The warning issued by British pediatricians regarding the rare possibility of finding in children, as a side effect of Covid-19, the presence of severe inflammation, a vasculitis known as Kawasaki syndrome, is in the last hours. But what is Kawasaki disease specifically ? What are its symptoms?
In the UK, in recent weeks, a notice sent to doctors by the Pediatric Intensive Care Society reported that ICUs in London and other parts of the country were treating seriously ill children with unusual symptoms:
At the same time, today the confirmation of an increase in the appearance of Kawasaki disease in children in recent months arrived from the Pediatrics ward of Bergamo. To be attributed to the coronavirus:
Let us then analyze the nature of this disease.
Index
- What is Kawasaki disease
- The causes
- Symptoms of Kawasaki disease
- Kawasaki disease diagnosis
- How is Kawasaki disease treated?
- Acetylsalicylic acid
- Intravenous immunoglobulin (IVIG):
What is Kawasaki disease
Put simply, Kawasaki disease (KD) is vasculitis , which is an inflammation of the blood vessels that tends to affect infants and children (most children with Kawasaki syndrome are between 1 and 8 years old, but infants and adolescents can also be affected).
It is essentially a self-limiting febrile inflammation of medium-sized vessels (ie capable of spontaneous resolution without the necessary use of drugs) that affects the pediatric age. In severe cases, it can also be associated with coronary artery aneurysms (CAAs) which, if left untreated, can lead to death (usually heart complications begin in the subacute phase of the syndrome, approximately 1-4 weeks after onset) .
The disease is more common in children of Asian descent and can occur year-round, but more often in spring or winter. Furthermore, it has been shown that the onset of the disease is 1.5 times more common in males than in females.
The causes
What causes Kawasaki disease is still unknown. But the clinical manifestations and data suggest the intervention of one or more infectious agents and the triggering of an abnormal immunological response in genetically predisposed children.
Symptoms of Kawasaki disease
The disease begins with fever often above 39 ° C, which increases and decreases between one and three weeks. The eyes become very red and within 5 days, a red hives-like rash appears, often patchy, usually on the trunk, around the diaper area and mucous membranes, such as the walls of the mouth or vagina. Also the throat and tongue become red (“strawberry red”), and the lips become split, red and dry.
Additionally, the region of the palms becomes red or purplish red and both the hands and feet can often swell. The lymph nodes in the neck also frequently enlarge.
This is accompanied by irritability, occasional lethargy and colicky abdominal pain.
In summary, the symptoms of Kawasaki disease are:
- high fever (unresponsive to antibiotics or medications like ibuprofen or acetaminophen)
- red eyes and conjunctivitis
- “strawberry” tongue (with raised papillae)
- maculo-papular rash that initially affects the trunk and perineal region, and then extends to the face and limbs
- red throat
- dry and split lips
- scales on the skin
- articolar pains
- swollen lymph nodes and neck pain
- irritability
- occasional lethargy
- colicky abdominal pain
- arrhythmia
In addition, palms may appear on the nails (partial leukonychia), while the palms of the hands and feet may turn red and manifest a “glove” and “sock” edema. Around the tenth day from onset, peeling of the skin of the fingers and the perineal region begins.
© Chalie Chulapornsiri / Shutterstock
© PJUTISIR / Shutterstock
In most cases, the course of the disease is self-limited and tends to heal spontaneously over a period of time ranging from 2 to 12 weeks.
Kawasaki disease diagnosis
Typically, blood tests and blood cultures (when children have at least 4 out of 5 predefined symptoms) and throat cultures are done to diagnose Kawasaki syndrome to rule out other disorders with similar symptoms, such as measles or juvenile idiopathic arthritis.
If the syndrome is found, children undergo an electrocardiogram and ultrasound of the heart to detect coronary aneurysms, heart valve leaks, inflammation of the pericardium, or inflammation of the heart muscle (myocarditis). Some anomalies do not appear immediately, so some tests are repeated several times over the course of months.
How is Kawasaki disease treated?
According to what is read on the website of the Higher Institute of Health, the main therapies are: acetylsalicylic acid and / or intravenous immunoglobulins.
Acetylsalicylic acid
It is used to treat Kawasaki disease because:
- can relieve pain and discomfort
- it can help reduce fever
- it is an anti-inflammatory and therefore reduces swelling
- prevents the formation of blood clots
- helps prevent the development of heart complications
Intravenous immunoglobulin (IVIG):
the treatment consists in injecting directly into the vein (intravenously) a solution of antibodies (immunoglobulins) taken from healthy donors. IVIGs can reduce fever and the risk of heart disease.
In addition, if a second dose of IVIG fails to work, corticosteroids can be used as the first treatment if the sick child is at risk of heart complications. Thus, biologics (monoclonal antibodies with anti-inflammatory function) and antibiotics can also be prescribed in patients with bacterial infections.
