Infant Illnesses | Spotlight on Kawasaki disease

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The condition occurs most often in children from three months old to five years old. (Getty Images)
The condition occurs most often in children from three months old to five years old. (Getty Images)
  • If your baby is running a fever and has a swollen tongue, he or she may have Kawasaki disease. 
  • The non-infectious condition occurs most commonly in children aged three months to five years. 
  • A local expert says a few conditions "mimic Kawasaki disease" and shares what parents should know to avoid "long term complications".

    Having a newborn baby is overwhelming enough, and if they show signs of illness, it can be really scary.

    Parent24 has put together a series on common infant illnesses to guide you when your baby is sick.

    Together with a local paediatrician or doctor, we'll help you decide when to panic. It's probably not as serious as you think, but let's be sure.

    Catch more instalments of our #infantillness series here

    A typical concern: 

    "My seven-month-old has suddenly sprouted a measles-like rash on her tummy and seems to have a swollen tongue. What's happening to my baby?"


    Your baby might have Kawasaki disease.  

    "Kawasaki disease is an acute febrile illness of childhood where medium-sized blood vessels, called arteries, become inflamed (vasculitis). It commonly affects the coronary arteries found in the heart, and if left untreated, about 25% of patients will develop coronary artery complications," explains Dr Elelwani Mathivha, a paediatrician practising at Netcare Femina Hospital. 

    According to Dr Mathivha, the illness, "... is the leading cause of acquired heart disease in children in most developed counties". 

    What causes Kawasaki disease

    The cause of the condition remains unknown, Mathivha says; however, research shows that it is likely genetic. 

    "The highest incidence is recorded in children of Asian descent, irrespective of geographical location. This suggests that there may be a genetic predisposition to developing the disease. It is also speculated that a recent infection may be a trigger for developing Kawasaki disease," the paediatrician told Parent24

    The condition occurs most often in children from three months old to five years old and, "... rarely presents outside of this age range," Mathivha says. 

    Also read: Your baby's brain explained | A Parent24 Series

    Symptoms to look out for: 

    According to Mathivha, there several symptoms of Kawasaki disease, including: 

    • Polymorphous measles-like rash, usually on the trunk
    • Bilateral inflammation of the eyes (both eyes affected) without a discharge
    • Swelling of lymph nodes around the neck (cervical lymphadenopathy)
    • Reddening and swelling of the soles of the feet and palms of the hands
    • Swelling and cracking of the lips
    • Reddening and swelling of the tongue (strawberry tongue) 

    Similar conditions

    There are a few conditions that, "... mimic Kawasaki disease," Mathivha says and may lead to a misdiagnosis. These include: 

    Adenovirus infection

    Adenovirus, like Kawasaki disease, presents with a fever, inflamed eyes, and swollen lymph nodes. However, children with adenovirus have discharge from the eye (exudative), whereas Kawasaki disease has a non-exudative eye infection, ie no discharge from the eyes.


    The rash of measles can easily be confused with that of Kawasaki disease. Measles, like adenovirus, also presents with an exudative conjunctivitis, unlike the non-exudate conjunctivitis in Kawasaki disease. 

    Scarlet fever

    Scarlet fever, like Kawasaki, presents with a high fever and a skin rash. However, children with scarlet fever have a fever that promptly responds to antibiotic therapy, whereas Kawasaki disease has an unremitting fever that does not respond to treatment.

    Less commonly occurring conditions that can also be confused with Kawasaki disease, according to Mathivha, include:

    • Drug reactions
    • Bacterial adenitis
    • Juvenile idiopathic arthritis
    • Rickettsial infections
    • Staphylococcal toxin syndrome
    • Rocky mountain spotted fever
    • Leptospirosis

    Despite these similarly presenting conditions, the paediatrician assures that with, "... careful history examination", a doctor will be able to identify and treat the disease properly.

    How long will it last, and how is it spread?

    "Kawasaki disease usually lasts between one and two weeks, with the average duration being 10 to 12 days. Severe cases can, however, last three to four weeks. During the course of the disease, antibodies form, which later provide immunity against the disease; thus recurrence is very uncommon," Mathivha explains. 

    And while the condition is not contagious at all, acting quickly is crucial. "It's not the actual disease, but rather the cardiac complications that may leave long term complications if untreated," Mathivha says. 


    "Kawasaki disease requires hospitalisation, and most of the medication used are administered intravenously". 

    When to call the doctor

    The paediatrician says that an ongoing and inexplicable fever that, "... doesn't respond to antipyretics and/or antibiotics", warrants a visit to the doctor. 

    Also see: Help! My baby's sick: 13 illnesses your baby is most likely to catch during his first 12 months

    Tips and advice for parents

    "Parents should remember that although this is an acute self-limiting condition with a very low mortality rate, it is still important to seek help early to avoid long term complications." 

    You can also ask a doctor or paediatrician directly via Health24 here: Ask an Expert


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