Kawasaki Disease

By Meg Marinis, Director of Medical Research Mar 28, 2013
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A mother's intuition is an extremely powerful thing. 

Moms know everything. Not only do they know if you're awake when you shouldn't be, but they can immediately tell when something's wrong. Whether you're sad, anxious, or sick – moms have this sixth sense, this feeling, that forms inside of them and only continues to grow until they know that their child is happy, safe, healthy. And thank goodness for moms – they can save our lives. Just look at Casey and her son Parker in tonight's episode…

But before I discuss Kawasaki's Disease… How cute was little Parker?? Or, Parkers – Three adorable triplet brothers played the role of Parker. They gave an excellent performance of portraying a very sick toddler – They even accidentally fell asleep while laying in their gurney!

Why was diagnosing Parker so difficult?

The symptoms of Kawasaki Disease can mimic many other childhood illnesses such as adenovirus, Scarlet fever, and Strep Throat. But according to the American Heart Association, if a patient presents with four or more of the following symptoms, a diagnosis of Kawasaki Disease can be made on Day Four of the fever.

• Fever that lasts for more than 5 days.
• Swollen lymph nodes in the neck.
• Rash, often worse in the groin area.
• Red bloodshot eyes, without drainage or crusting.
• Strawberry tongue and red, cracked lips.
• Red palms and soles of the feet; swollen hands and feet.

And when the fever starts to subside, many of these symptoms may also disappear, adding even more difficulty to the diagnosis. However, one of the more specific sighs of Kawasaki Disease is when the child's skin starts to peel around the toenails and fingernails. The skin on a hand or foot may peel off in larger pieces, similar to how a snake sheds its skin.

If a parent sees the above symptoms in their child, he or she should seek medical attention as soon as possible.

Doctors will make a diagnosis of Kawasaki Disease after ruling out other medical conditions because there is not a test specifically for the disease. Along with a physical exam, the doctor will run a series of blood tests to check for anemia, an elevated white-blood-cell count, an elevated platelet count, and an elevated erythrocyte sedimentation rate (this test can indicate blood vessel inflammation). Other studies that may be helpful in determining whether the child indeed has Kawasaki Disease include:

• A urine test to confirm a higher amount of white blood cells.
• An electrocardiogram to look for irregular heart rhythms.
• An echocardiogram to evaluate damage to the heart or surrounding vessels.

Is there a specific cause of Kawasaki Disease?

As of today, no one can identify a precise cause of the disease. Experts do believe that the disease may be triggered by an infectious component in people with a certain genetic predisposition. Studies have shown that younger siblings of a patient with Kawasaki Disease have a 10-fold increased risk of developing the disease. Also, the disease occurs more frequently in children with Asian ancestry.

Parker needed an immediate treatment called IVIG.

IVIG stands for intravenous gamma globulin, which consists of concentrated antibodies taken from healthy human donors. Administered into a vein, IVIG treats disorders of the immune system, boosts the body's immune response to serious illness, and also helps immuno-suppressed recipients of bone marrow transplants.

Completely safe (viruses such as HIV or Hepatitis C cannot be transmitted), IVIG treats Kawasaki Disease by reducing inflammation and preventing coronary artery damage. Complications of the infusion are rare but might include chills, fever, or a drop in blood pressure. If those side effects occur, the doctor may interrupt the IVIG treatment to give the patient an antihistamine before proceeding. Along with the IVIG, high doses of aspirin will be administered until the fever subsides.

Why was Meredith so worried about the tenth day??

Studies have shown that, in order to be effective, the IVIG treatment needs to be given within the first ten days of illness. Even without the treatment, the child's symptoms will eventually recede, but these children face a greater risk of developing heart problems later in life (Literally a kid could be running on the soccer field and die of a heart attack). These problems include damage to the coronary arteries as well as damage to the actual heart itself. Weakening of these vessels can lead to an enlargement or ballooning (an aneurysm) of the blood vessel wall. If tests reveal an aneurysm or any other abnormality, further medical or surgical treatment may be needed. Doctors often will recommend routine visits to a cardiologist for the child to be monitored for several years.

For more information on Kawasaki Disease, please visit:

http://www.kdfoundation.org/