Kawasaki Disease (Children)

Kawasaki Disease typically unfolds in two phases. The initial phase, lasting up to two weeks, is characterised by a persistent fever over 38°C (100.4°F) for at least five days, accompanied by several other symptoms such as:

• Eye redness
• A rash on the stomach, chest and genital areas
• Red, dry, cracked lips
• Redness and swelling in the palms and soles
• Enlarged lymph nodes
• Prominent BCG vaccination scar

In the subsequent phase, starting within two weeks of fever onset, the skin on the hands and feet may peel. Not all the symptoms may be present in every child.

Kawasaki disease is thought to be initiated by a viral infection.

First described by in Japan in the 1960s by Dr Kawasaki, this disease involves inflammation of the body's arteries, likely triggered by a viral infection. The primary concern is the potential damage to coronary arteries, impacting the heart muscle.

Kawasaki disease affects children primarily under the age of five and is seen across all ethnic groups, though it is more common among children of Japanese and Korean descent. Early recognition and treatment can lead to full recovery within a few days. However, untreated Kawasaki Disease can lead to serious heart-related complications. 

Diagnosing Kawasaki disease involves assessing symptoms and excluding other conditions, as no single test exists for its detection.

A diagnosis generally requires a fever of five or more days, along with at least four of the following symptoms:

• Eye redness
• A rash on the stomach, chest and genital areas
• Red, dry, cracked lips
• Redness and swelling in the palms and soles
• Enlarged lymph nodes
• Peeling hands and feet

Blood and urine tests may be conducted, alongside an echocardiogram, to examine the coronary arteries. Treatment includes a few hours of immunoglobulin infusion (a blood product) and oral aspirin, which mitigate the inflammation and lessen the likelihood of long-term coronary artery damage. Symptoms typically recede within two days post- treatment initiation. If treated within 10 days of symptom onset, heart complications are unlikely.

Delaying treatment (beyond 12 to 14 days) elevates the risk of severe complications, including inflammation of blood vessels and potential coronary artery involvement, which is particularly dangerous as these arteries supply blood to the heart.

Once the fever has resolved, the child can go home. Aspirin is usually continued for a few weeks.

Dental Care

Good dental hygiene is essential, especially for children and adults with congenital heart disease, as poor dental health can lead to infections spreading to the heart. Therefore, regular dental check-ups are crucial.

Inform your dentist about the heart condition before any treatment. To prevent germs from entering the bloodstream and affecting the heart, a single dose of antibiotics may be given one hour prior to dental procedures.

Exercise

Children who have Kawasaki disease with persistent coronary artery problems are advised to engage in light, low-impact physical activities, such as like golf and cricket.

Exercise is beneficial, even for those with heart conditions. It improves heart function, overall well-being and is associated with increased life expectancy and reduced heart disease risk in later life. It also aids in weight control and blood pressure reduction.

Different types of exercise, such as static (e.g., weight lifting) and dynamic dynamic (e.g., running), have varying impacts on the body and heart. Children with heart conditions should consult their doctor to determine safe levels and types of exercise, especially in school settings where physical activities can be intensive.

Vaccination

Most children with heart disease can follow standard vaccinations schedule. However, those with immune deficiencies, such as DiGeorge syndrome or an isomerism, or those who are receiving immunosuppression, such as post-transplantation, may require a modified vaccination schedule.

Travel Advice

Before travelling, especially long distances or to unusual destinations:

• Have a recent medical check-up
• Ensure appropriate insurance coverage
• Carry an adequate supply of medication
• Be informed about the local healthcare quality and accessibility
• Carry relevant documentation about the heart condition  
• For cyanotic heart disease patients, be aware of potential oxygen needs during flights
• Use support stockings and take aspirin or equivalent unless your doctor advises against it
  

Diet

Special diets are not normally required for those with heart disease, but a balanced one is important. Maintaining a normal weight is crucial as excess weight increases the heart's workload.

Infection

Children with heart disease are generally not more prone to infections, although some may be susceptible to chest infections or have associated immune deficiencies, particularly those with holes in the heart (ASD, VSD, PDA). Viral infections are common and usually resolve without antibiotics, but medical advice should be sought in case of uncertainty.

Medication

Not all children with heart disease require medication. Those who do may need it for fluid reduction, aiding heart pumping, rhythm control or blood thinning.

While these medications are generally safe, side effects can occur, especially with other illnesses or medication changes. Any unusual symptoms or side-should be promptly reported to the doctor.

Pregnancy

Most women with heart disease can have a normal pregnancy and delivery. Exceptions may include those with severe cyanosis or pulmonary hypertension, where pregnancy can pose significant risks.

It is essential to seek medical advice before pregnancy so the process can be monitored, and if treatment is necessary, it can be provided early.

The risk of heart disease in offspring varies, with some evidence suggesting that vitamin intake before and during early pregnancy may reduce risks.