Biology 103
2002 First Paper
On Serendip

When hearing the word Kawasaki the first thing to come to my mind was always the motorcycle. This was until the day I came into contact with the disease itself. Although I was not directly affected, my younger brother was. He was diagnosed at the age of nine, when I myself was ten. Because of my age at the time I did not really understand the disease. All I knew was that my brother had a heart condition serious enough to send him to the hospital for a while and that he had to return for follow-up visits for up to three years after this. It was not until recently that I asked myself, what is Kawasaki Disease?

Kawasaki is a disease that was detected fairly recently which is characterized by inflammation of arteries, especially coronary arteries (those that transport blood back to the heart) that are most at risk. Tomisaku Kawasaki released the first report concerning Kawasaki in 1967 and it was only in the 1970īs where recognition as a disease came about. From then on "Kawasaki disease (Also known as KD) has become the leading cause o f acquired heart disease among children in North America and Japan. (3)

The symptoms of KD include a very high or spiking fever (104 or higher) that lasts a few days to about a week and does not respond to treatment, red lips or mouth, red eyes (similar to conjunctivitis) without mucus discharge. The peeling off of the top layer of the tongue. (This is called "strawberry tongue for it's bright red, glossy look) Swollen hands and feet that may also become red, and swollen lymph nodes. The following table shows the criteria used to diagnose KD. (2)

Table 1. CDC CRITERIA FOR DIAGNOSIS OF KAWASAKI DISEASE

Fever >5 days unresponsive to antibiotics, and at least four of the five following physical findings with no other more reasonable explanation for the observed clinical findings:
1. Bilateral conjunctival injection
2. Oral mucosal changes (erythema of lips or oropharynx, strawberry tongue, or drying or fissuring of the lips)
3. Peripheral extremity changes (edema, erythema, or generalized or periungual desquamation)
4. Rash
5. Cervical lymphadenopathy >1.5 cm in diameter
Centers for Disease Control (1980). Kawasaki disease-New York. Mortality and

Morbidity Weekly Report, 29:61-63.

Other symptoms which may or may not develop, but often times help in diagnosing the disease are swelling of the joints and extremities, irritability, diarrhea, nausea, vomiting, a rash, abdominal pain, and swelling of the gall bladder. (2)

In most times these symptoms can disappear over a period of a couple of months even if untreated. However, there are lasting and extremely serious effects to the coronary arteries which can last forever. Because these arteries become inflamed, they can be significantly damaged. This in turn can cause small sacs in the blood called aneurysms. These allow blood to pool and platelets in the blood begin to gather. After a while they form a blood clot that slows or stops the blood from getting to the heart. If the flow of blood is stopped then the child can have a heart attack. Another complication is the scaring of the arterial walls, resulting from the healing of the aneurysm. (Also known as the regression of an aneurysm) This causes them to thicken, making the arteries more narrow, which can lead to the same result as an aneurysm. Even after these aneurysms heal, the arterial wall will never be the same. However long term research has not been done to determine the effects of this later on in life. (4)

Despite the fact that this is new disease, there have been extremely efficient treatments for the developed over the years. Aspirin is used to thin the blood to lessen the chance of platelets forming blood clots. It is also used to help reduce the extreme fevers in the beginning of the disease, and as a prevention of the inflammation of the arteries. A product called Gamma Globulin is also used to treat KD. This is essentially anti-bodies from donated blood which help to lower the inflammation of the coronary arteries and protect them from the damage this can cause.

Unfortunately, modern science has been unable to find a cause for KD, either microbial or infectious. As such, there is no way of preventing the disease or even of knowing who is more susceptible to it. As of today what is known is that it is a non-communicable disease, meaning that it is not contagious. You cannot catch KD by being near someone who has it. Also, Kawasaki is a children's illness. "About 80% percent of the people with Kawasaki Disease are under age 5. Most of those affected are boys who develop the disease about 1.5 times as often as girls, and children of Asian descent. In the United States there have been reports of over1, 800 cases being diagnosed annually. (1)
Because of this it is extremely important that research is conducted and information be distributed about this disease. It is necessary to gain awareness and to gather more information in hopes of one day deciphering this disease and being able to do away with it.
.

References

1)AMERICAN HEART ORGANIZATION
2)KAWASAKI DISEASE FOUNDATION
3)THE AMERICAN ACADEMY OF PEDIATRICS
4)THE HOSPITAL FOR SICK CHILDREN


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