Mysterious Fever of Children and Kawasaki Disease

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Fever is a very common illness and it is a symptom that describes a body temperature that’s higher than normal. It can affect both children and adults. More than 90% of the children experience fever in their growing age. Fever itself is usually not harmful – in fact, it helps the body’s immune system to fight off an infection.

What is the body temperature that defines fever?
It is a fever when a child’s body temperature is at or above one of these levels: measured orally (in the mouth): 100°F (37.8°C), measured rectally (in the bottom): 100.4°F (38°C), measured in an axillary position (under the arm): 99°F (37.2°C).

What are the most common diseases that may cause fever in children?
Most of the fevers in children are self-limited. Infectious disease is the leading cause for the common symptoms like fever, diarrhea, fatigue and coughing. There are 3 group of microbes that cause the fever, which includes bacteria, virus and atypical (such as tuberculosis, protozoa, etc). The other causes of fever are blood disease, immunology disease, or other problems such as the Kawasaki Disease.

Strawberry tongue

When should my child see a doctor if they have fever?
The most important action is to observe how your child looks and feels. If your child is lethargic, not drinking, acting abnormally, having a persistent fever for more than 2-3 days, or spiking fever with febrile fit, these are indications to seek doctor’s treatment. A doctor will investigate and advise what’s the cause of the respective fever is. Blood test, imaging or urine sample may be required.

What is Kawasaki disease in children? Is it related to fever?
Kawasaki disease is a commonly overlooked disease that happens to children. Fever is the most important symptom that may occur first. Kawasaki disease, which is also known as Mucocutaneous lymph node syndrome affects the lymph nodes, skin, the mucous membranes inside the mouth, nose and throat. The children may have red eye or Bacille Calmette Guerin, (BCG) scar redness in the disease progression.

Bilateral Red Eye

How do I know if my child has contracted Kawasaki Disease?
Most children diagnosed with Kawasaki disease will have a fever lasting for more than 5 days, plus at least four of these symptoms:

• Redness in both eyes.
• Changes around the lips (crack lips), tongue (strawberry tongue), or mouth (peeling).
• Swelling in fingers and colour change, or peeling.
• Rashes located in the chest, stomach, or genital area.
• Swollen lymph nodes around the neck can be one or both side.

The laboratory tests may play a major role for this non-typical presentation of Kawasaki Disease.

Why is Kawasaki Disease so serious?
Apart from prolonged fever, the disease is very serious because it will cause the inflammation of the coronary artery (heart). One out of every four children’s hearts with Kawasaki disease may be inflamed. The inflammation of the lining surrounding the heart is also known as pericarditis. In extreme cases, it can cause blood clots leading to a heart attack or stroke, damage to the heart with heart failure, or death.

How do I know if the coronary artery is affected?
Cardiac Echo should be arranged for the patient who is highly suspected or diagnosed with Kawasaki Disease to prevent further complications. Damage can occur to the blood vessels that supply to the heart muscle (the coronary arteries) and sometimes to the heart muscle itself. Serial imaging during follow-up may be needed if suspected of complication.

Coronary Aneurysm

How is Kawasaki Disease treated?
Early diagnosis and treatment of the disease will be the best way to prevent the disease’s complication. The initial treatment and complete treatment will decide the outcome. Therefore, your child will likely be treated in hospital, at least for the early part of the treatment. The standard treatment during the disease’s acute phase is high-dose of aspirin and immune globulin. Serial blood test and cardiac echo will play a major role in monitoring the disease progression. Recurrent may happen in 5% of the affected patient.

Do not hesitate to consult your paediatrician when in doubt.