Beware of Kawasaki Disease, which usually affects children

Health is the main thing that must be maintained. Currently, there are a lot of various diseases to watch out for. We should not underestimate the mild symptoms of an illness. Because many health cases end in fatal events because they are handled too late or not diagnosed clearly. One of them is Kawasaki disease, whose symptoms are often ignored, even though this disease is a serious disease and can be fatal.

What is Kawasaki disease (PK)?

PK was discovered by Dr. Tomisaku Kawasaki in Japan in 1967 and at that time it was known as mucocutaneous lymph node syndrome . In honor of its discoverer, the disease was finally named Kawasaki. In Indonesia, many of us do not understand this dangerous disease, even in the medical community. This is why the diagnosis is often late with all the consequences. The appearance of this disease can also trick the eye so that it can be diagnosed as measles, drug allergies, viral infections, or even mumps. This disease, which is more common in the Mongolian race, mainly affects toddlers and most often occurs at the age of 1-2 years. In fact, the author once found PK in a 3-month-old baby who had a fever for 18 days.

The incidence rate per year in Japan is the highest in the world, which is around 1 case per thousand children under five. The ranking was followed by Korea and Taiwan. In the United States, it ranges from 0.09 (in white race) to 0.32 (in Asia-Pacific descent) per thousand children under five. In Indonesia, the authors found that PK cases had existed since 1996. However, there were doctors who said they had found it before. However, Indonesia was only officially listed on the world map of Kawasaki disease after the report on the PK case series from Advani et al. was presented at the 8th Kawasaki disease international symposium in San Diego, USA, in early 2005.

Allegedly, cases in Indonesia are not small, and according to rough calculations, based on global and ethnic incidence rates in our country, every year there will be 3,300-6,600 PK cases. But in reality, the detected cases are still very far below this figure. Between 20 and 40 percent have damage to the coronary vessels of the heart. Some will recover. However, others are forced to live life with a defective heart due to disrupted coronary blood flow. A small percentage will die from heart damage.

What causes Kawasaki disease (PK)?

The cause of PK is not yet known, although it is strongly suspected that it is due to an infection. However, there is no convincing evidence regarding this. Therefore, how to prevent it is also unknown. The disease is also not proven to be contagious.

What are the symptoms of Kawasaki disease (PK)?

The initial symptom in the acute phase is a sudden high fever and can reach 41 degrees Celsius. Fever fluctuates for at least 5 days, but never returns to normal. In children who are not treated, fever may last for 1-4 weeks without interruption. Giving antibiotics did not help. About 2-3 days after the fever, other symptoms begin to appear gradually, namely red spots on the body that are similar to measles. However, the predominant cold symptoms of measles are usually mild or even absent in PK.

Other symptoms that arise are both red eyes, but without discharge (rubbing), swollen lymph nodes on one side of the neck so that sometimes mumps (parotitis) is suspected, red tongue resembling a strawberry, lips are also red and sometimes cracked, and palms hands and feet red and slightly swollen. Sometimes children complain of pain in the joints. During the healing phase, skin peeling occurs on the tips of the fingers and toes and then transverse line-shaped depressions appear on the toenails and hands (Beau's lines).

How to treat Kawasaki disease (PK)?

PK sufferers must be hospitalized in the hospital and receive supervision from a pediatric cardiologist. The most feared complication is the heart (occurring in 20-40 percent of patients) because it can damage the coronary arteries. Complications to the heart usually begin to occur after the 7th and 8th day since the onset of fever. At first, these vessels can be dilated, then there can be internal narrowing or blockage. As a result, blood flow to the heart muscle is disrupted which can cause damage to the heart muscle known as a myocardial infarction .

Examination of the heart is very important, including ECG and echocardiography (ultrasound of the heart). Sometimes an ultrafast CT scan , Magnetic Resonance Angiography (MRA) or cardiac catheterization is required in severe cases. Laboratory tests for this disease are not typical. Normally, the white blood cell count, erythrocyte sedimentation rate, and C reactive protein are increased in the acute phase. So, the diagnosis is made on the basis of clinical symptoms and signs alone, so the experience of a doctor is needed. In the healing phase, blood platelets increase and this will facilitate the occurrence of a thrombus or blood clot that blocks the coronary arteries of the heart.

The drug that absolutely must be given is immunoglobulin by infusion for 10-12 hours. The drug obtained from the plasma of blood donors is effective, both for relieving PK symptoms and reducing the risk of heart damage. However, the high price is an obstacle. The price of one gram is around IDR 1 million. PK sufferers need 2 grams of immunoglobulin per kg of body weight. For example, a child whose weight is 15 kg requires 30 grams, with a price of around IDR 30 million. Patients are also given salicylic acid to prevent heart damage and coronary artery blockage. If there are no complications, then the child can be discharged in a few days.

In late cases and coronary artery damage has occurred, longer hospitalization and intensive treatment are needed to prevent further heart damage. If drugs don't work, coronary bypass surgery ( coronary bypass ) is sometimes needed or even, although very rarely, a heart transplant. Death can occur in 1-5 percent of patients who are generally treated late and the peak occurs 15-45 days after the initial onset of fever. However, sudden death can occur many years after the acute phase. PK can also damage heart valves (especially the mitral valve) which can cause sudden death several years later. The chance of recurrence of this disease is about 3 percent.

In patients who clinically have recovered completely even though it is said that the coronary vessels will experience abnormalities in the inner layer. This facilitates the occurrence of coronary heart disease, later in young adulthood. If an acute coronary heart attack is found in a young adult, then it may be necessary to think that the patient may have had PK as a child. Presumably we all need to be aware of the disease so as not to cause further victims.

Although until now the exact cause of Kawasaki disease is not known, so prevention is still difficult to do. But the child's health condition must still be maintained so that they are not susceptible to disease. This can be done by managing a healthy and nutritious diet and by carrying out vaccinations so that the child's immune system increases.

This article was written by Prof. Dr. dr. Najib Advani, Sp. A(K), MMed (Paed) (Cardiologist Pediatrician and also a Specialist in the Management of Kawasaki Disease at EMC Alam Sutera Hospital).