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Time To Think ‘Kawasaki Disease’

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In this article, Sri Rambhatla reflects on one family’s experiences of Kawasaki Disease and reminds us of its clinical presentation, diagnosis and treatment.

Srinivasa Rambhatla is an academic foundation doctor working at the Royal Sussex County Hospital, and is an M4RD ambassador.

As a medical student/junior doctor, we are often told to remember the adage that “common things are common”. With this in mind, conditions such as Kawasaki’s disease are often neglected from the standard medical education.

Whilst it has been viewed as rare in the past, prevalence is increasing year on year, with a fourfold increase in diagnosis and admissions in the UK and a doubling of global incidence over a 10 year period. With a critical time period to treat before the long term sequelae of heart damage becomes prevalent, early detection and prompt treatment is needed.

Upon hearing Jasmine’s story, I was struck by the familiarity of the tale; how there was such an uncertainty of diagnosis due to lack of awareness, and how to this led to such tragic consequences. The delay in treatment led to a life threatening stay in intensive care, and lifelong consequences in terms of managing a transplanted heart. The impact it had on Jasmine’s life afterwards, from missing school to having to be under follow-up by the cardiologists shows what could have been easily avoided if she had been diagnosed and treated in time. This story, in essence, highlights the root problem of lack of awareness of such diseases.

Name:

Kawasaki’s Disease/Mucocutaneous Lymph node syndrome

Epidemiology:

Boys > Girls, more common in Japanese, Korean and Afro- caribbean populations

Symptoms:

Raised temperature for >5 days (not responsive to Ibuprofen/paracetamol) and:

  • Rash especially on the chest
  • Swollen cervical lymphadenopathy 
  • Dry, cracked, red lips
  • Red fingers/toes
  • Red eyes

Investigations: 

  • Electrocardiogram for arrythmias
  • Blood tests: CRP & ESR may be raised, FBC may show a normocytic anaemia and thrombocytosis
  • Echocardiogram may show coronary artery changes/aneurysms

Treatment:

Admission to hospital, aspirin and high dose intravenous immunoglobulin. Early treatment needed – within 5 days of fever onset.

Complications:

28% of treated children develop coronary artery damage, and 24% of treated children develop coronary artery aneurysms
39% infants (babies under 1yr) developed coronary artery aneurysms
28% of children affected had some heart damage
19% of all children developed coronary artery aneurysms

References

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