Kawasaki Disease
What is Kawasaki Disease?
Kawasaki disease is an illness that causes inflammation in blood vessels throughout the body. It primarily affects children under age 5, though older kids can develop it too. The condition causes fever and affects the skin, mouth, eyes, and lymph nodes.
This disease can be serious because it may damage the coronary arteries, the blood vessels that supply oxygen to the heart. Without proper treatment, about 25 out of 100 children develop heart complications. With early treatment, that number drops significantly. Most children recover fully when they get medical care within the first 10 days of symptoms.
Kawasaki disease was first described in Japan in 1967 by Dr. Tomisaku Kawasaki. Today it occurs worldwide and is the leading cause of acquired heart disease in children in developed countries. The exact cause remains unknown, but early diagnosis and treatment prevent most serious complications.
Symptoms
- High fever lasting 5 days or longer, often reaching 104°F or higher
- Red, swollen, cracked lips and a strawberry-like appearance of the tongue
- Red, bloodshot eyes without discharge or crustiness
- Rash on the torso, arms, legs, or genital area
- Swollen, red skin on the palms of hands and soles of feet
- Peeling skin on fingers and toes, usually 2 to 3 weeks after fever starts
- Swollen lymph nodes in the neck, often on just one side
- Irritability and fussiness beyond typical illness behavior
- Joint pain and swelling
- Abdominal pain, vomiting, or diarrhea
Symptoms typically appear in phases over several weeks. Not every child shows all symptoms, which can make diagnosis challenging. Early recognition is critical because treatment works best when started within 10 days of fever onset.
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Causes and risk factors
The exact cause of Kawasaki disease remains unknown. Researchers believe it may result from an unusual immune response to a common infection in children who have a genetic predisposition. The body's immune system overreacts and causes widespread inflammation in blood vessels. No specific virus or bacteria has been identified as the trigger, and the disease does not spread from person to person.
Certain factors increase risk. Boys develop Kawasaki disease about 1.5 times more often than girls. Children of Asian descent, particularly Japanese and Korean heritage, have higher rates. The disease occurs most often in children between 6 months and 5 years old, with peak incidence around 18 to 24 months. Winter and spring see slightly higher case numbers. Having a sibling who had Kawasaki disease may slightly increase risk, suggesting a genetic component.
How it's diagnosed
Doctors diagnose Kawasaki disease primarily through clinical examination. There is no single test that confirms the condition. Instead, physicians look for a combination of symptoms, especially fever lasting 5 days or more plus at least 4 of the other classic signs. Blood tests support the diagnosis by showing markers of inflammation and helping rule out other conditions.
White blood cell count is typically elevated in children with Kawasaki disease, a finding called leukocytosis. This blood test helps assess disease severity and monitor response to treatment. Other lab findings often include elevated inflammatory markers, mild anemia, and increased platelet count after the first week. Rite Aid offers testing that includes white blood cell count through our flagship panel at Quest Diagnostics locations. An echocardiogram, an ultrasound of the heart, checks for coronary artery damage and is standard in evaluating all suspected cases.
Treatment options
- Intravenous immunoglobulin, known as IVIG, given in the hospital to reduce inflammation and prevent heart damage
- High-dose aspirin to reduce fever, rash, joint pain, and blood clot risk during the acute phase
- Low-dose aspirin continued for 6 to 8 weeks or longer to prevent blood clots
- Additional medications such as corticosteroids or infliximab if IVIG treatment does not work
- Hospital admission for monitoring and IV treatment, typically for 1 to 2 days
- Follow-up echocardiograms at specific intervals to check heart health
- Cardiology care for children who develop coronary artery changes
- Rest and gentle activity during recovery, with gradual return to normal activities
- Adequate hydration and nutrition support during illness
- Long-term heart monitoring for children with coronary complications
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Frequently asked questions
High fever is typically the first symptom of Kawasaki disease. The fever usually starts suddenly and reaches 104°F or higher. It lasts at least 5 days and does not respond well to typical fever medications. Other symptoms develop over the following days.
Kawasaki disease is extremely rare in adults, though a few cases have been reported. More than 80 out of 100 cases occur in children under age 5. Adults with similar symptoms usually have a different condition. The disease behaves differently across age groups.
No, Kawasaki disease is not contagious and does not spread from person to person. Children with the condition can be around siblings and friends without risk of transmission. The disease appears to result from an abnormal immune response rather than direct infection.
Both conditions cause fever and rash in children, but scarlet fever is a bacterial infection caused by strep bacteria. Scarlet fever responds to antibiotics, while Kawasaki disease requires different treatment. Blood tests and throat cultures help doctors tell them apart. Kawasaki disease typically causes more eye redness and hand and foot swelling.
White blood cell count is elevated in most children with Kawasaki disease, showing the body is fighting inflammation. Other common findings include elevated inflammatory markers like C-reactive protein and erythrocyte sedimentation rate. Platelet count often rises after the first week. No single blood test confirms the diagnosis, but these results support clinical findings.
Without treatment, about 25 out of 100 children develop coronary artery problems. With prompt IVIG treatment within 10 days of fever onset, the risk drops to less than 5 out of 100. Most children who do develop artery changes see improvement over time. Some may need long-term heart monitoring or medication.
Most children start feeling better within 24 to 48 hours after receiving IVIG treatment. The acute phase typically lasts 2 to 3 weeks total. Full recovery, including skin peeling resolution, takes 6 to 8 weeks. Children with no heart complications usually return to normal activities within a few weeks.
Recurrence is rare but possible, happening in about 2 to 3 out of 100 children. Most children who had Kawasaki disease will not get it again. Families should watch for symptoms if fever develops, especially within the first 2 years after initial illness. Early treatment remains important if recurrence occurs.
Children should delay live virus vaccines like measles, mumps, and rubella for at least 11 months after receiving IVIG treatment. This is because IVIG can interfere with vaccine effectiveness. Other vaccines can be given on schedule. Talk to your child's doctor about the best vaccination timeline.
Most children recover completely with no lasting effects. Children who develop coronary artery changes need ongoing cardiology follow-up. Some may require medications to prevent blood clots or manage heart function. The type of monitoring depends on the severity of coronary involvement. Many artery changes improve or resolve over months to years.