Kawasaki Disease – Diagnosis and Treatment
Diagnosis
Doctors diagnose Kawasaki disease by combining clinical signs, physical exams, and various tests, since no single test confirms the condition. They look for a fever lasting at least five days, along with several key symptoms.
These include a red, swollen rash, changes in the hands and feet (like swelling or redness), conjunctivitis in both eyes (without pus), enlarged lymph nodes in the neck, cracked lips, a “strawberry” tongue, and red, swollen oral mucosa.
Patients may also have joint pain, sore throat, vomiting, and diarrhea.
Doctors use a set of clinical criteria to decide if a child may have Kawasaki disease. Some children develop peeling skin (desquamation) on their fingers or toes. Other common symptoms involve bilateral conjunctival injection and swollen lymph glands.
Because these signs can also appear in illnesses such as scarlet fever or measles, doctors rule out similar conditions.
Tests used during diagnosis include:
| Test | Purpose |
|---|---|
| Blood tests | Check for high white blood cell count, anemia, and increased CRP (signs of inflammation). |
| Urine tests | Rule out other causes and check for abnormalities. |
| Echocardiogram | Evaluate heart and artery function; look for heart artery changes. |
| Electrocardiogram | Detect irregular heart rhythms. |
Healthcare providers carefully check these features and use these tests to make a reliable diagnosis of Kawasaki disease, even without a single confirming test.
Treatment
Medicines Used for Care
Doctors usually start treating Kawasaki disease as soon as possible, while a child still has a fever. Care most often takes place in the hospital. Two main medicines are used:
| Medicine | Purpose | Notes |
|---|---|---|
| Intravenous Immunoglobulin (IVIG) | Lowers swelling in vessels and reduces the risk of heart artery damage. Helps stop vasculitis quickly. | Given through the vein; improves most children after a single dose; live vaccines should be delayed for about 11 months after this medicine. |
| Aspirin | Reduces pain, swelling, and fever; helps prevent blood clots. | High-dose given first; changed to low-dose after fever is gone for 48 hours. Aspirin is not given unless under supervision, due to the chance of Reye’s syndrome. |
Doctors use IVIG as the main treatment to slow down blood vessel swelling. Aspirin also provides an anti-inflammatory effect but comes with certain risks.
If some children don’t improve after the first IVIG, doctors may give a second dose or other medicines such as steroids.
What Happens After Initial Treatment
Once the fever is gone, the care plan often shifts. Children usually keep taking low-dose aspirin for at least six weeks.
If there are signs of problems with the coronary arteries, doctors might continue aspirin longer to protect against blood clotting and decrease the chance of coronary thrombosis.
Symptoms like arthritis, joint swelling, and fever typically get better soon after starting IVIG. However, those with incomplete KD or IVIG resistance may need closer monitoring or extra treatment.
If children develop infections like flu or chickenpox while on aspirin, doctors may stop aspirin to avoid Reye’s syndrome.
Checking for Ongoing Heart Issues
Kawasaki disease can cause the coronary arteries to swell or, in rare cases, develop aneurysms. To catch these problems early, doctors perform heart tests such as:
- Echocardiogram (Echo): Looks for coronary artery abnormalities and aneurysms.
- Electrocardiogram (ECG): Checks heart rhythm for arrhythmias.
Doctors usually repeat these tests 6–8 weeks after the start of symptoms and again at 6 months. If they find heart complications like aneurysms or coronary artery dilation, a pediatric cardiologist handles more tests and care.
Long-term problems can include giant coronary artery aneurysms, risk of heart attack (myocardial infarction), heart failure, and higher chances of morbidity and mortality. Ongoing monitoring helps reduce these risks and spot cardiac sequelae early.
Handling Recovery and Support
Children recovering from Kawasaki disease often return to normal activities quickly. Staying informed helps families work closely with healthcare teams, including pediatric cardiologists, about the best treatment and activity plans.
Tips for Support:
- Stay in regular contact with doctors.
- Follow advice from healthcare providers and the CDC.
- Ask about activity limits, especially if the heart is affected.
- Support your child’s emotional well-being.
- Connect with community or ethnic groups for shared experiences.
Getting Ready for Your Visit
Steps You Can Take Before the Visit
Prepare for your health care visit by bringing another adult, such as a friend or relative, to help take notes and catch information that might be missed.
Parents or guardians should write down all symptoms their child is showing, including those that may not appear to be linked to Kawasaki disease.
Recording the highest and lowest temperatures during fevers, and how long they last, provides important information for the care team.
List every medicine, vitamin, or supplement your child uses, along with the amount and when it is taken. Providing details about your child’s medical history and any recent illnesses gives context for the doctor.
Consider using a simple table like this to organize details:
| Item | Details |
|---|---|
| Main symptoms | |
| When symptoms started | |
| Highest fever temperature | |
| How long fever lasted | |
| Medications and doses | |
| Supplements or vitamins | |
| Allergies |
Prepare questions ahead of the appointment, such as:
- What could be causing my child’s symptoms?
- Are there any other health issues to consider?
- Will there be tests needed, and which ones?
- What treatment options are there, and what is recommended?
- Are there ways to help my child feel better while at home?
If your child is seeing a pediatric cardiologist or is part of a case report form, bringing as much detail as possible helps the care team plan deep treatments.
How Your Child’s Doctor May Respond
Doctors will likely ask about all symptoms, such as the length and intensity of fever. They may want to know if certain things have made symptoms better or worse and whether your child has been around anyone with contagious illnesses.
They will also ask for details about allergies and current medications.
A pediatric cardiologist may focus on questions about heart health and might need to record information for a case report form. Answering clearly and honestly helps guide the best care choices.
Parents should be ready to discuss all aspects of the child’s health and any changes noticed at home.
