Kawasaki disease is an autoimmune condition affecting arterial vessels, usually in children under five years of age. The disease is 50% more common among boys than girls. Diagnosis and detection is most commonly based on the child's clinical signs and symptoms.
Phases of Kawasaki disease
Kawasaki disease usually develops in three phases and fully manifests at around six weeks.
Acute phase or phase 1:
Phase 1 is the initial first to second week of symptoms which are severe and appear suddenly. These include:
- High fever - This is one of the earliest and most common symptoms. Temperature is usually over 38ËšC (100.4ËšF) and leaves the child feeling listless and irritable. The fever is not responsive to antibiotics or fever reducing medications such as paracetamol or ibuprofen. The fever commonly lasts between five and ten days but can last longer and peak as high as 40ËšC.
- Redness of the whites of the eyes - This is not usually painful and eyes do not tend to water.
- Rash - Typically, a blotchy, red rash is present on the torso, genitals, limbs and face. The spots appear red and raised but blisters do not usually form.
- The hands and feet may be red and swollen. The palms of the hands and soles of the feet may be painful causing the child's refusal to walk or crawl.
- The mouth may feel dry and lips may be swollen, cracked or bleeding. The tongue appears red and covered in small lumps and this is termed strawberry tongue. The throat may also be inflamed.
- Lymph nodes in and around the neck may be swollen, firm and slightly painful when touched.
Subacute phase or phase 2:
Phase 2 refers to the period between weeks 2 and 4 when symptoms may still persist but have become less severe:
- Fever usually subsides but may persist as a low-grade fever
- Skin on the palms of the hands and soles of the feet may peel
- Vomiting and diarrhea along with abdominal cramps
- Urine may contain white blood cells or pus
- Lack of energy and drowsiness
- Pain and swelling in the joints
Convalescent phase or phase 3:
Phase 3 is the recovery phase between the fourth and sixth week during which symptoms subside but the child lacks energy. Complications such as coronary artery vasculitis may develop during this phase or may still develop after a complete recovery.