Kawasaki Disease

Kawasaki disease (KD), is an acute febrile illness of unknown etiology that primarily affects children younger than 5 years of age. The disease was first described in Japan by Tomisaku Kawasaki in 1967. Clinical signs include fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips, and throat.

KD occurs worldwide, with the highest incidence in Japan, and it most often affects boys and younger children. In the continental United States, population-based and hospitalization studies estimate an incidence of KD ranging from 9 to 19 per 100,000 children under 5 years of age. In the year 2000, approximately 4248 hospitalizations with KD were reported among children under 18 in the US, of which 3277 (77%) were for children under 5 years of age.

Classically, five days of fever plus four of five diagnostic criteria must be met to establish the diagnosis. The criteria are: erythema of the lips or oral cavity or cracking of the lips, rash on the trunk, swelling or erythema of the hands or feet and red eyes (conjunctival injection).

KD can only be diagnosed clinically as no specific laboratory test exists for this condition. It is difficult to establish the diagnosis, especially early in the course of the illness, and frequently children are not diagnosed until they have seen several health-care providers. Many other serious illnesses can cause similar symptoms, and must be considered in the differential diagnosis, including childhood mercury poisoning (infantile acrodynia).

Many of the same physical characteristics of KD are also present in children diagnosed with acrodynia, or Pink Disease which results from exposure to mercury. Acrodynia is thought to be a form of hypersensitivity to mercury which was common in the early 1900s from the use of mercury in infant teething powders.

Mercury Intoxication: It Still Exists

A 3-year-old boy was transferred to the Hospital for Sick Children with a 4-week history of systemic symptoms manifesting as irritability and fatigue, loss of appetite, a 5 kg weight loss, and diaphoresis. There was no history of fever. He had severe pain in his wrists and legs not relieved by acetaminophen or nonsteroidal antiinflammatory drugs (NSAIDs), resulting in difficulty in weight bearing.

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Kawasaki Urinary Mercury Orlowski 1980

The temporal and geographic relationship between the description of the mucocutaneous lymph node syndrome (MLNS) or Kawasaki disease, and the Minamata Bay contamination with mercury in Japan is impressive. Also, the appearance of MLNS in the United States has paralleled the increasing concern with environmental pollution of natural bodies of water with mercury.

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Kawasaki’s Disease, Acrodynia, and Mercury

Kawaski’s Disease (KD), first described in Japan (1967), is an acute febrile multiorgan vasculitis, which predominantly (75 – 80%) affects children younger than 5 years. The disease has an increasing frequency and, in developed countries, has surpassed rheumatic fever as the leading cause of acquired heart disease in children. Early intravenous immunoglobulins in combination with acetyl-salicylic acid have significantly reduced the prevalence of coronary artery abnormalities.

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