disorder. The disorder affects the mucus membranes, lymph nodes, walls of the blood vessels, and the heart. Kawasaki disease can cause inflammation of blood vessels in the arteries, especially the coronary arteries. This inflammation can lead to aneurysms. An aneurysm can lead to a heart attack, even in young children, although this is rare.

SIGNS AND SYMPTOMS

Fever. The acute phase begins with a sudden high body temperature, can reach 41oC. Usually the fever is going up and down, settle down for 5 days or more, although it has been given a fever-lowering drugs. Red spots on body-like spots on the measles. Red eye, but not watery or slimy. Red lips, dry and cracked. Tongue and mucous membranes of red strawberries ("strawberry tongue") Redness of the palms of the hands and feet, usually accompanied by a little swollen. Swollen lymph nodes, usually in the neck, and only on 1 side. Some children may complain of pain in the joints. Stage of the healing occurs exfoliation of fingers and toes.

Additional symptoms may include:

Irritability Diarrhea, vomiting, and abdominal pain Cough and runny nose

TESTS No tests specifically diagnose Kawasaki disease. The diagnosis is usually made based on the patient having most of the classic symptoms. However, some children may have a fever lasting more than 5 days, but not all of the classic symptoms of the disease. These children may be diagnosed with atypical Kawasaki disease. Therefore, all children with fever lasting more than 5 days should be evaluated, with Kawasaki disease considered as a possibility. Early treatment is essential for those who do have the disease. The following tests may be performed:

Chest x-ray Complete blood count C-reactive protein (CRP) Echocardiogram Electrocardiogram ESR Serum albumin Serum transaminase Urinalysis - may show pus in the urine or protein in the urine

Procedures such as ECG and echocardiography may reveal signs of myocarditis, pericarditis, arthritis, aseptic meningitis, and inflammation of the coronary arteries. TREATMENT Treatment for Kawasaki disease starts in the hospital as soon as the diagnosis is made to prevent damage to the coronary arteries and heart. It may include:

Immunoglobulin (IVIG) medicine. This is given through a vein (intravenous, or IV) to reduce inflammation of the blood vessels. Intravenous gamma globulin is the standard treatment. It is given in high doses. The child's condition usually greatly improves within 24 hours of treatment with IV gamma globulin.

Aspirin to help pain and fever and to lower the risk of blood clots. High-dose aspirin is often given along with IV gamma globulin.

Aspirin therapy is often continued at home. Because of the risk of Reye syndrome, do not give aspirin to your child without talking to your doctor. If your child is exposed to or develops chickenpox or flu (influenza) while taking aspirin, talk with your doctor right away. *Even when they're treated with aspirin and IV gamma globulin, up to 25% of children may still develop problems in their coronary arteries. Some research has suggested that adding steroids to the usual treatment routine may improve a child's outcome *Your child may be tired and fussy, and his or her skin may be dry for a month or so. Try not to let your child get overly tired. And use skin lotion to help keep the fingers and toes moist. *If the disease causes heart problems, your child may need more treatment and followup tests. EXPECTATIONS (PROGNOSIS) With early recognition and treatment, full recovery can be expected. However, about 1% of patients die from complications of coronary blood vessel inflammation. Patients who have had Kawasaki disease should have an echocardiogram every 1 - 2 years to screen for heart problems. Medications

Immunoglobulin (IVIG) medicine. This is given through a vein (intravenous, or IV) to reduce inflammation of the blood vessels. Aspirin to help pain and fever and to lower the risk of blood clots.

Exercise Isometric exercise. Where there is very little muscle movement. So this would be weight lifting, rope climbing, tug of war, and archery. There is very little movement really but relatively constant force is exerted during the exercises. The other type of exercise is dynamic exercise such as running, basketball, and tennis. Where there is a lot of muscle movement and lot of extension and contraction of large groups of muscles. Treatment Medicatios should be taken as prescribed by the Doctor to prevent complications. Use lotions to help keep the fingers and toes moist.

Health teachings Instruct significant others not to let the client get overly tired. Instruct client or significant other to take medications as prescribed by the Doctor. Do not take Aspirin without order given by Doctor.

Out patient Diet Low fat and high-fiber, lots of fruit and vegetables. Low-cholesterol diet. Gluton-free because of the infammatory properties and reactions to gluton. Multi-vitamins, 1000 iuds of Vitamin D and Fish oil. Aspirin therapy is often continued at home. Follow up check-up or echocardiogram every 1 or 2 years is needed to know if there is heart problems occur.

Spiritual Encourage client to always pray and believes in Him that she can overcome his health condition.

COMPLICATIONS Complications involving the heart, including vessel inflammation and aneurysm, can cause a heart attack at a young age or later in life. CALLING YOUR HEALTH CARE PROVIDER Call your health care provider if symptoms of Kawasaki disease develop. A persistent high fever that does not come down with acetaminophen or ibuprofen and lasts more than 24 hours should be evaluated by a health care provider. PREVENTION There are no known measures that will prevent this disorder.

Submitted by: URBANO, JENNYLYN L. BSN IV, World Citi Colleges, Antipolo City

Kawasaki's disease facts

Kawasaki's disease is a syndrome of unknown cause that mainly strikes young children. Signs of the disease include fever and redness of the eyes, hands, feet, mouth, and tongue. The disease can be treated with high doses of aspirin (salicylic acid) and gammaglobulin. Kawasaki's disease usually resolves on its own within a month or two. Some children with Kawasaki's disease suffer damage to the coronary arteries.