Treatment for Kawasaki disease
Until the mid 1980’s, no specific treatment was available for Kawasaki disease. Studies at Children's Memorial Hospital and several other children’s hospitals proved that a medicine called intravenous immunoglobulin (IVIG), when given together with high doses of aspirin early in the illness, significantly reduces inflammation and the risk of coronary artery damage in most children.
Therapy requires hospitalization for the IVIG treatment administered through an IV. Like other blood products, IVIG undergoes rigorous tests for HIV, hepatitis and other blood-borne diseases. There have been no known cases of a child treated for Kawasaki disease developing an infection from the use of IVIG, but a small number may experience side effects such as fever or chills during the treatment.
After the start of IVIG and aspirin therapy, a very large majority of children show improvement within 24 hours. Fever resolves, rash fades, and lymph nodes return to their original size. However, the eyes and lips may remain red a little longer. In some children, joint pain and swelling persist after other symptoms have disappeared. If a child experiences prolonged fever, a second dose of IVIG or other medications may be recommended, which usually causes the fever to subside. The child will be ready for discharge when the fever subsides for 24 hours.
Some parents may be concerned about the possible development of Reye Syndrome, an illness associated with aspirin, but the benefits of giving aspirin to children with Kawasaki disease strongly outweigh the extremely low-risk of developing this rare disease.
Around the 14th day of illness, the aspirin dose is lowered and this therapy thins the blood slightly to prevent small clots from forming and potentially sticking to the walls of the coronary arteries. Some parents may be concerned about the possible development of Reye Syndrome, an illness associated with aspirin, but the benefits of giving aspirin to children with Kawasaki disease strongly outweigh the extremely low-risk of developing this rare disease. Two-three weeks after the first symptoms appear, a child may experience peeling of the skin around the fingernails, toenails, hands and feet. In younger children, the skin may also peel in the diaper area. Some children may develop lines or ridges on the fingernails and toenails, which is known as Beau's lines. This is another common characteristic of Kawasaki disease and is only visible until the nails grow out.
Potential complications
Kawasaki disease is an important childhood illness because damage to the coronary arteries, the vessels that supply blood to the heart muscle, can occur. As many as 1 in 4 children with Kawasaki disease develop heart complications without proper treatment. This incidence drops to about 3-4 percent (1 out of 25-30) of patients who receive treatment within the first 10 days of the onset of fever. Infants are usually the most seriously ill and are at the greatest risk for developing complications.
Heart complications include weakening of the coronary arteries leading to an aneurysm, or swelling of the blood vessel wall. A cardiac echocardiogram (ECHO) is used to examine the heart and coronary arteries carefully so that any sign of damage will be identified.
Follow-up care
Almost all children with Kawasaki disease are able to return to normal activity after discharge from the hospital.
Most children with Kawasaki disease are able to return to their normal activity after discharge from the hospital. A child's temperament, as well as eating and sleeping habits, may take longer to return to normal. Children will be monitored by our Infectious Diseases team for a minimum of 1 year following the onset of illness, with follow-up outpatient visits.
A follow-up outpatient visit consists of an echocardiogram followed by a physical exam by an Infectious Diseases specialist and possibly repeat blood tests. These visits are usually scheduled approximately 2 weeks after discharge, 2 months after discharge, and 1 year after diagnosis.
Children with heart complications require more frequent or prolonged follow-up care.Children may resume routine care with their pediatrician, and immunizations should be given as scheduled; however, they should not receive the MMR vaccine or the Varivax (varicella) vaccine for 11 months following the IVIG therapy as it may interfere with the immune response to these vaccines.
Reoccurrence of Kawasaki disease
It is unlikely that a child will develop Kawasaki disease again. Approximately 1 child in 100 can develop Kawasaki disease a second time, usually within several months to several years after the first episode. The symptoms are likely to be very similar to the first episode.