Kawasaki Disease is increasingly prevalent in Vietnam in recent years. For every two children admitted late with this disease, one suffers from coronary artery complications.
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Red palms and soles are indicative of Kawasaki Disease. |
Kawasaki Disease is an inflammation of small and medium-sized blood vessels in the body, characterized by persistent fever, rash, and redness of the lips, mouth, eyes, and extremities. Initially, during the acute phase, the blood vessels of Kawasaki patients are inflamed on a small scale. If not treated within 12 days, the inflammation can spread throughout the blood vessels, leading to aneurysms, blood clots, and vessel blockage. Subsequently, these lesions can develop into nodules, granules, and eventually scars, causing fibrosis of the blood vessels. This results in the vessels’ inability to supply sufficient blood to the heart, leading to myocardial ischemia.
Kawasaki Disease is the leading cause of coronary artery disease in children and one of the causes of sudden cardiac death and long-term coronary artery disease in adults. The disease predominantly affects children under 5 years of age, especially those between 6 to 24 months. The earliest symptom is an unexplained high fever that is sometimes self-resolving but then recurs continuously.
Additionally, the child’s eyes may become red and bloodshot, and they often squint due to light sensitivity. Another notable sign is very red lips, which may crack and bleed. The tongue also appears red with a strawberry-like texture. The rash associated with Kawasaki Disease typically appears between the third and fifth day, starting on the hands and feet before spreading to the torso. The rash is usually prominent during high fevers.
When ill, children often refuse to grasp anything and may not want to walk due to redness in the palms and soles, typically from the wrists and ankles down. After two weeks, the skin on the hands and feet begins to peel, starting from the fingers. Notably, children may also have a red rash around the anus, and this area may also peel similarly after two weeks. An important but often overlooked sign in Kawasaki patients is lymphadenopathy, where one side of the neck or under the jaw feels painful to the touch. The lymph nodes may shrink as the fever subsides.
During the acute phase, in addition to the aforementioned signs, children may experience vomiting, diarrhea, irritability, coughing, and a runny nose. If there is vascular inflammation in the heart, the child may show signs of arrhythmia and could potentially die within the first week.
Kawasaki Disease is challenging to diagnose because symptoms often do not appear simultaneously in the early stages. During the outbreak phase, the disease can present with various dysfunctions across organs such as the digestive and respiratory systems, making it easy to misdiagnose. There are times when the disease resolves spontaneously, leading doctors and patients to mistakenly believe they have treated it correctly. Additionally, due to the short neck of children, lymphadenopathy signs can sometimes be subtle and hard to palpate. An ultrasound of the lymph nodes can facilitate easier diagnosis.
Kawasaki Disease tends to present atypically in younger children or those over 5 years old. The disease may manifest as fever accompanied by some signs but not fully; there are instances of persistent fever that recurs multiple times, only detected when cardiac complications arise. Besides the clinical signs mentioned above, there are no specific laboratory tests to diagnose the disease. Therefore, parents should carefully monitor their children when they experience prolonged fevers.
Cardiovascular Complications
Cardiovascular complications can occur during the acute phase (within two weeks from the onset of the disease), subacute phase (after 4 to 8 weeks), or in the sequelae phase, which can last up to 13 years. Possible complications include damage to the heart valves and myocardium; commonly, changes in the size of the coronary arteries can occur, including aneurysms or blockages. Coronary artery aneurysms often do not return to normal size; in the long term, this can lead to myocardial infarctions and sudden death. Coronary artery disease is often difficult to treat, requiring high-cost advanced techniques such as angioplasty, bypass surgery, or heart transplants, which are not widely available in pediatric hospitals.
Children are at a higher risk for coronary artery disease if they contract Kawasaki Disease when they are younger than 1 year or older than 8 years, especially in boys. Additionally, children who are hospitalized late, do not receive timely specific treatment, or do not respond to treatment are also at high risk. Kawasaki patients should limit physical activity to avoid cardiovascular complications. Children should rest in bed during the acute phase. Nutritional attention is essential as children may experience mouth pain, irritability, and decreased appetite. It is advisable to ensure they drink plenty of fluids, eat foods they enjoy, and strive to provide a balanced diet to boost their immunity.
