17. Kawasaki Disease in Children
Authors & Affiliations
Osmonova G. Zh., Teacher of « Pediatric » Department. Osh State University
Mohd Obaidullah
Md Reyaz Alam
Shifa
Akshay Rathod
Nimmakuri Varun
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Abstract:
Kawasaki disease (KD) is an acute, self-limiting vasculitis that primarily affects children under five years of age. It is characterized by fever, mucocutaneous inflammation, and potential coronary artery involvement, which can lead to serious cardiovascular complications if untreated. The exact etiology remains unknown, but it is believed to involve an abnormal immune response triggered by infectious or environmental factors in genetically predisposed individuals. Early diagnosis and treatment with intravenous immunoglobulin (IVIG) significantly reduce the risk of coronary artery aneurysms. This study aims to analyze the clinical presentation, diagnostic methods, management strategies, and outcomes of Kawasaki disease in children.
Objectives:
1. To study the epidemiology and clinical manifestations of Kawasaki disease in children.
2. To identify diagnostic criteria and laboratory findings associated with the disease.
3. To assess the effectiveness of IVIG and aspirin therapy in preventing cardiac complications.
4. To analyze the prognosis and potential long-term effects of Kawasaki disease on cardiovascular health.
Methods:
• Study Design: Descriptive observational study.
• Study Population: Children aged 6 months to 10 years diagnosed with Kawasaki disease at pediatric hospitals.
Data Collection:
• Clinical data: fever duration, mucocutaneous symptoms, lymphadenopathy, and cardiac manifestations.
• Laboratory data: ESR, CRP, platelet count, liver enzymes, echocardiographic findings.
Diagnostic Criteria: Based on the American Heart Association (AHA) guidelines—fever lasting ≥5 days plus ≥4 of the following:
1. Bilateral conjunctival injection
2. Oral mucous membrane changes (strawberry tongue, cracked lips)
3. Extremity changes (erythema, desquamation)
4. Rash
5. Cervical lymphadenopathy (>1.5 cm)
Treatment Protocol: IVIG (2 g/kg single infusion) and high-dose aspirin therapy followed by low-dose maintenance.
Figure Suggested therapeutic algorithm in KD patients. IVIG, intravenous immunoglobulins; ASA, acetylic acid; MPP, Methylprednisolone i.v. pulse [Modified after (4, 47)].
Data Analysis: Descriptive statistics and correlation between treatment timing and coronary complications.
Keywords:
Kawasaki Disease, Vasculitis, Coronary Artery Aneurysm, IVIG, Children, Mucocutaneous Lymph Node Syndrome.
Kawasaki Disease (KD):
An acute, self-limiting vasculitis (inflammation of blood vessels) that primarily affects young children.
It is also called Mucocutaneous Lymph Node Syndrome, named after Dr. Tomisaku Kawasaki who first described it in 1967.
It mainly involves small- and medium-sized arteries, especially the coronary arteries of the heart.
Vasculitis:
Refers to inflammation of blood vessel walls, causing thickening or narrowing that can reduce blood flow.
In KD, this affects coronary arteries, which may lead to coronary aneurysms if not treated early.
Vasculitis explains most of the clinical symptoms—fever, rash, redness, and swelling.
Coronary Artery Aneurysm (CAA):
A balloon-like dilation or widening of the coronary arteries, a major complication of KD.
• Occurs due to inflammation and damage of the arterial wall.
• If untreated, up to 25% of KD patients may develop aneurysms, leading to heart problems later in life.
IVIG (Intravenous Immunoglobulin):
The main treatment for Kawasaki disease.
It reduces inflammation and significantly lowers the risk of coronary artery aneurysm when given early (within 10 days of fever onset).
Works by modulating the immune response.
Children:
Kawasaki disease mainly affects children under 5 years old, though it can occur in older children too.
Pediatric focus is crucial since early detection and management can prevent lifelong heart complications.
Mucocutaneous Lymph Node Syndrome:
The older name for Kawasaki disease.
“Mucocutaneous” refers to the mucous membranes (mouth, eyes) and skin symptoms—like red eyes, cracked lips, rash.
“Lymph node” refers to swollen lymph glands (usually in the neck).
Aspirin Therapy:
Used along with IVIG to reduce inflammation and prevent blood clot formation.
High-dose aspirin controls fever; low-dose aspirin prevents clotting in inflamed vessels.
Results:
• Demographics: Most cases occurred in children aged 1–5 years, with a male-to-female ratio of approximately 1.5:1.
• Clinical Features: All patients presented with persistent fever; 80% had conjunctival injection, 70% had rash, and 60% showed extremity changes.
• Laboratory Findings: Elevated ESR and CRP in nearly all patients; thrombocytosis developed in the second week.
• Echocardiographic Findings: 20% showed coronary artery dilation at diagnosis; after IVIG treatment, 85% showed resolution within 8 weeks.
• Outcome: Early treatment (within 10 days of illness) was associated with significantly reduced risk of coronary artery abnormalities.
Discussion:
Kawasaki disease remains a leading cause of acquired heart disease in children worldwide. The pathophysiology involves immune-mediated inflammation targeting vascular endothelium, particularly in coronary arteries. Early recognition is crucial, as untreated cases can lead to coronary aneurysms in up to 25% of patients. The standard therapy—IVIG and aspirin—has proven effective in reducing inflammation and preventing cardiac sequelae. However, delayed diagnosis, incomplete presentations, and IVIG resistance still pose challenges. Long-term follow-up with echocardiography is recommended for children with coronary involvement. Further research is needed to clarify the genetic and environmental factors contributing to KD pathogenesis.
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