What are the signs of Kawasaki disease?

The most common sign of Kawasaki disease is a fever. The fever is usually high, between 102°F to 104°F (38.8°C to 40°C). It tends to rise and fall, but stays above 101.3°F (38.5°C). It may not get better even after taking a fever-reducing medicine. The fever usually lasts more than 5 days. To prevent complications, your child's healthcare provider may make an initial diagnosis and start treatment before that time. Other signs include:

• Red rash

• Red palms

• A swollen lymph node, usually in the neck

• Swollen hands and feet

• Red eyes

• Red and dry cracked lips

• Red tongue with white spots (called “strawberry tongue”)

• Irritability

• Fast heart rate

• Diarrhea or vomiting

• Skin peeling

How is Kawasaki disease diagnosed?

Your child's healthcare provider can usually diagnosis Kawasaki disease based on your child's symptoms and a physical exam. Your child will likely be referred to a pediatric cardiologist. This is a doctor with special training to diagnose and treat heart problems in children. Tests may be done as well. These can include:

• Lab tests. Blood and urine samples are taken to check for signs of inflammation. These are also used to help rule out other health problems.

• Electrocardiography (ECG). This test records the electrical activity of the heart through small, sticky patches on the child's chest. The patches are connected to a machine with wires. The machine records the electrical activity. This helps check for problems with heart rhythm and heart structure.

• Echocardiography (echo). This test uses sound waves to create a picture of the heart. This can show problems with heart structure, valves, and heart function. This can also show problems with the coronary arteries.

How is Kawasaki disease treated?

• Treatment starts as soon as the problem is suspected. A hospital stay of a few days or longer may be needed.

• The main treatment for Kawasaki is medicine. These can include:

  • High-dose gamma globulin (IVIg). This is given through an intravenous (IV) line. It helps boost the body’s immune system response. It also helps reduce the risk of damage to the coronary arteries and the heart.

  • High-dose aspirin. This helps reduce inflammation. It also helps reduce the risk of blood clots.

  • Corticosteroids. These may be given if your child doesn't respond to immunoglobulin.

• Your child is observed until symptoms improve. Once at home, your child may need to take low-dose aspirin for 6 to 8 weeks. Your child may need to take aspirin longer if the healthcare provider is concerned about abnormal heart vessels.

When to call your child's healthcare provider

Call your child's healthcare provider right away if your child has any of the following:

• Fever, as directed by your healthcare provider

• Symptoms that return or worsen

• Shortness of breath

• Chest pain

• Your child acts very ill, is unusually sleepy, or is very irritable

What are the long-term concerns?

• The main concern with Kawasaki disease is coronary artery aneurysms. Aneurysms in the coronary arteries (blood vessels that supply the heart with oxygen) may cause heart attacks or sudden death. Aneurysms may also cause blood clots to form within the coronary arteries which may require more intensive blood thinners long term.

• Some symptoms may not resolve for 2 to 3 weeks. These can include joint pain and peeling skin on the hands and feet.

• Going forward, your child may need regular visits with the healthcare provider. Also, routine tests may need to be done to check your child’s heart and blood vessels.

• If your child develops heart problems, they will need ongoing care. The healthcare provider will discuss your child’s health with you and tell you more about treatment options.