Kawasaki Disease

Treatment Overview

Kawasaki disease is treated with medicines. Long-term care may be needed and might include continued medicine, limited physical activity, and repeated testing.

Early treatment of Kawasaki disease prevents most blood vessel and heart damage. If children with Kawasaki disease are hospitalized and treated within 10 days after the first signs of illness, the risk of heart disease and aneurysms greatly decreases.

For the best treatment, have your child’s pediatrician work with a pediatric cardiologist.

Medicines

Medicines used to treat Kawasaki disease include intravenous immunoglobulin, aspirin, and possibly anticoagulants.

Intravenous immunoglobulin (IVIG). Intravenous immunoglobulin (IVIG) is used to reduce inflammation of blood vessels. IVIG usually is given in 1 dose through a vein, over 8 to 12 hours. The treatment usually requires that the child stay in the hospital for at least 24 hours. After IVIG treatment, the illness usually improves very quickly. IVIG works best if it is given before the tenth day of fever. Sometimes a second dose of IVIG is needed because the first dose did not reduce the fever and inflammation.

Aspirin therapy.At first, high-dose aspirin is used to relieve inflammation and fever. If there are no complications, smaller daily doses are then given for 2 to 3 months to lower the risk of dangerous blood clots. Because of the risk of Reye syndrome, aspirin should be given only under the guidance of a doctor. If the child is exposed to or develops chickenpox or flu (influenza) while taking aspirin, talk with a doctor right away. For more information, see the topic Reye Syndrome.

Anticoagulants. Anticoagulants may be used if the child has an aneurysm. Anticoagulants help prevent new blood clots.

After initial treatment, the child's fever and inflammation should improve, but the child may still be irritable, not have an appetite, and not be very active. Also, the child’s fingers and toes may peel or his or her fingernails may get deep lines in them (Beau's lines). It may be several weeks before the child feels completely well.

Follow-up treatment

Your child's doctor may do echocardiograms to check for aneurysms. This test may be done at 2 to 3 weeks and at 6 to 8 weeks after the illness. It may also be done at later times.

If echocardiogram results from follow-up exams are normal, your child probably will not need further care.

But if these test results show changes in the coronary arteries, long-term care of the disease may be needed. This care may include:

• Repeated exams and tests every year or every 3 to 5 years, depending on the child's risk for heart problems.
• Continued low-dose aspirin therapy, sometimes combined with other medicines that lower the risk of blood clots.
• Limited physical activity.
• Annual flu shot (influenza vaccine (What is a PDF document?)).

What to think about

Treatment with immunoglobulin (IVIG) sometimes interferes with the effectiveness of immunizations against measles, mumps, rubella (MMR) (What is a PDF document?), and chickenpox (What is a PDF document?). For children who have received IVIG treatment, the MMR and chickenpox immunizations should be postponed for 11 months.

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Author:	Debby Golonka, MPH	Last Updated: December 23, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Stanford T. Shulman, MD - Pediatrics
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