A to Z of Medical Conditions

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Kawasaki disease – what are the signs and symptoms of Kawasaki disease?

Kawasaki disease

Kawasaki disease

 

Kawasaki disease is a rare condition that mainly affects children under the age of five. It’s also known as mucocutaneous lymph node syndrome.

The characteristic symptoms are a high temperature that lasts for more than five days, with:

a rash

swollen glands in the neck

dry, cracked lips

red fingers or toes

red eyes

After a few weeks the symptoms become less severe, but may last longer. At this stage, the affected child may have peeling skin on their fingers and toes.

The symptoms of Kawasaki disease usually develop in three phases over a six-week period.

The three phases are described below.

Phase 1: acute (weeks 1-2)

Your child’s symptoms will appear suddenly and may be severe.

High temperature

The first and most common symptom of Kawasaki disease is usually a high temperature (fever) of 38C (100.4F) or above.

The fever can come on quickly and doesn’t respond to antibiotics or medicines typically used to reduce a fever, such as ibuprofen or paracetamol. If your child has a fever, they may be very irritable.

Your child’s fever will usually last for at least five days. However, it can last for around 11 days without the proper treatment. In some rare cases, the fever can last for as long as three to four weeks.

The fever may come and go, and your child’s body temperature could possibly reach a high of 40C (104F).

Rash

Your child may have a blotchy, red rash on their skin. It usually starts in the genital area before spreading to the torso, arms, legs and face.

The spots are usually red and raised, but there will not be any blistering.

Read more about skin rashes in children.

Hands and feet

The skin on your child’s fingers or toes may become red or hard, and their hands and feet may swell up.

Your child may feel their hands and feet are tender and painful to touch or put weight on, so they may be reluctant to walk or crawl while these symptoms persist.

Conjunctival injection

Conjunctival injection is where the whites of the eyes become red and swollen. Both eyes are usually affected, but the condition isn’t painful.

Unlike conjunctivitis, where the thin layer of cells that cover the white part of the eye (conjunctiva) becomes inflamed, fluid doesn’t leak from the eyes in conjunctival injection.

Lips, mouth, throat and tongue

Your child’s lips may be red, dry or cracked. They may also swell up and peel or bleed.

The inside of your child’s mouth and throat may also be inflamed. Their tongue may be red, swollen and covered in small lumps, also known as “strawberry tongue”.

Swollen lymph glands

If you gently feel your child’s neck, you may be able to feel swollen lumps on one or both sides. The lumps could be swollen lymph glands.

Lymph glands are part of the immune system, the body’s defence against infection. They may swell to over 1.5cm wide, feel firm and be slightly painful.

Phase 2: sub-acute (weeks 2-4)

During the sub-acute phase, your child’s symptoms will become less severe but may last longer. The fever should subside, but your child may still be irritable and in considerable pain.

Symptoms during the second phase of Kawasaki disease may include:

peeling skin on the fingers and toes – also sometimes on the palms of the hands or the soles of the feet

abdominal pain

vomiting

diarrhoea

urine that contains pus

feeling drowsy and lacking energy (lethargic)

headache

joint pain and swollen joints

yellowing of the skin and the whites of the eyes (jaundice)

It’s during the second phase of Kawasaki disease that complications are more likely to develop, such as a coronary artery aneurysm, which is a bulge in one of the blood vessels that supply blood to the heart.

Read more about the complications of Kawasaki disease.

Phase 3: convalescent (weeks 4-6)

Your child will begin to recover during the third phase of Kawasaki disease, which is known as the convalescent phase.

Your child’s symptoms should begin to improve and all signs of the illness should eventually disappear. However, your child may still have a lack of energy and become easily tired during this time.

Occasionally, complications can develop during the third phase of Kawasaki disease, but they’re more likely to develop before this stage.

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Endocarditis – what symptoms do you need to look out for?

Endocarditis

Endocarditis

The symptoms of endocarditis can develop rapidly over the course of a few days (acute endocarditis) or slowly, over the course of a few weeks or possibly months (subacute endocarditis).

Subacute endocarditis is more common in people with congenital heart disease.

Symptoms of endocarditis

The most common symptoms of endocarditis include:

a high temperature (fever) of 38C (100.4F) or above

chills

night sweats

headaches

shortness of breath, especially during physical activity

cough

heart murmurs – where your heart makes a whooshing or swishing noise between beats

tiredness (fatigue)

muscle and joint pain

Other symptoms can include:

the appearance of a spotty red rash on the skin (this is known as petechiae)

narrow, reddish-brown lines of blood that run underneath the nails

painful raised lumps that develop on the fingers and toes

painful red spots that develop on the palms of your hand and soles of your feet

mental confusion

When to seek medical advice

You should contact your GP as soon as possible if you develop any of the above symptoms, particularly if you’re at a higher risk of developing endocarditis, such as having a history of heart disease.

Read more about the causes of endocarditis.

These symptoms are more likely to be caused by a less serious type of infection. However, your doctor will want to investigate.

When to seek emergency medical advice

A stroke is one of the most serious complications that can develop from endocarditis.

If you suspect a stroke, you should dial 999 immediately to request an ambulance.

The most effective way to identify the symptoms of a stroke is to remember the word FAST, which stands for:

Face – the face may have fallen on one side, the person may be unable to smile, or their mouth or eye may have drooped

Arms – the person may be unable to raise both arms and keep them there as a result of weakness or numbness

Speech – the person’s speech may be slurred

Acute
Acute means occurring suddenly or over a short period of time.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessels
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Fatigue
Fatigue is extreme tiredness and lack of energy.
Fever
A high temperature, also known as a fever, is when someone’s body temperature goes above the normal 37°C (98.6°F).
Haemorrhage
To haemorrhage means to bleed or lose blood.
Nodules
A nodule is a small growth or lump of tissue.
Inflammation
Inflammation is the body’s response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
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Bornholm disease – what is it and what are the signs and symptoms?

Bornholm disease

Bornholm disease

Bornholm disease (also called pleurodynia) is a viral infection that causes pain in the chest or upper tummy and flu-like symptoms.

It usually clears up by itself after a few days, but can sometimes last longer (up to three weeks).

Bornholm disease mainly affects children and young adults.

This page covers:

 

Symptoms of Bornholm disease

The main symptom of Bornholm disease is a severe stabbing chest pain, which is often worse when you breathe deeply, cough or move.

The pain tends to come and go, with episodes lasting 15-30 minutes. In very severe cases, the pain can make it difficult to breathe and the affected area may be tender.

Other symptoms of Bornholm disease include:

tummy pain

high temperature (fever)

headache

sore throat

cough

aching muscles

These symptoms usually start suddenly and last for a few days. They can sometimes last longer (up to three weeks), or they can come and go for a few weeks before eventually clearing up.

When to get medical help

If you have chest pain, it’s important to get it checked out, particularly if it’s severe and comes on suddenly. Get more advice about chest pain and when to get medical help.

Bornholm disease can be serious for newborn babies, so if you’re in the late stages of pregnancy or have a newborn baby and you’ve come into contact with someone with the condition, ask your midwife or GP for advice.

Treating Bornholm disease

There’s no specific treatment for Bornholm disease. The infection usually clears up on its own within a week.

As the condition is caused by a virus, it can’t be treated with antibiotics. You can use over-the-counter painkillers, such as paracetamol and ibuprofen, to help with any pain.

Newborn babies at risk of getting Bornholm disease may be treated with immunoglobin to make the effects of the virus less severe and help prevent complications. This is only offered on the advice of a specialist.

How the infection is spread

Bornholm disease is very infectious and can be easily spread from one person to another, usually through contact with secretions from the nose or mouth, or the poo of an infected person.

You can get infected by eating or drinking contaminated food or drink, or if you touch contaminated objects such as nappies and then touch your mouth.

This is why it’s very important to wash your hands properly and avoid sharing utensils if you or someone close to you has Bornholm disease.

Less commonly, you can catch Bornholm disease by breathing in infected droplets from coughs or sneezes.

As Bornholm disease is so infectious, there are sometimes outbreaks in schools or nurseries.

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Blood clots – find out the signs and symptoms of blot clots!

Blood clots

Blood clots

Introduction

Every year, thousands of people in the UK develop a blood clot in a vein. It’s known as venous thromboembolism (VTE) and is a serious, potentially fatal, medical condition.

VTE is the collective name for:

deep vein thrombosis (DVT) – a blood clot in in one of the deep veins in the body, usually in one of the legs

pulmonary embolism – a blood clot in the blood vessel that carries blood from the heart to the lungs

Although serious, most blood clots can be completely avoided. The key is to be aware if you’re at risk and take some simple preventative steps.

This article is about blood clots in veins. If you want information on blood clots in arteries, which is a common cause of heart attack and stroke, see the topic on arterial thrombosis.

Who gets blood clots?

Anyone can get a blood clot, but you’re more at risk if you can’t move around much or if you’re unwell.

You’ve probably heard of blood clots linked to long-haul plane journeys or the contraceptive pill, but most blood clots actually develop during or just after a stay in hospital.

Your risk is also increased if you:

are over 60 years old

are overweight or obese

have had a blood clot before

are having hormone replacement therapy (HRT)

are pregnant or have recently given birth

are dehydrated

have cancer or are having cancer treatment

have a condition that causes your blood to clot more easily than normal, such as antiphospholipid syndrome

The rest of this topic will focus on blood clots linked with admission to hospital.

Hospital-acquired blood clots

In 2005, a House of Commons Health Committee report stated that every year in England an estimated 25,000 deaths occur as a result of hospital-acquired VTE.

The report also stated that the estimated number of deaths due to VTE, “is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than 25 times the number who die from MRSA“.

The government recognises that deaths from hospital blood clots are preventable and has recommended that all patients admitted to hospital should be assessed for their risk of developing blood clots, and measures to reduce this risk should be taken when appropriate.

Assessing your risk of blood clots

When you arrive at hospital, you should be checked for your risk of blood clots. Hospital staff will record your age and weight and ask you about your general health. The assessment will also take into account the reason for your hospital stay.

Your risk of clots is likely to be higher, for instance, if you’re having a major operation, if you’re going to be confined to bed for long periods, or if you have any of the other “risk factors” mentioned above.

If the assessment shows that you’re at risk of a blood clot, you should be offered preventative treatment. The options include blood-thinning medication (anticoagulants) and compression stockings or foot pumps to keep your blood circulating and help prevent any clots forming.

Hospital staff should check whether bleeding might be a problem before offering medication to help prevent clots.

If you’ve been admitted to hospital and you haven’t had your blood clot risk checked, it’s important that you ask a doctor or nurse. Equally, if you’ve been told you’re at risk of clots and have been given medicine, stockings or other devices, it’s important that you understand how to use them properly.

Don’t be afraid to ask hospital staff about reducing your risk of blood clots – it could save your life.

Questions you might like to ask your healthcare team about blood clots are:

am I at risk of blood clots?

how likely am I to have bleeding problems?

what happens if I have problems with a medication or treatment I am having to help prevent clots?

Reducing your risk of blood clots

There are things you and the medical professionals looking after you can do before, during and after your hospital stay to minimise your risk of developing a blood clot.

Before coming into hospital

You can help yourself before coming into hospital by:

trying to lose any excess weight

keeping as mobile as you can

talking to your doctor if you take HRT or the combined contraceptive pill – you may need to stop them a few weeks before your operation

While in hospital

While you’re in hospital, you will reduce your chances of a blood clot if you:

drink plenty of fluids to keep hydrated

wear your compression stockings day and night (except when you’re washing)

wear any other compression devices you’ve been given

take any blood-thinning medicines you’ve been offered

get up and move around as soon as you’re advised to

After leaving hospital

You’re still at risk of developing a blood clot in the days and weeks after leaving hospital, so you might be advised to continue preventative measures for a short period. Your care team will discuss this with you before you are discharged.

You may be given compression stockings to wear until you are fully mobile, and you may need to keep using anticoagulants for several weeks. You should also take care to stay as mobile as possible and keep yourself well hydrated.

How to tell if you have a blood clot

Before leaving hospital, you should be told about anything you need to look out for that could suggest you’ve developed a blood clot.

Symptoms of a blood clot can include:

cramping pain, redness, warmth, or swelling in one of your legs – these are symptoms of DVT

breathlessness, chest pain, fainting or coughing up blood – these are symptoms of a pulmonary embolism

If you develop symptoms of a blood clot, see your GP or go to your nearest accident and emergency (A&E) department as soon as possible.

Blood clots can be treated if they’re spotted in time. Read more about treating blood clots.

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Maple syrup urine disease – the signs, symptoms and complications!

Maple syrup urine disease

Maple syrup urine disease

Maple syrup urine disease (MSUD) is a rare but serious inherited condition.

It means the body can’t process certain amino acids (the “building blocks” of protein), causing a harmful build-up of substances in the blood and urine.

Normally, our bodies break down protein foods such as meat and fish into amino acids. Any amino acids that aren’t needed are usually broken down and removed from the body.

Babies with MSUD are unable to break down the amino acids leucine, isoleucine and valine. Very high levels of these amino acids are harmful.

One of the characteristic symptoms of MSUD is sweet-smelling urine, which gives the condition its name.

Diagnosing MSUD

At around five days old, babies are offered newborn blood spot screening to check if they have MSUD. This involves pricking your baby’s heel to collect drops of blood to test.

If MSUD is diagnosed, treatment can be given straight away to reduce the risk of serious complications. With early diagnosis and the correct treatment, the outcome can be greatly improved. However, treatment for MSUD must be continued for life.

Without treatment, severe and life-threatening symptoms can develop, including seizures (fits) or falling into a coma. Some children with untreated MSUD are also at risk of brain damage and developmental delay.

Around 1 in 185,000 children worldwide are thought to be affected by the condition.

Symptoms

Symptoms of MSUD usually appear within the first few days or weeks after birth. More general symptoms include:

sweet-smelling urine and sweat

poor feeding or loss of appetite

weight loss

Babies with MSUD may also have episodes known as a metabolic crisis, sometimes early in their life. Symptoms of a metabolic crisis include:

lack of energy

vomiting

irritability

breathing difficulties

It’s important to get medical help immediately if your baby develops symptoms of a metabolic crisis. Your doctor will give you advice to help you recognise the signs.

In some cases, a metabolic crisis may be triggered later in childhood by an infection or illness. The hospital will provide you with emergency treatment instructions to follow if your child is ill, which helps prevent these symptoms developing.

Treating MSUD

Diet

Children diagnosed with MSUD are first referred to a specialist metabolic dietitian and given a low-protein diet. This is tailored to reduce the amount of amino acids your baby receives, especially leucine, valine and isoleucine.

High-protein foods need to be limited, including:

meat

fish

cheese

eggs

pulses

nuts

Your dietitian will provide detailed advice and guidance, as your baby still needs some of these foods for healthy growth and development.

Some children need to take supplements of isoleucine and valine alongside the prescribed diet. This is to help maintain a healthy level of these amino acids in the blood without causing harm. Blood tests are needed to monitor these levels.

Breastfeeding and baby milk also need to be monitored and measured, as advised by your dietitian. Regular baby milk contains the amino acids that need to be restricted, so a special formula is used instead. This contains all the vitamins, minerals and other amino acids your baby needs.

People with MSUD need to follow a low-protein diet for the rest of their life to reduce the risk of a metabolic crisis. As your child gets older they’ll eventually need to learn how to control their diet and will stay in contact with a dietitian for advice and monitoring.

Emergency treatment

If your baby develops an infection, such as a high temperature or cold, their risk of having a metabolic crisis increases. It’s possible to reduce the risk by changing to an emergency diet while they’re ill.

Your dietitian will provide detailed instructions, but the aim is to replace milk and foods containing protein with special high-sugar drinks and amino acid supplements.

If your baby can’t keep down their emergency feeds or has repeated diarrhoea, contact the metabolic team at the hospital to let them know you’re heading straight to the accident and emergency (A&E) department.

You should also be given a leaflet to bring with you in the event of an emergency in case the doctors haven’t seen MSUD before.

Once in hospital, your baby can be monitored and treated with fluids given directly into a vein (intravenous fluids).

You should also take your baby to hospital if they develop the symptoms of a metabolic crisis, such as irritability, loss of energy or breathing difficulties.

Liver transplant

A liver transplant is sometimes an option to treat MSUD. If a person with MSUD receives a donated liver, they’ll no longer be at risk of a metabolic crisis and can have a normal diet.

However, a liver transplant is a major procedure with its own risks. You will have to take medicine to suppress the immune system (immunosuppressant medication) for the rest of your life to stop your body rejecting the new liver.

It’s important to consider all the pros and cons before deciding whether or not to have a liver transplant. Your doctor will be able to discuss whether this is a suitable option.

How MSUD is inherited

The genetic change (mutation) responsible for MSUD is passed on by the parents, who usually don’t have any symptoms of the condition. This is known as autosomal recessive inheritance.

This means a baby needs to receive two copies of the altered genes to develop the condition – one from their mother and one from their father. If the baby only receives one mutated gene, they’ll just be a carrier of MSUD.

If you’re a carrier of the affected genes and you have a baby with a partner who’s also a carrier, your baby has:

a 25% chance of developing the condition

a 50% chance of being a carrier of MSUD

a 25% chance of receiving a pair of normal genes

Although it’s not possible to prevent MSUD, it’s important to let your midwife and doctor know if you have a family history of the condition. Any further children you have can be tested for the condition as soon as possible and given appropriate treatment.

You may also wish to consider genetic counselling for support, information and advice about genetic conditions.

Information about your child

If your child has MSUD, your clinical team will pass information about him or her on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).

This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time.