Kawasaki Disease still remains largely
undiagnosed in India
The goal of
therapy for KD is to manage symptoms to maintain cardiovascular health
New Delhi, 21 November 2017: In what can be called a rare but rapidly
spreading disease, the Kawasaki Syndrome or Disease (KD) continues to remain
one of the largely undiagnosed conditions in Indian children, primarily due to
lack of awareness amongst pediatricians. KD is believed to be the commonest
vasculitic disorder of children. Incidence rates as high as 60 to 150 per
100,000 children below 5 years of age have been reported from several
countries. The IMA indicates that untreated children are at risk for developing
potentially fatal coronary artery aneurysms.
KD is a condition that causes inflammation in
the walls of medium-sized arteries throughout the body, including the coronary
arteries, which supply blood to the heart muscle. It is also called
mucocutaneous lymph node syndrome because it also affects lymph nodes, skin,
and the mucous membranes inside the mouth, nose and throat.
Speaking about this, Padma Shri Awardee Dr K
K Aggarwal, National President Indian Medical Association (IMA) and President
Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary
General IMA in a joint statement, said, "Although the exact cause of KD is not
known, it is not thought to be a contagious disease. Some theories link KD to bacteria, viruses or other
environmental factors, but none has been proved. Certain genes can increase a child's
susceptibility to KD. This disease is one of the leading causes of acquired
heart disease in children. However, lasting damage can be prevented with
effective treatment. Some of the heart complications that may develop as a
result of KD include inflammation of blood vessels (vasculitis), usually the
coronary arteries, that supply blood to the heart; inflammation of the heart
muscle (myocarditis); and heart valve problems. As per the AHA, the diagnosis
of incomplete or atypical KD should be considered in any infant or child with prolonged
unexplained fever, fewer than 4 of the classical clinical findings, and
compatible laboratory or echocardiographic findings.”
Some of the
classic symptoms of KD apart from fever include redness in both eyes; a very
red, swollen tongue; redness of the palms or soles; skin peeling; a rash; and swollen
lymph nodes. The symptoms usually appear in three phases.
Adding
further, Dr Aggarwal, said, “Treatment
should begin as soon as the signs and symptoms appear, preferably while the child
still has a fever. The goals of initial treatment are to lower fever and
inflammation and prevent heart damage. The recommendations may include infusion
of an immune protein (gamma globulin) through a vein (intravenously) to lower
the risk of coronary artery problems; and high doses of aspirin to help treat
inflammation.”
The goal of therapy is to prevent thrombosis and
myocardial ischemia while maintaining optimal cardiovascular health. Risk-stratification
of patients for effective long-term evaluation and management should be done
according to the relative risk of myocardial ischemia, either related to
coronary artery thrombosis or stenoses/occlusions. The guidelines also
recommend development of effective and collaborative programs between pediatric
and adult cardiology providers for effective long-term management of the
patient.
