Kawasaki disease in children and cardiac complications

Kawasaki is a rare disease of children under the age of five, the first case of which was observed by Tomisaku Kawasaki, a pediatrician at Tokyo Red Cross Hospital in 1961. Since then, many studies and experiments have been conducted on this disease, to the extent that its deadly complications can be prevented by careful timely diagnosis and correct treatment of this disease.

What is Kawasaki disease? Kawasaki disease in children affects the body's immune system and affects various organs in the body, causing symptoms and multi-organ involvement. This disease is the main cause of acquired heart diseases in infants and young children. The difference in prevalence and age of involvement in Kawasaki disease in different countries of the world seems to be related to race. The involvement of coronary arteries, which are the blood vessels of the heart itself. It is the most important complication of this disease. This condition causes inflammation in the blood vessels and the symptoms can be severe. In addition to fever for several days, children with Kawasaki disease may develop symptoms such as skin lesions, swelling of the neck glands, swelling of the hands and feet, and redness of the eyes, lips, and tongue. In its early stages, Kawasaki disease can affect the function of the heart muscle or heart valves. If it is diagnosed early and proper treatment is done. The probability of heart attack is greatly reduced. Children's heart specialist and answers to parents' questions

Interesting facts about this disease**:**

- 80% to 90% of Kawasaki disease cases occur in children younger than 5 years and older than 6 months. Older children and adults are less likely to get this disease, but some do. - Kawasaki disease is not contagious. This disease among family members or children who are kept in child care centers. It is not transmitted from person to person. Kawasaki disease is more common in Asian children. However, it can affect people of all racial and ethnic groups. - The cause of Kawasaki disease is unknown, but it is thought to be a reaction by the body's immune system.

Symptoms and symptoms of Kawasaki disease in children**:** Kawasaki disease in children begins with a fever above 39 degrees, which lasts for at least five days. Other signs and symptoms may include:

- anywhere on the body is possible. Rash, but it is more severe in the diaper area. - Red eyes without purulent discharge. - Swelling and tenderness of the lymph nodes on one side of the neck. - Swollen hands and feet with redness in the palms and soles. - Very red, swollen and cracked lips. Strawberry-like tongue with red and rough spots. - Considerable irritability and restlessness. - Scaling of the fingers and toes, which usually occurs 2 to 3 weeks after the onset of fever.

What are the symptoms of heart disease in children?

Note: The above key signs and symptoms may not be present at the same time. In some very young infants, only a few of these symptoms manifest themselves completely. Other non-specific symptoms may also be present, such as vomiting, diarrhea, stomach pain, cough, runny nose, headache, and joint pain or swelling.

** Corona and Kawasaki disease in children** Kawasaki disease in children may appear in a special way when children are infected with corona. Kawasaki shock syndrome is an event that occurs in approximately 5% of children with Kawasaki disease. This form of Kawasaki disease occurs in children after contracting COVID-19. This form of the disease mostly has severe digestive symptoms. Laboratory data is in favor of Kawasaki. Approximately 40% of children develop moderate to severe mitral valve regurgitation. And a third of them decrease the ejection fraction (the ability to contract the heart muscle) on the left side of the heart. Finally, children with Kawasaki shock syndrome have a higher risk of resistance to IVIG treatment and the development of coronary artery aneurysms. Related article What are the types of heart disease in children?

When to call a doctor**:** If your child has a fever for 4 to 5 days with any of the above main signs and symptoms. Ask your doctor if you could have Kawasaki disease. It can be challenging to diagnose, so your child may have to undergo several tests.

Diagnosis of Kawasaki disease in children**:** There is no single specific test to diagnose Kawasaki disease in children. If they suspect Kawasaki disease. The doctor may order tests to check the heart's function (echocardiogram) and may take blood and urine samples. In addition, your doctor may refer you to a pediatrician in infectious disease, rheumatology, or cardiology for further guidance on diagnosis and treatment.

Side effects due to lack of treatment**:** If Kawasaki disease in children is not treated, it can lead to serious complications such as inflammation of the blood vessels. This can be particularly dangerous. Because it can affect the coronary arteries that supply blood to the heart muscle and cause an aneurysm or dilatation along with the weakening of the coronary artery wall. Fortunately, treatment within the first 10 days of the disease significantly reduces the risk of aneurysm. For this reason, it is very important to diagnose Kawasaki disease by the tenth day of the disease. Treatment should be started as soon as possible.

Treatment of Kawasaki disease in children**:** Children with Kawasaki disease are hospitalized. The medicine used to treat Kawasaki disease in the hospital is called intravenous gamma globulin (IVIG). IVIG is administered intravenously over 8 to 12 hours. Children will stay in the hospital for at least 24 hours after finishing their dose of IVIG to make sure the fever does not return and other symptoms improve. Children may also be given aspirin to reduce the risk of heart problems. Aspirin should only be given to young children under medical supervision, as it can cause a serious liver disease called Reye's syndrome. If the child does not respond to a single dose of IVIG, i.e. fever returns or abnormal findings are detected in the first heart echocardiogram, additional treatments may be needed. Another dose of IVIG or other anti-inflammatory drugs such as steroids may be used. In this situation, a pediatric specialist in rheumatology, infectious diseases or cardiology may be consulted.

What are the expectations after discharge from the hospital**:** Children who are treated with the diagnosis of Kawasaki disease. They are sent home from the hospital with a low dose of oral aspirin and take aspirin for 6 to 8 weeks. After the initial recovery, these children may seem very tired or "off" for several weeks. Rest is very important. Scaling of the skin of the hands and feet is something to be expected and is not a dangerous sign. If you develop a fever or other symptoms of Kawasaki disease return, contact your doctor immediately. To determine if your child should return to the hospital? Is further evaluation required?

Follow-up care**:** In order to ensure the progression to the complications of the disease, especially checking the progression of the coronary aneurysm, you must take care of children with Kawasaki disease very carefully and fundamentally. Aneurysm often occurs after two weeks of disease. Therefore, children should be scheduled for an echocardiogram and examination at 2 weeks and at 6 to 8 weeks after the onset of fever. If there are abnormal findings in any of the echocardiograms, frequent follow-up and echocardiograms will be necessary. Note: Live virus vaccines should be withheld for at least 11 months after IVIG injection, as IVIG can render these types of vaccines ineffective. These include the MMR (measles, mumps, rubella) and varicella (chicken pox) vaccines. Children over 6 months old should receive an inactivated influenza vaccine.

Long-term follow-up**:** Children who are treated for Kawasaki disease and do not develop an aneurysm have a very good long-term outcome. However, it is important for them to follow a healthy diet and lifestyle. Cholesterol levels should be checked every 5 years. Children with coronary aneurysms should be under the care of a pediatric cardiologist and require long-term special care and follow-up.

You can use the following articles to read more.

https://www.healthline.com/health/kawasaki-disease https://www.mayoclinic.org/diseases-conditions/kawasaki-disease/symptoms-causes/syc-20354598 https://www.cdc.gov/kawasaki/index.html