Kawasaki Disease Treatment
Kawasaki disease is an uncommon condition, and at this time, there are no cures. A diagnosis of Kawasaki disease will be made early on, and the treatment is designed to treat the symptoms and help in the healing process. Doctors who focus on children will perform all diagnostic procedures and tests on a regular basis to make sure that the child is improving.
Treatment for fever along with a number of other symptoms plus the other more serious complications of Kawasaki disease will be determined by the condition of your child however as is usually the case it’s a good idea to discuss treatment options with your doctor before beginning them.
Treatment of Acute Disease
As it can cause serious complications, Kawasaki disease is treated in hospitals. Patients should begin treatment as soon as possible. When Kawasaki disease isn’t treated promptly, your child may take longer to recover. Their risk of getting sick and developing complications will also increase. There are several treatments for Kawasaki disease – including;
Aspirin
A child suffering from Kawasaki disease may be prescribed aspirin. A child under 16 may be recommended to take aspirin in this situation. Aspirin should never be given to your children unless a healthcare professional prescribes it. The medication may cause potentially life-threatening side effects such as Reye’s syndrome.
NSAIDs such as aspirin are non-steroidal anti-inflammatory drugs. They are used to treat Kawasaki disease for the following reasons:
- Pain and discomfort can be eased by it
- It can also assist in reducing a high body temperature
- A high dose of aspirin reduces swelling (it is an anti-inflammatory).
- Low doses of aspirin are antiplatelet (they prevent blood clots from forming).
Symptoms determine how much aspirin and for how long your child needs to take it. Aspirin at high doses will probably be given until their temperature drops. Aspirin may be prescribed until six to eight weeks after the onset of their symptoms to reduce complications and prevent blood clotting. If a problem develops in the blood vessels supplying blood to the heart, this can reduce blood clots.
Intravenous immunoglobulin
IVIG stands for intravenous immunoglobulin. A solution of antibodies taken from healthy donors is immunoglobulin. An intravenous injection is one that is injected directly into a vein. The immune system produces antibodies to fight disease-carrier organisms. IVIG has been shown to reduce fever and heart problems. Gamma globulin is the immunoglobulin used to treat Kawasaki disease.
Within 36 hours of receiving IVIG, your child’s symptoms should improve. A second dose of IVIG may be given if their high temperature doesn’t improve after 36 hours.
Corticosteroids
A corticosteroid is a type of medicine containing hormones, which are powerful chemicals with wide-ranging effects on the body. A child may need them if IVIG hasn’t worked, or if they’re found to have a high risk of heart problems. In some countries, parents are concerned about the cost of IVIGs. In such a case, corticosteroids can be the first line of treatment.
Treatment of Refractory Disease
In 10% of patients, the disease is refractory (i.e., fever persists or recurs 36 hours after initial IVIG dose). A second infusion of IVIG at 2 grams per kilogram is usually given to these patients. According to the AHA guideline, relative roles of IVIG and other adjunctive therapies (e.g., cyclophosphamide, corticosteroids, plasma exchange, and TNF antagonists) are unclear, although other evidence has emerged since the last update.
Researchers found that adding corticosteroids to IVIG (adjusted OR = 0.16; 95% CI, 0.09 to 0.31) for refractory Kawasaki disease decreased the number of patients who failed to respond to therapy and decreased the risk of coronary artery disease at one month.
Additionally, TNF-α antagonists are being used as a treatment for conditions which do not respond to IVIG. After IVIG was unsuccessful, infliximab (Remicade) was given to 18 of 20 patients with inflammatory markers and symptoms. In the retrospective cohort study, patients given infliximab had faster coronary outcomes and resolution of fever compared with IVIG retreatment. The same study shows that treating primary Kawasaki disease with infliximab did not improve the treatment response over IVIG and aspirin alone according to a phase 3 randomized controlled study.
A study of 125 patients with Kawasaki disease who were treated with plasma exchange at the start of therapy showed that patients without CAB (coronary artery abnormalities) remained lesion-free during follow-up, and 2 of 6 patients with aneurysms and 10 of 12 patients with coronary dilatation experienced symptoms improvement.
Mild to moderate cardiac aneurysms are treated with aspirin alone. Some dotors may also prescribe other antiplatelet agents, such as dipyridamole (Presenting) or clopidogrel (Plavix). Thrombolytic agents in combination with heparin and aspirin are used in the treatment of coronary thrombosis, and heparin and warfarin are reserved for treating larger aneurysms.
Long-Term Management
The 2006 AHA guideline provides clear recommendations for the management and surveillance of risk related cardiovascular health risk in children with Kawasaki disease. These recommendations are consistent with the guidelines issued by the Japanese Circulation Society Joint Working Group in 2010. As a result of intimal thickening and stenosis in segments adjacent to giant aneurysms and in areas of resolved smaller aneurysms, coronary disease risk is increased over the long term. Those with Kawasaki disease who do not have aneurysms or stenosis are less likely to have late complications, although the evidence for long-term atherosclerosis risk is mixed.
Patients can benefit from support groups as they navigate acute and long-term treatment and recovery. Kawasaki Disease Research Center (hospital research group) and Kawasaki Disease Foundation (http://www.kdfoundation.org) are helpful resources.
After the initial treatment
Children may need to take low-dose aspirin for six weeks after a fever subsides – longer if a coronary artery aneurysm develops. Blood clotting is prevented by aspirin.
If children contract flu or chickenpox during treatment, aspirin may need to be stopped. Reye’s syndrome, a life-threatening health condition and complication that affects the blood, liver, and brain of children and teenagers after a viral infection, has been linked to aspirin use.
Children with gamma globulin may begin to improve soon after their first treatment. Kawasaki disease lasts 12 days without treatment. Heart complications, however, may last longer.
Other Adjunctive Options
Due to their cholesterol-lowering and immunomodulatory effects, statins also play a role in the treatment of Kawasaki disease. The effectiveness of statins in the early stages of Kawasaki disease and whether statins can lower the risk for atherosclerosis in the long run require further study.
Other adjunctive therapies, including abciximab and pentoxifylline, are yet to be definitively determined. A platelet glycoprotein IIb/IIIa receptor inhibitor, abciximab has been used in conjunction with standard therapies for patients with KD and giant aneurysms. Pentoxifylline inhibits tumor necrosis factor-alpha and may reduce the incidence of aneurysms.
Monitoring heart problems
A health care provider may recommend follow-up tests to check your child’s heart health at regular intervals, usually six to eight weeks after the illness began, and then again six months later. Your kid may be referred to a pediatric cardiologist if his/her heart problems persist. Kawasaki disease heart complications are treated differently depending on the type of heart condition.
Wait to vaccinate
Live vaccines such as chickenpox or measles should not be given to your child within 11 months of receiving gamma globulin. Gamma globulin can affect the effectiveness of these vaccinations. Your child’s health care provider should know that your child has Kawasaki disease.
Is Kawasaki Disease Contagious?
Everyone wants to know if Kawasaki disease is contagious. We’ve all seen the worry and fear in parents’ eyes when they’re told their child has it. Kawasaki disease can happen to anyone; it doesn’t matter your race, sex, or age.
There is a lot of confusion around whether this disease is contagious or not. The common belief that it is not means that people don’t think it is necessary to treat the other members of your family. Most scientists and doctors believe that Kawasaki disease isn’t contagious and it can’t be passed from one person to another. It cannot be spread through prolonged exposure or casual contact.
The current literature suggests that Kawasaki disease is not contagious, and that only contact (through contact with an open wound) with someone who already has it puts you at risk for developing the disease. You can get Kawasaki disease through the openings in your skin, it’s important to wash your hands thoroughly when you come in contact with someone who has it.
Kawasaki disease is contagious in the same way that the common cold is contagious: close contact with someone who has this or any other contagious illness can spread it.