Kawasaki syndrome in children symptoms complications and modern treatment methods

Kawasaki Syndrome is a rare but serious disease that mainly affects children, especially those under five years old. It causes inflammation of the blood vessels and can significantly impact heart health if not diagnosed and treated promptly.

The symptoms usually include persistent fever, skin rash, redness of the eyes, and swelling of the hands and feet—signs every parent should watch for carefully.In this article by Dalily Medical, we will explore the key symptoms of Kawasaki Syndrome, its possible complications, and the latest effective medical treatments that help protect your child’s health and reduce risks.If you’re looking for accurate and comprehensive information about this rare disease, you’re in the right place. Keep reading to learn everything you need to know about Kawasaki Syndrome in children and how to manage it properly and quickly.

What is Kawasaki Disease?

Kawasaki disease is a rare illness that mainly affects children, especially those under 5 years old. It causes inflammation of the blood vessels throughout the body, which can lead to serious heart problems if not treated quickly.

Does it have another name?

Yes, Kawasaki disease is also known as mucocutaneous lymph node syndrome because of the symptoms that appear on the skin and lymph nodes.

What are the main symptoms of Kawasaki disease?

The most important symptom is a fever that lasts at least 5 days, and in some cases, it may last up to 2 weeks. Other symptoms include skin redness, swelling of the hands and feet, and redness of the eyes without discharge.

Is Kawasaki disease lifelong?

Most children fully recover after treatment. However, in very rare cases, long-term problems can occur, especially if the inflammation affects the coronary arteries that supply the heart. These complications may include:

Weakness or problems with heart valves
Heart rhythm disorders
Myocarditis (inflammation of the heart muscle)
Coronary artery aneurysms (dilation of the arteries)

In these cases, the child may need ongoing monitoring and treatment to maintain heart health.

Is Kawasaki disease treated with antibiotics?

At first, when a child has a prolonged fever and inflammation symptoms, doctors may give antibiotics as a precaution until the diagnosis is clear. But antibiotics are not the main treatment for Kawasaki disease because it is a blood vessel inflammation, not a bacterial infection.

Can Kawasaki disease cause heart failure?

Yes, Kawasaki disease can cause serious heart complications, including heart failure, especially if untreated. The mortality rate from heart problems in untreated Kawasaki disease patients is about 2-3%.

What exactly is Kawasaki disease?

It is a rare illness affecting children that causes inflammation in blood vessels throughout the body, especially the coronary arteries that supply the heart.

Is Kawasaki disease contagious?

No, Kawasaki disease is not contagious. It cannot be transmitted from one child to another.

What causes Kawasaki disease?

The exact cause is still unknown. However, scientists believe it happens due to an intense immune reaction following a viral or bacterial infection, mostly in children with certain genetic predispositions.

Which children are more likely to get Kawasaki disease?

Children under 5 years old are most at risk. Boys are slightly more affected than girls. The disease tends to occur more in winter and spring.

Is Kawasaki disease dangerous?

⚠️ Kawasaki disease can be dangerous if not treated promptly because it may cause heart problems, especially affecting the coronary arteries. Fortunately, most children recover completely with the right treatment at the right time.

What is the fastest way to detect Kawasaki disease?

If a child has a fever lasting more than 5 days along with a rash, redness of the eyes, mouth, and hands, parents should see a doctor immediately for diagnosis and early treatment.

Can a child get Kawasaki disease more than once?

It is very rare, but not impossible. Most children only get Kawasaki disease once in their lifetime.

What is the main treatment for Kawasaki disease?

Intravenous Immunoglobulin (IVIG): This treatment reduces inflammation and lowers the risk of complications.
Aspirin: Taken in specific doses to prevent blood clots in the arteries.
Regular follow-up with a cardiologist: Very important to ensure the heart remains healthy.

Is there a vaccine or prevention for Kawasaki disease?

Unfortunately, there is no vaccine or proven prevention method yet because the exact cause is not fully understood.

Can the child return to school after recovery?

Yes, the child can return to school after the fever subsides and the doctor approves. However, their health, especially heart health, should continue to be monitored closely.

Does Kawasaki disease affect other organs besides the heart?

Yes, it can also cause inflammation in:

Skin (rash and sensitivity)
Lymph nodes (swelling)
Mouth (redness and cracking)
Eyes (redness without discharge)
It may sometimes affect the digestive or respiratory systems as well.

Can some symptoms continue after treatment?

After treatment, some children may still have mild changes in their coronary arteries, which is why ongoing follow-up with a cardiologist is necessary.

Is diagnosis easy?

Not always, because Kawasaki disease symptoms can resemble other viral or bacterial infections. Diagnosis depends on a combination of symptoms and medical tests.

Can complications happen if Kawasaki disease is not treated?

Yes, serious complications include:

Coronary artery aneurysms
Blood clots
Heart muscle problems
Heart failure in severe cases

Should every child with prolonged fever be tested for Kawasaki disease?

Not necessarily. But if the fever continues along with symptoms like:

Red eyes
Skin rash
Swelling of hands or feet
They should see a doctor immediately for evaluation.

Can the child return to normal life after treatment?

In most cases, children fully recover and return to normal life without long-term problems, especially if treatment started early.

Do children need to keep taking medication after treatment?

Usually, they continue low-dose aspirin for some time as directed by the doctor to reduce the risk of blood clots.

Can the child fully recover from Kawasaki disease?

Yes, most children make a full recovery, especially if diagnosed and treated early. However, some may require ongoing medical follow-up, especially if heart problems develop.

Does Kawasaki disease occur in adults?

It is very rare. The disease primarily affects children under 5 years old, and adult cases are extremely uncommon.

Can Kawasaki Disease Cause Psychological Problems in Children?

Directly, no. The disease itself does not affect the child’s mental health. However, like any serious or chronic illness, it can cause anxiety and stress for the child and their family. In such cases, psychological support and follow-up may be needed to help reduce anxiety.

Latest Research and Developments in Kawasaki Disease Treatment

Doctors and researchers are continuously developing new methods to improve the diagnosis and treatment of Kawasaki disease. New medications aim to reduce inflammation and its complications, especially heart-related issues.

Possible Causes of Kawasaki Disease in Children

Abnormal Immune Response:
The immune system in some children overreacts to a viral or bacterial infection, leading to inflammation of the blood vessels.
Viral or Bacterial Infection:
Some theories suggest certain viruses or bacteria may trigger the disease, especially in genetically predisposed children.
Genetic Factors:
Children with a family history of Kawasaki disease are more likely to develop it, indicating a genetic role.
Environmental and Seasonal Factors:
The disease appears more frequently in certain seasons like winter and spring. Some studies link air pollution with increased cases, though evidence is not conclusive.
Age and Gender:
The disease mainly affects children under 5 years, especially those between 2 and 4 years old. Boys are slightly more affected than girls.
Ethnicity:
Kawasaki disease is more common among children of Asian descent, especially Japanese and Korean, but it can affect any child worldwide.
Immune System Dysfunction:
Some children have immune hyperactivity, where their immune system mistakenly attacks their own blood vessels causing inflammation.
Microbial Superantigens:
Certain bacteria (like staphylococci and streptococci) produce toxins that can excessively stimulate the immune system, causing the disease.
Weather and Climate Changes:
Changes in wind patterns and climate, particularly in Asia, may influence disease occurrence, suggesting airborne environmental factors.
Chemical Pollutants:
Exposure to chemicals like pesticides and pollution might trigger the disease in genetically susceptible children.
Genetic Defects in Viral Response:
Some children have genes that cause abnormal immune responses to viruses, leading to excessive inflammation as seen in Kawasaki disease.
Kawasaki-like Syndromes (e.g., COVID-19 related):
After the COVID-19 pandemic, a Kawasaki-like syndrome has been observed in children infected with coronavirus, prompting renewed research on viral triggers.

Stages of Kawasaki Disease and Its Symptoms

Stage 1 (Weeks 1 and 2)

This is when Kawasaki symptoms are most obvious. Watch for:

High fever lasting more than 5 days that does not go down easily with standard fever reducers.
Red eyes without discharge.
Red, swollen lips and tongue, often described as “strawberry tongue.”
Skin rash, often on the belly, back, hands, and feet.
Swelling and redness in hands and feet, followed by peeling skin around fingertips.
Swollen lymph node(s) in the neck, usually one enlarged node rather than generalized swelling.

Stage 2 (After Week 2)

After acute symptoms improve, watch for:

Skin peeling, especially around fingertips and nails.
Abdominal and joint pain.
Heart changes, which are the most serious complication, including inflammation of coronary arteries.

Other Less Common Symptoms to Know

Diarrhea or vomiting.
Irritability and persistent crying in infants.
Abdominal pain or headaches.

Types of Kawasaki Disease in Children

Typical (Classic) Kawasaki Disease
Diagnosed when the child has:

Fever lasting more than 5 days
Red eyes without discharge
Skin rash
Changes in lips and mouth (dry lips, red tongue)
Swelling and redness of hands or feet
Swollen lymph nodes in the neck

If a child has fever plus 4 of these symptoms, it’s classified as typical Kawasaki.

Incomplete (Atypical) Kawasaki Disease
Symptoms are less clear or incomplete, often affecting infants and very young children.

Persistent fever but fewer other symptoms
Requires blood tests and heart imaging to confirm diagnosis
Higher risk of heart complications due to delayed diagnosis

Recurrent Kawasaki Disease
Rare cases where a child gets Kawasaki disease again after recovery.

Usually linked to immune or genetic predisposition
Continuous follow-up is important to catch recurrences early

4. Kawasaki Disease Associated with Other Syndromes (e.g., Post-COVID)

After the COVID-19 pandemic, some children developed an inflammation similar to Kawasaki disease but with more severe symptoms.
This is sometimes called Multisystem Inflammatory Syndrome in Children (MIS-C).
It includes additional symptoms such as low blood pressure and involvement of other organs in the body.
This condition requires urgent and intensive medical care.

How to Easily Diagnose Kawasaki Disease in Children

Diagnosis of Kawasaki disease is usually done through three main steps:

Medical History and Physical Examination
The doctor starts by asking the parents about the child’s condition and symptoms, then performs a thorough exam focusing on:

Duration of fever: if the child has a high fever lasting more than 5 days.
Presence of at least 4 of the following symptoms:
- Red eyes without tears or discharge.
- Skin rash on the body.
- Cracked or red lips and tongue (strawberry tongue).
- Swelling and redness of the hands and feet.
- Enlarged lymph nodes in the neck (usually one node).

If the child has persistent fever plus 4 or more of these symptoms, Kawasaki disease is very likely.

Blood Tests
Blood tests help the doctor know if there is inflammation in the body and also rule out other diseases similar to Kawasaki, such as:

Increased white blood cell count (sign of inflammation).
Elevated inflammation markers like CRP and ESR.
Platelet count may be low initially and then rise as the disease progresses.
Mild anemia.
Sometimes mild changes in liver or kidney function tests.

Heart Examinations
Kawasaki disease can affect the heart, especially the coronary arteries. Therefore, doctors request specific heart tests:

Echocardiogram (Echo):
Uses sound waves to create images of the coronary arteries and check for swelling or dilation, confirming complications.
Electrocardiogram (ECG):
Monitors heart activity and rhythm, detecting any possible irregularities.

Diagnosing Incomplete Kawasaki Disease and Risk Factors Easily

What is Incomplete Kawasaki Disease?

Some children do not show the full set of classic Kawasaki symptoms, which is called Incomplete Kawasaki disease. In these cases:

The child has persistent fever but not all classic symptoms appear.
The doctor relies on blood test results showing clear signs of inflammation.
Heart tests like echocardiograms are performed to check for coronary or heart issues.
It is very important to exclude other similar diseases such as scarlet fever, measles, or some viral infections.

⏱️ Importance of Early Diagnosis

Early diagnosis allows the child to receive the appropriate treatment on time, which significantly reduces the risk of serious heart complications.

⚠️ Major Risk Factors for Kawasaki Disease

Young Age
Most children affected are under 5 years old, especially between 1 and 3 years.
Gender
Boys have a slightly higher risk of getting Kawasaki disease compared to girls.
Genetics and Family History
If there is a family history of Kawasaki disease, the child’s risk increases.
Race and Ethnicity
Kawasaki disease is more common in children of Asian descent, particularly Japanese and Korean, but it can occur in any race or nationality.
Season
Cases tend to increase during winter and spring.
Overactive Immune System
Some children have a very sensitive immune system that overreacts to infections.
Exposure to Viral or Bacterial Infections
In some cases, Kawasaki disease may start as an immune reaction after a viral or bacterial infection, even if that infection is not the direct cause.
Environmental Factors
Certain chemicals or pollutants might trigger the disease.
Existing Immune or Inflammatory Disorders
Children with chronic immune problems are more vulnerable.
Living in Crowded Areas
Higher population density and close gatherings increase the chance of exposure to infections and immune triggers.

Treatment of Kawasaki Disease in Children: Step by Step

Treatment must start quickly to prevent serious complications, especially those affecting the heart. Therefore, doctors follow an organized and effective treatment plan.

Treatment Goals

Rapidly reduce inflammation in the body.
Protect the coronary arteries that supply blood to the heart.
Lower fever and improve the child’s overall condition.

1. Main Treatment

Intravenous Immunoglobulin (IVIG)

This is the primary and most important treatment for Kawasaki disease:

Given through an IV in the hospital.
It contains concentrated antibodies that help calm the immune system.
The dose is usually given once over 10 to 12 hours.
In most cases, the fever improves within the first 24 hours.

Important: IVIG treatment should start within 10 days from the first day of fever.

Aspirin

Although aspirin is not often used in children, it is essential in Kawasaki treatment, but in specific doses under strict medical supervision:

At the beginning of the illness: high doses to reduce fever and inflammation.
After improvement: low doses daily to reduce the risk of blood clots.

⚠️ Note: If the child has a viral infection such as chickenpox, the doctor must monitor carefully, because aspirin can increase the risk of the rare Reye’s syndrome.

2. Additional Treatments (For Difficult Cases)

Some children do not respond to the initial treatment, so the doctor may add:

A second dose of IVIG.
Corticosteroids (like Prednisolone) to quickly reduce inflammation.
Biological drugs (such as Infliximab or Anakinra) if the condition is severe or if there are heart complications.

3. Follow-up After Treatment

Even after the child improves, continuous monitoring is necessary to ensure the heart remains healthy:

Regular echocardiograms to monitor the coronary arteries.
Periodic blood tests to check platelet counts and inflammation markers.
Continuing low-dose aspirin for a period (which may last weeks or months), depending on the child’s condition and heart status.

⚠️ Does Kawasaki Disease Ever Require Surgery? When and Why?

In most cases, Kawasaki disease is treated with medication without surgery. However, in severe cases affecting the heart, surgery might be needed to protect the heart muscle from complications.

When Might Surgery Be Needed?

Surgery becomes necessary if:

Large aneurysm in the coronary arteries: The artery balloons out and risks rupture.
Coronary artery stenosis (narrowing or blockage): The artery that supplies blood to the heart becomes blocked or narrow, reducing blood flow.

Types of Surgical Interventions in Kawasaki Disease

✅ 1. Cardiac Catheterization
Not open-heart surgery but a precise, effective procedure:

A thin tube is inserted through a vein (in the leg or arm) and guided to the heart.
A balloon may be used to widen the narrow artery, or a stent may be placed to keep it open.
Goal: Improve blood flow and prevent clots.

✅ 2. Coronary Artery Bypass Grafting (CABG)
Open-heart surgery used in very severe cases:

A healthy vein is taken from the child’s body (such as from the leg).
It is grafted to bypass the blocked artery.
Goal: Safely restore blood supply to the heart.

✅ 3. Aneurysm Resection
If there is a very large aneurysm posing danger:

Surgical removal of the aneurysm.
It may be replaced with an artificial part or a patch from another artery.
Goal: Protect the artery and prevent rupture.

4. Thrombectomy (Clot Removal)
If a clot forms inside an artery and blocks blood flow:

The clot may be removed surgically or by catheter.
Goal: Prevent complete blockage and protect the heart muscle.

5. Heart Transplant – Very Rare
In extremely severe cases with complete heart failure:

The last option may be a heart transplant.
Performed at specialized centers when all other treatments have failed.

Medical Specialists Involved in Kawasaki Disease Care

General Pediatrician: Usually the first to suspect Kawasaki disease and refer the case to specialists.
Pediatric Cardiologist: Monitors the effects of Kawasaki on the coronary arteries and heart function.
Pediatric Rheumatologist/Immunologist: Manages severe immune-related inflammation.
Pediatric Hematologist: Deals with platelet problems or blood clots.
Pediatric Cardiothoracic Surgeon: Performs heart surgery if the condition develops serious cardiac complications.