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Question
What is Kawasaki Disease? Is it caused by Covid-19?
Answer
Kawasaki disease (KD), also known as Mucocutaneous Lymph Node Syndrome, causes swelling (inflammation) in the walls of blood vessels (arteries) throughout the body. The inflammation tends to affect the coronary arteries, which supply blood to the heart muscle, in about 15-25 percent of patients affected by the disease. It mostly affects children who live in East Asia or are of Asian ancestry living in other parts of the world. KD was first described in 1967 by a Japanese physician; Dr Tomisaku Kawasaki.
Its effect on the coronary arteries can be serious. It is one of the leading causes of heart attack in children. KD can also cause coronary arteries to expand (aneurysm) and rupture. It can be treated successfully if identified early. Most children recover without any complication.
KD is not contagious, but sometimes it occurs in clusters in a community. This is probably due to the contribution from viruses, bacteria, chemicals and irritants to the disease. The exact cause of KD is yet unknown. Some believe that genetic factors may play a role.
Is there any connection between Kawasaki Disease and Covid19?
In children, COVID-19 is usually mild. Rarely children can be severely affected, and symptoms may differ from adults. During this pandemic number of children and adolescents were admitted to intensive care units with a condition called “multisystem inflammatory syndrome in children” (MIS-C). The first reports of such cases emerged from England in April 2020. Although the exact incidence of MIS-C is unknown, it appears to be a rare complication of COVID-19. Some of the clinical features of this MIS-C are similar to Kawasaki. In addition, some children with KD tested positive for Covid19 as well. This could be a mere co-incidence. More studies are needed to confirm or refute this association.
Symptoms of Kawasaki Disease
- Fever (>101⁰F / >38.5⁰C) lasting more than 5 days. Fever may not reduce even with medication and the child is unusually irritable.
- Rash – red spots often seen in the chest and legs and groin area.
- Swelling and redness in the hands and bottom of feet
- Redness of eyes (without pus discharge)
- Swollen, bright red tongue (looks like the peel of a strawberry, hence the name “strawberry tongue” is often mentioned)
- Red and dry lips
- Swollen glands (lymph nodes), especially in the neck area
In the second phase of Kawasaki Disease the child may develop joint pain, stomach pain, diarrhoea and vomiting. Peeling of the skin on the hands and feet will be seen from second week onwards. During this period KD can cause complications in the heart (expansion of coronary arteries / aneurysm)
The third phase of the disease may last up to 8 weeks. During this period the signs and symptoms will slowly fade unless complications develop.
Early identification and appropriate treatment can completely resolve the illness and even reverse the complications. Due to the potential complication in the heart, KD can become serious. Despite this risk, most children recover completely without any long-term problems. The treatment cost of KD can be very high and in some cases long term follow up will be required.
In conclusion, KD is an already known disease but whether this disease is provoked by Covid19 is unclear yet. Since most cases of KD are treatable without any long-term issues, it is important to seek medical advice early. If your child suffers from fever and any symptoms described above, speak to your family physician without delay.
References
- Ghelani, Sunil J., Neha S. Kwatra, and Christopher F. Spurney. 2013. “Can Coronary Artery Involvement in Kawasaki Disease be Predicted?” Diagnostics 3: 232-243. doi:10.3390/diagnostics3020232.
- Jones VG, Mills M, Suarez D, Hogan CA, Yeh D, Segal JB, Nguyen EL, Barsh GR, Maskatia S, and Mathew R. 2020. “COVID-19 and Kawasaki Disease: Novel Virus and Novel.” Hospital Pediatrics (American Academy of Pediatrics). Accessed May 28, 2020. doi:10.1542/hpeds.2020-0123.
- Rowley, Anne H, and Stanford T Shulman. 2004. “Nelson Textbook of Pediatrics.” By Richard E Behrman, Robert M Kliegman and Hal B Jenson. Philadelphia: Saunders.
- Son, Mary Beth F, David R Fulton, Sheldon L Kaplan, Robert Sundel, Adrienne G Randolph, Carrie Armsby, and Elizabeth TePas. 2020. Coronavirus disease 2019 (COVID-19): Multisystem inflammatory syndrome in children. May 22. Accessed May 28, 2020. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-multisystem-inflammatory-syndrome-in-children.
- Sundel, Robert, Marisa Klein-Gitelman, Sheldon L Kaplan, and Elizabeth TePas. 2020. Kawasaki disease: Clinical features and diagnosis. May 18. Accessed May 28, 2020. https://www.uptodate.com/contents/kawasaki-disease-clinical-features-and-diagnosis.
- Sundel, Robert, Marisa Klein-Gitelman, Sheldon L Kaplan, and Elizabeth TePas. 2020. Kawasaki disease: Epidemiology and etiology. May 18. Accessed May 28, 2020. https://www.uptodate.com/contents/kawasaki-disease-epidemiology-and-etiology.
