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: A friend of mine said that babies are especially vulnerable to Kawasaki Syndrome after carpet cleanings, and Asians in particular. We just had all of our carpets cleaned, and our half-Japanese son is 8 months old. Should we be concerned in any way?

A: Until the cause of Kawasaki syndrome is known, it will not be possible to say with certainty whether rug shampooing is a risk factor for the development of the illness. Some studies have suggested that it is related, and many others have found no association.

All these studies are the so-called case-control study type, where an investigator talks to a Kawasaki family and a "control" family whose child did not develop Kawasaki Syndrome. The investigator asks about all kinds of exposures such as rug shampooing. If the Kawasaki family had their rugs shampooed within one month of the Kawasaki Syndrome developing in their child, but the control family did not shampoo their rugs during the same time, this may be important information or just coincidence. How an investigator picks the control families is an important issue, and picking the proper control family is easier said than done. Control families have to be similar enough to the Kawasaki family that they can really be compared.

It is important to recognize that Kawasaki Syndrome occurs at a higher rate in Asian children, but that the rug shampooing data has been published from non-Asian countries, like the U.S. the Japanese have never been great advocates of the rug shampooing theory, perhaps because the use of rugs in homes was fairly infrequent when cases of Kawasaki Syndrome began to emerge in Japan in the 1960s and 1970s. I do not believe any Japanese study has indicated a relationship between Kawasaki Syndrome and rug shampooing.

My personal bias is that rug shampooing is not related to Kawasaki Syndrome. To my mind, the illness is caused by an infectious agent or a group of closely related agents that affect children of all races, but Asians most frequently because some genetic characteristics of Asians allow the agent to attack the host with greater force. If the country with the most cases (Japan) has not seen any relationship between rug shampooing and Kawasaki Syndrome, then I doubt if one exists. However, this is my personal opinion, and undoubtedly other Kawasaki experts in the U.S. would disagree with me.

I believe that one should keep children off freshly shampooed rugs until they dry. This is not because of a concern about Kawasaki Syndrome, but instead with the goal of allowing all fumes and the like to be gone.

Q: Could our child get this disease again?

A: Recurrent Kawasaki Disease is reported to occur in 1% to 3% of patients who have the disease. No factors predicting who will have recurrent disease have been determined, unfortunately, but obviously the risk of a second episode is low.

Q: My son, now 10, was 7 years old when he was diagnosed with Kawasaki Disease. He was quite ill; he was not diagnosed until 12 days after the onset of the disease, even though he exhibited many of the typical symptoms. By the time he was treated, his coronary artery had begun to dilate and there was inflammation around the artery. Is it true that because the coronary artery does not return to its original diameter, and because aneurysms in the heart are retracted but do not disappear altogether, that the long-term prognosis is not known? Also, our son's specialist has not recommended follow-up cardiac testing. This seems to be counter to other opinions I have read. He feels that as long as my son does not exhibit symptoms that relate to cardiac disease, follow-up cardiac tests are not necessary.

A: Only those children who do not develop coronary disease do not need cardiac follow-up. It is true to some extent that long-term prognosis is not known for those who sustained only very mild coronary disease. However, there are definable known risks for children with more significant cardiac disease, and a pediatric cardiologist should follow those children. Echocardiography would be performed at intervals to be determined by the cardiologist, and stress testing might be performed when the child was old enough to cooperate, in addition to any other testing deemed necessary by the pediatric cardiologist.

Q: At the time of our son's hospitalization three years ago, the current thinking was that Kawasaki was the result of the combination of a rare form of staph and strep. Is this still the thinking, or are other causes under consideration?

A: Regarding the cause of the disease, the only correct statement is that the cause is not known. Whoever mentioned staph and strep was merely giving one group's hypothesis; this has not been borne out by other investigators.

| Current Research | Medical Literature | About the Network | Families | Listserv | Back to Home Page |

We welcome your suggestions, too. Please notify us by e-mail if you have any questions or ideas, or if you would like to add your name to our mailing list (and leave your mailing address in the message).

Send comments to: kawasaki@compuserve.com We'd love to hear from you. Let us know if it is OK to list you on our "Families" page.

Web design by Greg Wiles

Illustration by Marcel Isler