Treatment and Management of Kawasaki Disease

Is Kawasaki Disease Curable or not?

Kawasaki disease isn’t curable in terms of a single treatment that eliminates the cause, but it is treatable and many children recover from this disease completely without long term health issues, particularly with early diagnosis and treatment. Kawasaki disease, although rare, is becoming increasingly recognised in India as a major cause of acquired heart disease in children. It mostly affects children under the age of five, with a higher occurrence in boys. The disease begins suddenly and leads to inflammation in blood vessels throughout the body. If not treated in time, it can damage the blood vessel walls, especially those that supply blood to the heart. 

Keep reading to explore the different treatment approaches available for Kawasaki disease in India. 

What is Kawasaki Disease?  

Kawasaki disease is an illness that makes the blood vessels in the body swell and become inflamed. However, what exactly causes Kawasaki disease is unknown. The exact cause is unknown. It is not considered contagious. The prevailing theory is that it may be an abnormal immune response to an unknown trigger (possibly an infection) in genetically predisposed children. Additionally, it may occur in children with a genetic predisposition to the disease. Moreover, this disease is not contagious. 

The acute symptoms, such as fever, may eventually subside without treatment. However, without appropriate medical treatment during the acute phase, the risk of permanent damage to the coronary arteries is significantly increased. Therefore, medical evaluation and treatment are essential. 

Kawasaki disease more commonly occurs in children under 5 years old and is mostly seen those in less than 2 years’ old. However, it can affect older children as well, and this disease happens more often in boys and is commonly seen in the winter and spring seasons. 

Signs & Symptoms of Kawasaki Disease 

Kawasaki disease is diagnosed clinically. The key diagnostic criteria require a fever lasting at least 5 days, plus at least four of the following five principal features: 

1. Bilateral, non-purulent conjunctivitis (redness in both eyes without pus). 
2. Changes in the lips and oral cavity: Such as cracked, red lips and a 'strawberry' tongue (bright red with bumps). 
3. Polymorphous rash: A widespread, non-specific rash. 
4. Changes in the extremities: Redness and swelling of the hands and feet in the acute phase, followed by peeling of the skin from the fingertips and toes during the convalescent phase (weeks 2-3). 
5. Cervical lymphadenopathy: Swelling of a lymph node in the neck (usually >1.5 cm), often on one side. (Note: This is the least common of the five criteria and is frequently absent.) 

Other common symptoms that support the diagnosis include: 

• Extreme irritability (especially in infants). 
• Joint pain (arthritis). 
• Abdominal pain, vomiting, or diarrhea. 

A notable but less common complication is: 

• Hydrops of the gallbladder (which can cause abdominal pain and vomiting). 

What is the First Line Treatment for Kawasaki Disease? 

The initial and most effective treatment for Kawasaki disease should begin as early as possible, ideally while the child still has a fever. The first-line treatment for Kawasaki disease includes: 

1. Intravenous Immunoglobulin (IVIG) : The primary treatment involves administering a protein called gamma globulin through an IV. This therapy helps reduce inflammation in the blood vessels and significantly lowers the risk of developing complications in the coronary arteries. Most children show signs of improvement soon after receiving a single dose of IVIG. Without this intervention, the illness can last for about 12 days, although heart-related issues may continue beyond that. 
2. Aspirin Therapy : Doctors may prescribe high doses of aspirin to help lower inflammation, bring down fever, relieve pain, and reduce joint swelling. Once the child’s fever has subsided for at least 48 hours, the dose is typically lowered. Unlike most childhood illnesses, where aspirin is avoided due to the risk of Reye’s syndrome, it can be used in Kawasaki disease under medical supervision. If the child contracts chickenpox or the flu while on aspirin, their healthcare provider may advise stopping the medication temporarily. 

What to Do at Home After My Child Receives Treatment for Kawasaki Disease? 

After your child begins treatment for Kawasaki disease, there are important steps you can take at home to support their recovery: 

• Make sure your child stays up to date with vaccinations, including those for COVID-19, influenza and chickenpox. However, be cautious while they are on aspirin, as combining aspirin with viral infections can slightly increase the risk of Reye’s syndrome. 
• Avoid giving your child live virus vaccines, such as MMR (measles, mumps, rubella), varicella, and the nasal flu vaccine, for 11 months after they receive intravenous immunoglobulin (IVIG). IVIG may reduce the effectiveness of these vaccines by interfering with the immune response. 
• If an echocardiogram reveals any heart abnormalities, your child should avoid strenuous physical activities as advised by the doctor. Your healthcare provider will advise you based on the severity of the findings. 

Can You Fully Recover From Kawasaki Disease? 

Most children recover from Kawasaki disease within four to six weeks, although they may still feel fatigued and irritable for up to eight weeks. Although most children recover completely, the disease may recur in approximately 2% to 3% of cases. 

Here are some additional factors to keep in mind: 

• In some instances, Kawasaki disease leaves lasting effects. It may harm the arteries and result in heart problems in the future. 
• For example, it may increase the risk of atherosclerosis. If a child develops coronary artery aneurysms, where the arteries become abnormally widened, they will need long-term medical monitoring. 
• This may include annual or periodic follow-ups for life, and, in certain cases, procedures to restore healthy blood flow. 

Healthcare providers closely monitor these children to prevent blood clots and to ensure the heart muscle continues to receive enough oxygen. So, while full recovery is possible for many, some may face lifelong health checks and interventions. 

Is Kawasaki Disease Painful? 

Kawasaki disease can be painful, especially during its early phases. Children with Kawasaki disease often experience significant discomfort due to several symptoms: 

• Skin Changes : The rash and peeling of skin on the hands and feet can be uncomfortable and sometimes painful. 
• Joint Pain : Many children develop joint pain (arthralgia) and swelling, particularly in the knees, hips, and ankles. About one-third of patients experience temporary arthritis, which can be painful. 
• High Fever : Kawasaki disease typically begins with a sudden, high fever that can last for at least five days and may not respond to usual fever medications. The fever itself can cause considerable discomfort and irritability. 
• Painful Swelling : Swelling and redness of the hands and feet are common. These parts may become sore and sensitive when touched or when bearing weight, often causing children to hesitate to crawl or walk. 
• Abdominal Pain : Stomach pain is another common symptom that can cause considerable discomfort, sometimes accompanied by vomiting and diarrhea. 
• Mouth and Throat Irritation : The mouth, lips, and throat may become dry, red, cracked, swollen, and even bleed, which can be painful. Additionally, the tongue may become swollen and bumpy, adding to the discomfort. 

Is Kawasaki Disease Harmful? 

Kawasaki disease can be a life-threatening condition if left untreated. It can cause damage to the blood vessel walls, especially those that supply blood to the heart, which can lead to further complications. 

Thus, early diagnosis and timely treatment play a key role in managing Kawasaki disease and preventing long-term heart complications. With proper medical care, most children recover well, though some may need lifelong follow-up. Supporting your child at home with vaccination awareness and activity restrictions is also essential to ensure a smooth recovery. 

Reader information: This article is intended for general informational and educational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Kawasaki disease is a complex medical condition that requires prompt evaluation and management by qualified healthcare professionals. The information provided here is based on current medical understanding and may not apply to every individual case. Parents or caregivers should always seek the advice of a pediatrician or pediatric specialist for any concerns regarding a child’s health, symptoms, or treatment. Never ignore or delay seeking medical care because of information read in this article. 

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