Kawasaki Disease

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 ...

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