What is the treatment for Kawasaki Disease?
The main approach to treating Kawasaki Disease is intravenous immunoglobulin and aspirin. Sometimes, as doctors are trying to exclude other causes of your child’s illness, antibiotics are given at the beginning of the illness. If another illness is suspected (which often happens) other treatments may be started too.
It is important that the intravenous immunoglobulin is given as soon as possible to your child once a diagnosis of Kawasaki Disease is suspected or is confirmed as research shows that early diagnosis and treatment significantly reduces the likelihood of damage to the heart.
However it will not prevent aneurysms occurring altogether but seems to help minimise the amount of possible damage. It works by reducing the fever and to ‘damp down’ the inflammation throughout your child’s body. Immunoglobulin is the antibody containing part of blood. Immunoglobulin is a blood product but is carefully checked to make sure it is as safe as possible. The amount of immunoglobulin needed is quite large and therefore the treatment runs as an infusion (through a drip, in hospital) usually over 12 hours, although exact timings can vary.
Sometimes children can react to treatment with immunoglobulin. They may get chills, start sweating, be very pale or have redness and blotching of the skin. A child’s blood pressure may be raised during the immunoglobulin infusion. If your child reacts to the treatment, doctors will consider stopping the infusion temporarily and restarting it at a slower rate.
After treatment with immunoglobulin, your child’s doctor will advise you that for a period of 6 months they will need to avoid having any live vaccinations. This is not because your child will come to any harm but simply because the antibodies the immunoglobulin infusion contains contain may mean that vaccination would not be effective.
If children are thought to be at a higher risk of heart damage, they may also be given treatment with steroids which your child’s doctor will discuss with you.
More information about Treatments:
Your child will be treated with aspirin (usually dissolved in water, taken by mouth) in high doses when the diagnosis is first made. The dose of aspirin is much more than you would normally give someone for a fever. The amount of aspirin given will be calculated based on the weight of your child, (so many grams of aspirin per kg of the child’s weight). The aspirin treatment is used to reduce the fever, calm inflammation and alleviate soreness in the body. When your child’s fever fully settles, usually at about 10 days into the illness, the aspirin will be decreased to lower dose. This lower dose is given to prevent the blood from clotting inside any aneurysms that might form. Aspirin medication will need to continue until at least 6 weeks from the start of the illness – when an echocardiogram (ultrasound of the heart) will be performed to check for any damage to the heart.
In children who develop coronary artery abnormalities, low dose aspirin may be continued indefinitely. However, this dose is very small and is safe to take.
Some children may experience side effects whilst on high dose aspirin; these include headaches, tummy pain and tiredness. If your child has any of these problems and they are not accounted for by the illness itself, then the dose of aspirin may be adjusted.
It can be quite stressful trying to persuade an unhappy child who is still feeling unwell to take their aspirin. Try mixing it with juice or even disguising it in food! The only guideline to follow really is that children should have something in their stomach (preferably milk based) prior to taking aspirin medication – as aspirin can cause tummy upsets if taken on an empty stomach.
Reyes Syndrome and Aspirin
You may have heard of Reye’s Syndrome, a condition that can affect the brain and liver. It has been reported to occur in children on very high doses of aspirin who are suffering from chicken pox or influenza. This condition is very rare. However, if you are concerned or your child does come into contact with or contract chicken pox or influenza whilst still on high dose aspirin, you should discuss it straight away with your doctor. It is, however, sensible to omit the aspirin for a few days if your child has a very high fever (more than 39C).
Doctors use blood tests to monitor the illness during the early stages. There are several blood tests which look for markers of high levels of inflammation which can be used. Two particular tests which you might have heard mention of are ESR (Erythrocyte sedimentation rate) or CRP (C-reactive protein) are blood tests which look for general markers of inflammation in your child’s body. Both these markers tend to be very high during the acute stage of Kawasaki Disease.
Other tests will look at white blood cells – the cells of the immune system involved in protecting the body – and tests are likely to show that the white blood cell count is high at the start of the illness.
Blood tests also look at platelets (sometimes called thrombocytes). These are small cells in the blood which help stop bleeding by clumping and clotting in response to injuries. In a patient with Kawasaki Disease, there will often be a rise in platelet count (the number of platelets in the blood) quite early on. As the disease is brought under control, blood returns to normal and your child’s fever will resolve. However it is important to know that coronary artery aneurysms can still develop in the heart in the first few weeks. It is therefore very important that aspirin treatment is continued until your doctor advises that this can be stopped.
Your child will be kept under constant review for several weeks following the start of the illness. He or she will have at least three echocardiograms. ECG’s (a test which looks at the rhythm of the heart) may also be performed during the follow up period. The irritability and/or moodiness which many children experience will hopefully be reducing, but may require some patience and understanding!
Some children develop dermatitis – itchy, raised and red areas of the skin, following Kawasaki Disease. This is usually not severe and can be managed with emollient creams such as E45. If it becomes a particular problem you should discuss it with your doctor.
Many children have recurrence of high fevers, finger peeling or red eyes whenever they get an infection in the months (and even years) after acute Kawasaki Disease. This does not necessarily mean that they are suffering a recurrence of Kawasaki Disease but this is the way their body reacts to infection.
Bristol Royal Hospital for Children has an established long-term Kawasaki Disease follow up clinic. Long term follow up is recommended for all children who have had lasting heart damage as a result of Kawasaki Disease. This allows doctors to monitor your child’s heart health and general health as they grow, providing advice and guidance. You may have questions too as your child grows up and long term clinic support is an opportunity for you to ask any questions you might have to doctors who are experienced in caring for children with Kawasaki Disease.
Kawasaki Disease was identified as a condition as recently as 1967 – so we are still in the process of building up knowledge and understanding about the longer term effects of the disease. There is an increased risk of longer term heart complications for children who have had lasting heart damage from Kawasaki Disease and long-term care is aimed at supporting families, and providing access to ongoing clinical care by expert doctors.
Can my child get Kawasaki Disease again?
Kawasaki Disease can happen more than once but this is very rare. Only about 1 in 50 children who are diagnosed with Kawasaki Disease will get it again. Unlike other illnesses – for some of which, children develop immunity or resistance to developing it again (like chicken pox for example), there is no natural resistance built up from a first Kawasaki Disease illness.