What are the symptoms of Kawasaki disease?

The signs and symptoms of KD (Kawasaki disease) will typically develop and manifest over a period of six weeks and can be categorised into three phases. These are described as follows:

Phase 1 – Acute phase during weeks one and two

During this stage, the symptoms tend to appear rapidly and are often severe.

High temperature (fever)

A prolonged fever is the most common and the very first symptom of KD, your child will normally have a temperature of 38℃ (100.4℉) or higher, often reaching 40℃ (104℉).

This fever can often progress rapidly and appear without warning and will not respond to medicines such as antibiotics that are typically used to aid in reducing the fever. Other medications that are ineffective include:

• Paracetamol
• Ibuprofen

If your child has a fever, they may also become very irritable. The fever tends to be prolonged, lasting more than four or five days. In some cases, fever can persist for more than 11 days if not treated. In rare cases, the fever can last for more than three or four weeks.

Rash

A blotchy, red rash may develop on the skin. This rash will typically begin around the genitals and then spread to the arms, legs, torso and eventually the face. The spots of the rash are normally raised and red, however blistering does not occur.

Feet and hands

The toes and fingers may become hard or red and slightly swollen if your child is infected with Kawasaki disease. Your child may also note that their feet and hands feel tender and are extremely painful when touched or when weight is applied to these areas. This often makes children reluctant to crawl or walk.

Conjunctival injection

This symptom refers to a condition wherein the eyes become red and often swollen. Both eyes are normally affected, although it is important to bear in mind that pain is not associated with conjunctival injection.

Unlike the more common conjunctival infection (also known as pink eye), which involves the cell layer that covers the white area of one’s eye, known as the conjunctiva, fluid will not leak from your child’s eyes when suffering from conjunctival injection.

Tongue, throat, lips and mouth

Your child’s lips may become cracked, dry or red and even swell which can result in cracking, peeling and bleeding. The inside of their throat and mouth will also swell up and the tongue will become red, swollen and bumpy, resembling a strawberry, hence the name for this symptom is strawberry tongue.

Inflamed lymph glands

By gently feeling your child’s neck, it may be possible for you to feel inflamed lumps, these could be lymph glands that are swollen.

Just to recap:

**My Med Memo - Lymph nodes are tiny glands that resemble the shape of beans and are located throughout the body. Lymph nodes are responsible for transporting waste material, nutrients and fluid, known as lymph fluid between the bloodstream and tissues in the body. The lymphatic system forms a vital part of the body’s immune system being the system of defence against infection and illness.

The lymph glands may swell to more than 1.5 centimetres in width (0.6 inches) and may feel firm and slightly painful when pushing on them.

Phase 2 – Sub-acute phase during weeks two to four

During the second phase of Kawasaki disease, symptoms will typically lessen in their severity, however, the symptoms experienced tend to last longer. A high temperature will generally subside, but there may still be some irritability in your child’s behaviour as a result of the pain associated with the condition.

The symptoms that can occur during phase two include:

• Vomiting
• Abdominal pain
• Diarrhoea
• Peeling of the skin on the toes and fingers (this peeling can sometimes occur on the soles of your child’s feet or on the palms of their hands)
• Pus/discharge in urine
• Lacking energy and feeling drowsy, generally lethargic
• Swollen joints and joint pain
• Headache
• Jaundice (this condition refers to the yellowing of skin and eyes)

The complications that are associated with Kawasaki disease are more prone to developing during stage two. One such complication includes the development of a coronary artery aneurism (CAA), this condition refers to a bulge developing in a blood vessel that supplies the heart with blood. Complications will be discussed in more detail later on.

Phase 3 – Convalescent phase during weeks four to six

Pronounced “kon-vuh-les-uh nt”, convalescent refers to a period of regaining strength and recovering from an illness.

With this definition in mind, during phase three your child will start to recover from Kawasaki disease through treatment.

During this phase, the symptoms will lessen and start to improve, and eventually, disappear. During this phase, your child may show signs of fatigue and lack energy.

While complications associated with Kawasaki disease may still develop during this stage, it is less likely than during stage two.

When to see a doctor

If you notice that your child is experiencing a fever that persists for longer than a period of three days, then you should contact your doctor. If your child has a fever as well as four of the below symptoms, then it is vital that you make an appointment to see your doctor immediately. These signs include:

• Strawberry tongue (red, swollen and bumpy tongue)
• Redness of the eyes
• Peeling skin
• Rash on the body (begins in genital regions and spreads)
• Redness on the soles of feet or palms of hands
• Swollen lymph glands

If Kawasaki disease is treated within a period of ten days from the onset of the initial symptoms, this can reduce the risk of complications developing.

Are there any unusual symptoms and signs of Kawasaki disease?

The symptoms that are described above are often resolved without any complications occurring, even in cases where the condition is left untreated (although seeking treatment is highly recommended).

Some of the less common, yet potentially fatal, symptoms of Kawasaki disease include:

• Pericarditis – This refers to the inflammation of the heart lining
• Arthritis – This is the inflammation of the joints
• Meningitis – This is a condition that involves the inflammation of the spinal cord and covering of the brain
• Heart complications such as heart attack (myocardial infarction) and heart disease

The prognosis of patients who suffer from complications or symptoms is dependent on the specific complication and its severity.