Kawasaki Disease

Treatment

Mayo Clinic specialists have great expertise in treating children with Kawasaki disease. Mayo Clinic physicians have extensive experience in infectious diseases and heart disease in children, and Mayo Clinic is a leading center for the diagnosis and surgical treatment of heart defects. Children needing hospitalization are cared for at Mayo Eugenio Litta Children's Hospital.

The child's treatment team determines the best treatment based on:

• The child's age, overall health and medical history
• The stage of the disease once diagnosed
• The child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the condition
• The parent's opinion or preference

There are two treatment options for Kawasaki Disease:

Gamma Globulin
The use of intravenous gamma globulin (IVIG) can shorten the acute phase of Kawasaki disease and prevent coronary damage. When the fever has been gone for two to three days, the dose is decreased. Children are also prescribed a low dose of aspirin through the convalescent phase; aspirin is then stopped unless they have coronary damage. For children who are diagnosed after the tenth day and continue to have a fever, IVIG still may be helpful. Careful monitoring is necessary during the administration of gamma globulin, as children react differently to this drug.

Aspirin
Aspirin is used to decrease inflammation and lower fever, as well as prevents blood clots. Aspirin has never been shown to decrease the risk of aneurysms. Generally, high doses of aspirin are used in the first few days to control fever. Once the fever has been broken for two to three days, the dose is decreased. Children continue to take low dose aspirin through the convalescent phase and then stop, unless they have coronary damage.

Treatment for Kawasaki is most effective in the first 10 days of the illness. Before the discovery of IVIG treatment, approximately 20 percent of children developed coronary changes. Now only 4 percent of children have coronary changes if given proper treatment. Infants (particularly those less than 6 months old), males and children who receive the IVIG treatment after 10 days of being sick with symptoms are at higher risk for developing coronary problems.

Coronary changes can be evaluated and followed by a pediatric cardiologist, who will take an echocardiogram (ultrasound of the heart). The first echocardiogram is usually performed 10 to 14 days into the illness. A follow-up echocardiogram is then done four to six weeks later. If both tests are normal, then the coronary arteries are considered normal, and no additional cardiology treatment is necessary. If persistent coronary changes are present, the coronary arteries will need to be watched over time. The majority of changes will go away within the first two years of the illness, but significant changes may never go away (such as very large aneurysms). If coronary changes are present, the child will typically remain on low-dose aspirin therapy and will need long-term follow-up with a pediatric cardiologist.