Re: Kawasaki Disease & Carpet Shampoo

[Staci__0__0]

Posted By Staci on May 24, 1999 at 09:27:44
My friend's son was diagnosed with Kawasaki Disease in December of 1998.  She recently told me that there may be a link to Carpet Shampoo.  I have a 23 month old son and just recently shampooed my carpets.  I am wondering if there is any way you can tell my what in the shampoo is suspected to cause this illness.  Thank you, Staci

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 24, 1999 at 13:11:55
Dear Staci,
I havent heard anything about a link with carpet cleaning.  Where did you get this information?  It is thought that Kawasakis disease is due to an infection.
Here is some general information about Kawasakis disease.
In 1967, Tomisaku Kawasaki described a new acute illness that had been affecting infants and young children in Japan. The principal manifestations of this disease were fever, injection of the conjunctivae, a reddening of the lips and oral cavity, reddening of the palms and soles, a polymorphous exanthema (rash) of the body trunk, and swelling of the cervical lymph nodes . The fever lasted for approximately 1 to 2 weeks. Desquamation (peeling) began at the nails during the second week of the illness and then spread to the finger tips and toes. He termed this illness mucocutaneous lymph node syndrome, which has come to be known as Kawasaki disease. A prominent feature of this illness was the 1% to 2% of patients with sudden death due to cardiac failure. These infants were subsequently found at autopsy to have coronary arteritis with associated thrombosis and aneurysm formation. Kawasaki disease is recognized as an important cause of acquired heart disease in children.
Most cases of Kawasaki disease occur in children between the ages of 6 months and 8 years, with a median age of 2 years. Boys are affected more commonly than girls in a ratio of 1.5:1. The annual incidence is highest in children from Japan and Korea where the annual attack rate is 40 to 150 cases per 100,000 children younger than 5 years of age. In contrast, the annual incidence for this age group in other geographic areas, including the United States, is approximately 6 cases per 100,000 children.
Kawasaki disease is believed to be an infectious illness based on its acute and self-limited course, its occurrence in young children, and the geographic clustering of cases. However, no specific infectious agent has been consistently isolated from patients with this disease
The diagnosis of Kawasaki disease requires fever and the presence of at least four of the five principal clinical features. If the patient has fever and fewer than four principal features, then a diagnosis of Kawasaki disease can be made by documenting the presence of coronary artery disease using two-dimensional echocardiography or coronary angiography. Measles, scarlet fever, and Stevens-Johnson syndrome are other acute febrile illnesses that may mimic Kawasaki disease and should be carefully considered in each case to avoid misdiagnosis.

The cardiac manifestations of Kawasaki disease in the acute stages of the illness are diverse and may potentially include pericarditis, myocarditis, endocarditis, inflammation of the conduction system, and coronary artery involvement. Coronary involvement has received the most attention because of its short- and long-term implications. In a large Japanese study, 146 (25%) of 594 patients with acute Kawasaki disease were shown by coronary angiography to have coronary aneurysms. Myocardial infarction is a possible complication of coronary aneurysm that usually occurs in the first year. Many such events are asymptomatic and take place during sleep. Others are symptomatic and heralded by shock, increased irritability, abdominal pain, and chest pain. Mitral regurgitation is relatively uncommon, having been detected in only about 1% of patients over the acute and subacute stages of the disease.
The long-term complications of coronary lesions in Kawasaki disease relate to the persistence of coronary aneurysms, the development of thrombotic occlusion, the progression to ischemic heart disease, and a theoretical risk for premature atherosclerosis. The patients with normal coronary arteries at the outset apparently have an excellent prognosis. Coronary aneurysms detected after the acute stage regress in almost one half of the cases. Small and moderate-sized coronary aneurysms have the highest likelihood of regression. In contrast, giant coronary aneurysms (> 8 mm in diameter) have the lowest rates of regression, the highest risk for stenosis, and the strongest association with myocardial infarction. Systemic artery aneurysms develop in about 2% of patients. They occur most commonly in the axillary and iliac arteries, and rarely produce ischemic manifestations.

Initial treatment with high doses of salicylates shortens the duration of fever and lowers the frequency of coronary aneurysms.
Children suspected of having Kawasaki disease should be examined as soon as possible by two-dimensional echocardiography to evaluate the coronary arteries. A 12 lead electrocardiogram is also recommended to look for evidence of ischemia and any conduction system abnormalities. Initial therapy consists of aspirin 80 to 100 mg per kg per day in four divided doses and intravenous gammaglobulin in a single 2 g dose. The high doses of aspirin are continued until the child has become afebrile. The aspirin is then given in a reduced single daily dose (3 to 5 mg per kg) for the next 6 to 8 weeks and then discontinued if the child has no coronary abnormalities. The lower doses of aspirin are continued for their antiplatelet effects for an indefinite period in children with coronary lesions. All children with Kawasaki disease should have repeat two-dimensional echocardiography 10 to 14 days after the onset of illness to identify any new coronary lesions.
The American Heart Association has developed guidelines for the long-term management of patients with Kawasaki disease. Any coronary abnormalities are followed by repeat two-dimensional echocardiography at appropriate intervals. Stress testing may be employed in children with known coronary artery disease. A positive stress test warrants consideration of coronary angiography. Children with critical coronary stenoses are treated by percutaneous angioplasty or bypass surgery, depending on the age of the child and extent of the lesions. Whether children who have had Kawasaki disease are predisposed in adulthood to atherosclerosis is an important question for future studies.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.











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