Kawasaki Disease Essay, Research Paper

During the late twentieth century many new diseases have been discovered. Tomisaku Kawasaki discovered one of these diseases, Kawasaki disease, or technically mucocutaneous lymph node disease, in 1961. This particular disease remained undetected for so long because its cause is still unknown. Dr. Kawasaki, a pediatrician, uncovered this disease after studying fifty cases during his practice in Japan. Kawasaki found that in those fifty cases most were characterized by fever, redness of the eyes, diffuse red rash, redness and swelling of the hands and feet, as well as enlarged lymph nodes in the neck.

In Kawasaki s studies only those five and under were examined for this disease, however it has been shown to affect a few over that age. The peak age of those affected are eighteen to twenty-four months. Eighty percent of the cases involve children ages four and under. As shown in Figure 1, those affected are children usually age four or less. The graph of Figure 1 clearly shows that there is the greatest percentage of those diagnosed at the age of three or less. Kawasaki disease is very rare over the age of ten and any time that it is diagnosed to a patient above that age it should be interpreted with suspicion. The diagnosis may not be completely accurate because there is still as of yet no definitive way to test for Kawasaki disease, only the doctor s interpretation of the symptoms. In the United States approximately three thousand patients will be hospitalized for Kawasaki disease every year. Even with the amount of cases and the time being spent into investigating and treating the disease there are still many unanswered questions.

The highest incidence of Kawasaki disease is found in Japan. The chance of Kawasaki disease in Japanese children under the age of five is approximately one tenth of a percent. The incidence in North American children under the age of five is ten times lower, about one one hundredth of a percent. Asian Americans are at the highest risk of developing Kawasaki disease followed by African Americans and then Caucasians. The disease tends to be more common and to present more severe consequences in males than females. The disease appears to be seasonal, occurring more frequently in the winter and spring months.

Kawasaki was also the first that noticed the disease has no definite cause. He was unable to determine the cause of the disease. No other doctor has yet to determine the cause of the disease either. Originally it was thought to be a retrovirus. This theory has lacked support in the recent decades as more and more doctors begin to point to the genetics of the people it affects as the main reason for infection. It is believed by those that follow this idea that a certain person might be genetically predisposed to the disease. This belief has been furthered by the fact that brothers and sisters often end up developing the disease, even though it is not contagious. However, the ultimate cause of the disease is still unknown.

One of the questions that have yet to be answered by any of the doctors is the cause of the disease. Kawasaki disease has no apparent cause. The disease isn t contagious and doesn t hold any resemblance to any known diseases. Several tests and features have suggested an infectious agent, but that has yet to be proven. The current ideas are that the disease only affects those that are genetically predisposed to the disease. Another idea relates the idea to rug shampooing. The ideas behind the cause of the disease are many yet undeterminable as of now.

Kawasaki disease will usually persist for a few weeks and, if treated properly, has no long-term effects. In a few rare cases some children develop the symptoms twice, the reasons behind this occurrence is also unknown. Like some other diseases Kawasaki disease appears to occur in epidemics that will take place every few years. These few reasons have stumped doctors and researchers as to the cause of the disease, but many are hopeful that with continued interest and support a cause and ultimate cure can be found.

Kawasaki disease occurs in three phases. The first of which is characterized by a fever, pus in the urine, red eyes, brilliantly red tongue, dry lips, rash, swollen hands and feet, enlarged lymph nodes and abnormal liver tests. However, most patients do not exhibit all the symptoms. The fever is unresponsive to Tylenol or aspirin and their equivalents. The first phase usually lasts for about ten days.

The end of the fever, rash, characterizes the second phase and enlarged lymph nodes, but irritability and poor appetite might still exist. The skin around the fingers and toes may start to peel. The beginning of arthritis and heart problems may begin on this stage. The heart problems that may occur are a weakening of the coronary arteries. These weak areas may eventually lead to a heart attack. The second phase usually lasts from day ten to twenty one.

The third phase of Kawasaki disease is referred to as the convalescent phases. It is during this phase that the clinical signs of the illness disappear and laboratory results return to normal. Another fear of Kawasaki disease is the formation of an aneurysm. These aneurysms are very dangerous and if one is blocked or bursts the child can have a heart attack and potentially die. However the chance of deaths due to Kawasaki disease is between one half and two percent.

Kawasaki disease is described as acute childhood vasculitis. Since the cause is unknown and there are no definitive early laboratory markers, the diagnosis of the disease is made by fulfillment of clinical criteria. These criteria include fever of at least five days’ duration and at least four of the following: red tongue and dry fissured lips, swelling of the hands and feet, enlarged lymph nodes in the neck, a red rash covering most of the body, redness in the eyes. In the presence of these five basic features, many doctors do believe the diagnosis can be made with a fever lasting fewer than 5 days. Along with these five basic symptoms the patient may also have an abnormal liver test. Perhaps the most important part to the diagnosis is that any other known disease cannot explain the illness and symptoms. Figure 2 shows a study of these five basic symptoms and the diagnosis of Kawasaki disease.

As shown in Figure 2, a study that was conducted of fifty-six patients diagnosed with Kawasaki disease. They are categorized as to how many and what of the five basic symptoms they exhibited. The study shows that forty eight percent of those studied exhibited all five symptoms, about thirty four percent show four symptoms, eleven percent show three symptoms, five percent show two symptoms, and finally about two percent only show one symptom. The diagnosis of Kawasaki disease is not always assumed to be correct since it is not provable that they have it, only that they show some of its key symptoms.

Before the doctors begin treating for Kawasaki disease it is generally assumed that they should give antibiotics until a bacterial infection is disproved. The treatment for Kawasaki disease is intravenous gammaglobin. Intravenous gammaglobulin is given over a twelve-hour period at a dosage of two grams per kilogram of the patient. The gammaglobin appears to prevent or at least limit the formation of an aneurysm. However, the gammaglobin may only be effective if given within the first ten days of the illness. Some doctors argue that it does help even after the initial ten days and most do continue with the treatment since the side effects are negligible The gammaglobin also appears to help stop the fever, however many doctors also start with aspirin therapy. Approximately eighty to one hundred milligrams of aspirin are given to the patient. Since aspirin therapy is also associated with Reyes syndrome a flu and chicken pox vaccination should be given if put on aspirin for an undetermined amount of time. Flu and chicken pox are believed to be a contributing factor to Reyes syndrome and the vaccinations are only a precaution. The treatment of Kawasaki disease is a simple procedure and most patients recover completely.

The main concern of Kawasaki disease is the long-term effects that the disease has upon the coronary arteries. With proper therapy the long-term effects are very rare. Even with untreated patients the effects on the circulatory system are present in low numbers. In fact, approximately twenty percent of untreated patients develop weak coronary arteries. It is still suggested that any child suffering from Kawasaki disease should have his circulatory system monitored by his or her primary physician, a cardiologist, and a rheumatologist, if certain symptoms occurred. Other complications of Kawasaki disease are myocarditis, and an increase in the risk of a heart attack.

Kawasaki disease lasts about three weeks. Most patients make a full recovery from the disease with no long-term effects. While the disease may move on after three weeks some of the effects it has may stay with the child longer. If arthritis or myocarditis was present in the child then those symptoms could last another six to eight weeks. Coronary artery disease, if present, may persist for the next year, but should get considerably better as the year goes on. Of all cases of patients with Kawasaki disease only one or two percent have permanent and serious heart complications.

Since Kawasaki disease s discovery in the early sixties the doctor s have learned how to treat the disease and the complications associated with the disease. The cause of the disease has yet to be determined. Those affected by the disease are usually small children and live normal lives after the disease has gone away. While Kawasaki disease has the possibility to be a very serious situation it doesn t usually reach that point except in rare circumstances.

Kawasaki disease presents an enigma to those trying to study it. The disease doesn t resemble any current disease, since it has some of the same certain characteristics, but always varies on a key few different parts. It is not too deadly unless it remains untreated. It may have long-term effects, but those are easily avoided by common and standard medical procedure. The disease affects few individuals and doesn t pose a major health threat to the world. Because of these facts the study of Kawasaki disease is mainly out of curiosity than to prevent the disease, since adequate measures for dealing with the disease have already been discovered. Kawasaki disease is a small mostly unknown disease that affects few children and often doesn t have any serious adverse effects upon those affected.

Figure 1

The above graph shows the patients age at the time of their diagnosis with Kawasaki disease. The graph clearly shows that there is the greatest percentage of those diagnosed at the age of three or less. Kawasaki disease is very rare over the age of ten and any time that it is diagnosed to a patient above that age it should be interpreted with suspicion. The above diagnosis may not be completely accurate because there is no definite way to test for Kawasaki disease, only the doctor s interpretation of the symptoms.

Figure 2

DIAGNOSTIC CRITERIA FOR KAWASAKI DISEASE

NO. OF PATIENTS__________________________________

SYMPTOMS NO.(%) 27 12 4 2 1 2 2 1 1 1 1 1 1

CONJUCTIVAL INFECTION 54(96) X X X X X X X X X X X

RED EYES

POLYMORPHIC EXANTHEM 49(88) X X X X X X X X

RASH

EXTREMITY CHANGES 48(86) X X X X X X

SWOLLEN HANDS AND FEET

OROPHARYNGEAL CHANGES 47(84) X X X X X X X X

RED TONGUE AND DRY LIPS

CERVICAL ADENOPATHY 38(68) X X X X X X X

SWOLLEN LYMPH NODES

NUMBER OF CRITERIA MET 5 4 3 2 1

In a study conducted of fifty-six patients diagnosed with Kawasaki disease they are categorized as to what of the five basic symptoms they exhibited. The symptoms technical name is given and the more common name for it is given below. The graph shows that forty eight percent of those studied exhibited all five symptoms, about thirty four percent show four symptoms, eleven percent show three symptoms, five percent show two symptoms, and finally about two percent only show one symptom. The diagnosis of Kawasaki disease is not always assumed to be correct since it is not provable that they have it only that they show some of its symptoms.

Works Cited

Kawasaki Disease. Ed. Karl Hempel. Feb. 1999. The Health Gazette. 6 Apr. 2000. .

Kawasaki Disease. Ed. Thomas Lehman. Dec. 1999. Pediatric Rheumatology Page. 6 Apr. 2000. .

Miller, Steve and Bernard Valman. Children s Medical Guide. New York: DK Publishing, 1997.

Newburger, Jane W. Treatment of Kawasaki Disease. Lancet 27 Apr 1996. MasterFILE Select.

Pease, Roger W., eds. Merriam Webster s Medical Desk Dictionary. Springfield, Massachusetts: Merriam-Webster Inc., 1993.

Stapp, Joan and Gary Marshall. Fulfillment of Diagnostic Criteria in Kawasaki Disease. Southern Medical Journal Jan 2000. MasterFILE Select.