Kawasaki Disease: Signs, Symptoms and Diagnosis

What are the symptoms?
Kawasaki disease (KD) is diagnosed when a patient runs a fever of 101°F – 104°F and above for at least five days. (If the fever isn’t treated, it can last up to 11 days.) The fever is accompanied by at least four of the following five symptoms:

  • A rash over the torso, especially in the groin area.
  • Redness and swelling of the palms and soles of the feet when the illness starts. Light peeling of the skin on the fingertips and toes occurs in the second and third weeks. Larger pieces of skin can peel off the hands and feet as well.
  • Bloodshot eyes that can be sensitive to light.
  • Swollen lymph glands in the neck (one large lymph node that measures more than 1.5 centimeters). Sometimes the neck feels stiff.
  • Irritation and inflammation of the mouth, lips and throat. “Strawberry” tongue – the tongue is bumpy and red with enlarged taste buds.

Patients may experience abdominal pain. About one-third develop temporary arthritis with pain and swelling of knee, hip and ankle joints. Incomplete Kawasaki disease should be considered if a child has fever and inflammation without all the symptoms above. 

collage of symptoms of Kawasaki disease

Photos courtesy of Kawasaki Disease Foundation  

What causes it and how can it be prevented?
We aren’t sure what causes KD, but it doesn’t seem to be contagious. It’s also not hereditary in a typical way, although more than one child in a family can develop it, which may indicate a genetic predisposition. 

There’s no known way to prevent KD. Parents should know that there’s nothing they could’ve done to prevent the disease.

How is KD diagnosed? 
A health care provider must examine the child, observe signs and symptoms and rule out similar diseases. Just one test or even a group of tests by a health care provider won’t diagnose KD.

An echocardiogram will provide a baseline picture of the heart, even though a normal echocardiogram doesn’t always mean the child is free of KD. The health care provider may request blood tests or diagnostic studies.

Can COVID-19 cause Kawasaki disease?
While children were initially thought to be largely spared from the COVID-19 illness, a few children around the world are presenting with symptoms. These include fever, significant abdominal pain, and some features of Kawasaki disease (red eyes, red tongue, swollen hands/feet, rash). This new syndrome has been named multisystem inflammatory syndrome in children (MIS-C(link opens in new window)). These children may or may not test positive for SARS-CoV-2, the virus that causes COVID-19, from a swab of their nasopharynx or from an antibody blood test. 
Since some children have become very ill extremely quickly and cardiac complications can develop, children with these symptoms should be swiftly evaluated and cared for in hospitals with pediatric intensive care units, as needed.

Further research is needed on the full spectrum of inflammatory disorders that appear to be related to COVID-19.

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