By Dr Ananya Mandal, MD
Treatment of Kawasaki disease usually requires hospitalization. This is due to the high risk of serious vascular complications that may be seen in 2% to 5% of children affected by the condition. In most cases, the condition resolves without treatment but may take longer than when treatment is administered. Furthermore, treatment reduces the risk of complications such as coronary artery aneurysms and vasculitis. Two main treatments for Kawasaki disease are aspirin and intravenous administration of immunoglobulins.
Aspirin is not usually recommended for children under the age of 16 years since it has the potential to cause Reye's syndrome in this age group, which can lead to severe organ damage, especially to the liver and brain. Aspirin is a non-steroidal anti-inflammatory drug (NSAID) that is commonly used for pain relief, fever and suppression of inflammation. If it is used to treat Kawasaki disease, aspirin has the following effects:
Pain relief, although this requires high doses
Reduction in fever, although this may also require high doses
Reduced swelling of the of the hands and feet
Reduced clotting of blood platelets to counteract the increased clotting seen with Kawasaki disease due to a raised platelet count
Initially, high doses of aspirin are prescribed to ease pain and fever. This is followed by low doses which are given for up to 6 to 8 weeks after symptom onset in order to minimize the risk of clotting and coronary artery abnormalities.
Immunoglobulin are antibodies, proteins created by the body in response to an antigen or protein from a foreign element that invades the body. Usually, human antibodies that have been obtained from healthy donors are used.
The solution is injected directly into the veins and the antibodies help the immune system fight the inflammatory changes associated with the disease. The immunoglobulin that is used to treat Kawasaki disease is gamma globulin. After injection, it may take up to 36 hours for the symptoms to reduce and subside and a second dose is administered if the fever persists beyond this time.
Another class of anti-inflammatory agent that has been used to treat conditions that lead to widespread inflammation is corticosteroids. These may be used if a child does not respond to two doses of intravenous immunoglobulins. Although steroids reduce inflammation, they may fail to reduce blood vessel complications.
Management at home
After symptoms have subsided, the child is discharged and advised to stay in bed until symptoms have subsided and to drink plenty of fluids. The child's heart is continually monitored using echocardiograms even after the child's symptoms have subsided and they have been discharged. These checks are continued at regular intervals since the risk of this complication remains for a long time after the disease has resolved.
Reviewed by Sally Robertson, BSc