Kawasaki Families' Network

Some Questions and Answers

Dr. Anne Rowley, director of pediatric infectious diseases at the Loyola Children's Hospital, has fielded some questions from Kawasaki parents. Here is an edited version of select questions and her responses.

Q: Our daughter got Kawasaki a year ago, shortly after she had her immunizations. Now I don't know whether to take her for her shots this year. Is there any connection?

A: Immunizations have been studied in the past by several groups as to whether they might be related to Kawasaki disease, and the answer has consistently been no. People do seem to have a fear of immunizations, which is unfortunate for their children. Since Kawasaki disease is most common in young childhood, when children are frequently receiving immunizations, of course there will be some children who get their Kawasaki disease shortly after receiving an immunization, but this does not mean the two events are related.

Q: My son is still having problems with his sedimentation rate. This was his big problem when he was very sick symptomatically. It still keeps fluctuating. I can always tell because of the irritability that accompanies the change. When we ran our weekly blood work his sed rate was back up to 23. It had been down to 4 for several weeks and now all of a sudden it's up and down. At its highest it was 125. Is there information on these kids that have problems with the sed rate?

A: The sedimentation rate, ESR, is a measure of inflammation in the body. It is typical for it to be very elevated in Kawasaki disease in the acute phase, and it slowly comes back to normal over a 6-8 week period after the onset of fever. It is often elevated in many other inflammatory illnesses. When treating Kawasaki disease, we generally focus on the symptoms of the illness and not the ESR. Kawasaki patients generally feel, look and act better about 2-3 weeks after the onset of fever, but the ESR is still elevated for that 6-8-week time frame. This is very characteristic of Kawasaki disease. A normal ESR ranges from about 5-20, depending on the method used, and having 20 is not worse than having 5. If a Kawasaki patient still had an elevated ESR after the two-month period, I might question the original diagnosis (even the best of us Kawasaki experts have treated the occasional child with juvenile rheumatoid arthritis as Kawasaki disease because we weren't sure of the diagnosis at first). Some children with Kawasaki disease have problems with joint symptoms and elevated ESR for about one month longer than the two-month time frame. However, symptoms that last longer than that again would make me wonder about the diagnosis. Of course...if he were unfortunate enough to have developed coronary disease, that would certainly clinch the Kawasaki diagnosis.

Q: Last year our child was diagnosed with Kawasaki and now has developed anemia. Does Kawasaki disease cause anemia?

A. Anemia is quite common with acute Kawasaki disease (when the child is ill with the symptoms), but resolves as the child's symptoms resolve. There is no known association between Kawasaki disease and the development of anemia later in life. Anemia in young childhood is usually due to iron deficiency (totally unrelated to Kawasaki disease), but may be due to other causes. The child's physician should be able to perform tests to determine the cause of the anemia, or if the child is in the right age group for iron deficiency, sometimes iron is prescribed and the blood count rechecked to see if the problem has resolved.

Q: Previous to high fever and rash, our son had other cold-like symptoms: runny nose, itchy eyes, swollen glands in neck, occasional red spots and inflamed throat. Although the fever and rash are gone and the heart is OK (due to early hospitalization and treatment), four weeks later all these symptoms have come back (except for the rash and fever). We have read that other diseases have similar symptoms to Kawasaki syndrome; would you know what they are?

A: There are many viral and bacterial illnesses that can give swollen glands in the neck and red throat. The runny nose/itchy eyes sounds more allergic. I would not be worried about these symptoms representing Kawasaki disease if the fever has resolved. Of course, your physician is the best one able to determine what is going on with your child. There are a large number of illnesses that can mimic Kawasaki disease, but physicians should be able to narrow the possibilities with a history, physical examination and some laboratory evaluation. There are some reports of a viral-like illness being noted prior to the development of Kawasaki disease in some children. Whether there is a sort of prodrome before developing Kawasaki disease will not really be answered until the cause of the illness is identified.

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