Paediatricians in India have been witnessing an increase in cases of Kawasaki disease (KD) over the last two decades. It is an enigmatic ailment that usually affects children under 5 years of age. While it can be alarming for parents, understanding the condition is key to recognising its symptoms and seeking prompt medical attention. Despite being the most common cause of acquired heart disease in children globally, the ailment is frequently misdiagnosed or goes unnoticed. Approximately 100 new children with Kawasaki disease seek consultation annually at the Advanced Pediatrics Centre in the PGIMER Chandigarh. At the centre, more than 1,400 children with Kawasaki disease are followed. Most of the patients are from Chandigarh, Mohali, Panchkula and neighbouring states of Punjab, Haryana, and Himachal Pradesh. Dr Rakesh Kumar Pilania, Assistant Professor of Paediatrics at the Paediatric Allergy Immunology Unit, Advanced Paediatrics Centre, PGIMER, Chandigarh, tells The Indian Express how KD is the most common cause of acquired heart disease in children globally, and yet the ailment is frequently misdiagnosed or goes unnoticed. Q: What causes KD? The cause of KD is still unknown. It usually occurs in children under 5 years of age, but it can affect older children and sometimes adolescents too. According to experts, it happens after an infectious trigger in genetically predisposed children. Q: What are the symptoms? KD is marked by a high fever that usually lasts more than five days, a swollen lymph node on the neck, and ‘everything red’. Swollen red hands and feet, red ‘strawberry tongue,’ red cracked lips, red eyes, and red rashes are the initial signs of this disease. A few days later, skin peels over the tips of fingers and toes. As there is no blood test to identify KD, it can be easily confused with many other febrile illnesses of childhood. As a result, the diagnosis of KD is often either delayed or missed altogether. This can have serious consequences. Q: What are the risks associated with the disease? The acute stage of KD can linger for a couple of weeks before going away on its own if treatment is not received. But even after the severe symptoms go away, the illness can still cause enlargement of blood vessels, especially the coronary arteries that provide blood to the heart muscle. If left untreated, inflamed coronary arteries develop dilatations in the artery wall — known as coronary aneurysms. This increases the risk of blood clots and heart attacks. Patients with KD who do not receive prompt treatment are at a significantly high risk of developing coronary aneurysms. Q: A child has KD. What’s the way forward? The good news is that KD can be easily treated if the diagnosis is made in time. Treatment is with a medicine that is given through the veins, viz. intravenous immunoglobulin or IVIg. IVIg is a mixture of antibodies that is infused intravenously to control the inflammation. For treatment to be effective, it must be started as soon as possible and preferably within 7-10 days of the onset of fever. Frequent echocardiography must be done to look for coronary artery aneurysms. After the inflammation subsides, a repeat echocardiogram is done after 4-6 weeks to confirm the status of coronary arteries. If you think your child could have KD, ask for a consultation with your paediatrician. For this condition, time is of the essence, as KD is virtually a medical emergency. With timely intervention, most children recover fully from KD without any lasting complications. Q: What can happen in the long term? KD can cause serious problems in the heart’s arteries, thereby increasing the risk of heart attacks and sudden death. This can sometimes occur many years after the acute illness. There is evidence that some cases of heart problems in young individuals may be because of undiagnosed and untreated KD in childhood. This highlights the importance of early recognition and treatment of KD to prevent future heart issues. Q: Could I have had Kawasaki Disease as a child? It is possible that some individuals who experienced KD as children may have remained undiagnosed and untreated. For some of these individuals, cardiac injury is not discovered until an adult catastrophe strikes. See a cardiologist knowledgeable in KD if you believe you may have had an illness resembling KD in childhood.
