Kawasaki Disease in Adults - Symptoms, Diagnosis & Treatment

Understanding Kawasaki Disease

Kawasaki disease is an acute febrile illness that causes inflammation in blood vessel walls, particularly the arteries and veins that supply blood to the heart. It primarily impacts young children, but rarely, adolescents and adults may develop Kawasaki disease as well.

While treatable, Kawasaki disease can lead to serious heart complications if not properly diagnosed and managed. Understanding more about Kawasaki disease in adults can help patients of all ages receive appropriate care.

Symptoms of Kawasaki Disease

Kawasaki disease often starts with:

• A persistent high fever lasting 5 or more days
• Extreme irritability in younger children
• General malaise

Within a few days, other symptoms arise including:

• Bloodshot eyes
• Red, cracked lips and strawberry tongue
• Widespread skin rash
• Swollen hands and feet
• Swollen lymph nodes, especially on one side of the neck
• Redness or peeling of palms and soles

Adults may experience similar symptoms as children but find them less pronounced, contributing to missed diagnoses.

Prevalence of Kawasaki Disease in Adults

Up to 80% of Kawasaki diagnoses occur in children under age 5. Cases in adolescents and adults remain uncommon. Research estimates:

• About 1 in 10 cases occur in children ages 5-9 years old
• Only 1 in 30 cases involve ages 10-19 years
• Approximately 1 in 150 cases involves ages 20+ years

So while adults can develop Kawasaki disease, pediatric patients make up the vast majority. Adult cases likely often go undetected due to lack of awareness about Kawasaki disease presenting differently in adults.

Challenges Diagnosing Kawasaki Disease in Adults

Several factors contribute to difficulty diagnosing adult-onset Kawasaki disease:

• Low physician awareness - most associate it only with young children
• Nonspecific flu-like symptoms
• Incomplete symptom presentation compared to kids
• Symptoms dismissed as other conditions

This leads to delays in treatment to minimize heart injuries related to prolonged inflammation.

Causes and Risk Factors for Kawasaki Disease

The exact cause of Kawasaki disease remains unknown. Leading theories suggest an infectious agent sparks an intense inflammatory response in genetically predisposed individuals.

Infectious Agent Theories

Many researchers speculate a common infectious organism interacts with immune system pathways to trigger widespread inflammation. Suspect infectious agents include:

• Adenoviruses
• Coronaviruses
• Rhinoviruses
• Bocavirus

But testing fails to consistently detect these organisms in Kawasaki patients. So while they may contribute, an unknown factor likely interplays with infection to cause disease.

Genetic Factors

Genetics seem to impact Kawasaki disease risk. For example:

• Asian children have higher rates than other ethnicities
• Siblings of affected children have a 10 times greater risk
• Certain gene variants are more common in KD patients

But genes only partially explain patterns of inheritance. Much remains unknown about the genetics influencing development of Kawasaki.

Environmental Influences

Seasonal outbreaks in winter/spring and clustering of cases suggest environmental triggers. Additionally, exposure to factors like pollution, dust mites, carpet cleaning chemicals have correlations to developing Kawasaki disease.

However, research on exact external factors remains in early phases. Ongoing studies continue investigating potential causative links.

Treating Kawasaki Disease in Adults

All patients with Kawasaki disease require hospitalization for monitoring and rapid treatment. Most adults receive:

IVIG Therapy

High doses of intravenous immunoglobulin (IVIG) containing antibodies to suppress inflammation prove highly effective, especially when administered promptly in the illness course. IVIG paired with aspirin significantly reduces heart complications.

Aspirin

High dose aspirin therapy is a mainstay for reducing inflammation and preventing blood clots that could cause heart attacks or strokes. Adult Kawasaki patients take high dose aspirin until tests confirm their inflammatory markers have normalized.

Corticosteroids

Steroids like prednisone may pair with IVIG therapy to improve efficacy in some patients. However, research on long term impacts of steroids remains ongoing.

Anticoagulants

Anticoagulant medications often administer alongside aspirin to prevent dangerous blood clots. Heparin bridges to warfarin therapy in the outpatient setting.

Other Targeted Therapies

Some patients with severe refractory disease receive newer biologic agents like tumor necrosis alpha inhibitors or interleukin inhibitors - but data on efficacy in acute disease state remains limited.

Complications and Long Term Risks

With timely diagnosis and management, the prognosis for Kawasaki disease patients significantly improves. However, some patients develop complications:

Heart Conditions

Up to 25% of patients untreated in the acute phase develop coronary artery aneurysms or enlargements. This causes higher risk for blood clots, heart attacks, arrhythmias and sudden death.

Heart Disease

Inflammation of heart blood vessels early in life predisposes patients to accelerated atherosclerosis, fatty plaque buildup raising risk of heart attacks and strokes later in adulthood.

Liver Function Problems

Some patients develop portal hypertension from hepatic sinusoidal obstruction syndrome impairing liver function.

Gallbladder Disorders

For unknown reasons, Kawasaki disease can inflame bile ducts or gallbladder resulting in cholecystitis or symptomatic gallstones.

Arthritis

A small percentage of patients develop arthritis or joint pain that persists for months or years after acute illness resolves.

Ongoing research aims to better predict individuals most at risk for cardiac complications to guide long term monitoring and lifestyle management.

Increasing Adult Kawasaki Disease Awareness

Heightening medical understanding of Kawasaki presentations in adults and appropriate diagnostic protocols can improve identification of cases that may otherwise go unnoticed.

Given links between timely treatment and improved outcomes, recognize adults can develop Kawasaki so all ages receive responsive care.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.