Kawasaki Disease Symptoms

Kawasaki disease symptoms appear in phases.

First phase
Signs and symptoms of the first phase may include:

 Fever, which often is higher than 101.3 F (38.5 C) and lasts one to two weeks
 Extremely red eyes (conjunctivitis) without a thick discharge
 A rash on the main part of the body (trunk) and in the genital area
 Red, dry, cracked lips and an extremely red, swollen tongue ("strawberry" tongue)
 Swollen, red skin on the palms of the hands and the soles of the feet
 Swollen lymph nodes in the neck and perhaps elsewhere
Irritability

Second phase
In the second phase of the disease, your child may develop:
 Peeling of the skin on the hands and feet, especially the tips of the fingers and toes,
often in large sheets
 Joint pain
 Diarrhea
 Vomiting
Abdominal pain

Third phase
In the third phase of the disease, signs and symptoms slowly go away unless
complications develop. It may be as long as eight weeks before energy levels seem
normal again.

When to see a doctor

If your child has a fever that lasts more than four days, contact your child's doctor. Or,
see your child's doctor if your child has a fever along with four or more of the following
signs and symptoms:

 Redness in both eyes

 A very red, swollen tongue
 Redness of the palms or soles
 Skin peeling
 A rash
Swollen lymph nodes

Treating Kawasaki disease within 10 days of its onset may greatly reduce the chances
of lasting damage.

(A) Bilateral, non-exudative conjunctivitis with perilimbal sparing - "conjunctival injection". (B) Strawberry tongue and
bright red, swollen lips with vertical cracking and bleeding. (C)Erythematous rash involving perineum. (D) Erythema
of the palms, which is often accompanied by painful, brawny edema of the dorsa of the hands. (E) Erythema of the
soles, and swelling dorsa of the feet. (F) Desquamation of the fingers. (G) Erythema and induration at the site of a
previous vaccination with Bacillus Calmette-Guérin (BCG). (H) Perianal erythematous desquamation.
Treatment

Children with Kawasaki disease should be hospitalized and cared for by a physician
who has experience with this disease. When in an academic medical center, care is
often shared between pediatric cardiology and pediatric infectious disease specialists
(although no specific infectious agent has been identified yet).It is imperative that
treatment be started as soon as the diagnosis is made to prevent damage to the
coronary arteries.

Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease[38]

and is administered in high doses with marked improvement usually noted within 24
hours. If the fever does not respond, an additional dose may have to be considered. In
rare cases, a third dose may be given to the child. IVIG by itself is most useful within
the first seven days of onset of fever, in terms of preventing coronary artery aneurysm.

Salicylate therapy, particularly aspirin, remains an important part of the treatment

(though questioned by some) but salicylates alone are not as effective as IVIG. Aspirin
therapy is started at high doses until the fever subsides, and then is continued at a low
dose when the patient returns home, usually for two months to prevent blood clots from
forming.

Except for Kawasaki disease and a few other indications, aspirin is otherwise normally
not recommended for children due to its association with Reye's syndrome. Because
children with Kawasaki disease will be taking aspirin for up to several months,
vaccination against varicella and influenza is required, as these infections are most
likely to cause Reye's syndrome.

Corticosteroids have also been used,especially when other treatments fail or symptoms
recur, but in a randomized controlled trial, the addition of corticosteroid to immune
globulin and aspirin did not improve outcome.Additionally, corticosteroid use in the
setting of Kawasaki disease is associated with increased risk of coronary artery
aneurysm, and so its use is generally contraindicated in this setting.

In cases of kawasaki disease refractory to IVIG, cyclophosphamide and plasma

exchange have been investigated as possible treatments, with variable outcomes.
There are also treatments for iritis and other eye symptoms. Another treatment may
include the use of Infliximab (Remicade). Infliximab works by binding tumour necrosis
factor alpha.

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