Discussion

Kawasaki disease signs include a fever that lasts for at least 5 days, different types of skin rashes, swollen lymph nodes in the neck, redness of the conjunctiva that is not pus-filled, and changes in the lips, mouth, and limbs. To be diagnosed with complete Kawasaki disease, the person must have a fever and at least four of the other five signs listed above. Facial nerve palsy is a nerve problem that can happen after Kawasaki disease. The facial nerve palsy’s exact rate with Kawasaki disease has not been found yet. In the academic literature, there have been 41 full reports of cases. The majority of the patients (86.1%) were under 18 months of age, with 63.9% of these instances being under 12 months. The average amount of time that facial paralysis lasts in these cases is 16 days. A mix of vascular ischaemia, vasculitis, and immune processes that hurt the facial nerve can lead to facial nerve palsy. ^{Reference Yu, Liu, Wang, Lu, Wang and Sun5}

Mastrangelo et al. did a full study in 2019 of all the clinical and test data of babies with Kawasaki disease younger than 12 months old. The study found that people who were hurt often only showed some signs of being sick. Also, having Kawasaki disease as a baby makes you more likely to have heart problems as an adult. This is the case for about 60% of kids who have both full and partial Kawasaki disease diagnoses. ^{Reference Mastrangelo, Cimaz and Calabri6} For about half of the cases, coronary artery aneurysms are present, and most of them show only partial signs of Kawasaki disease. ^{Reference Mastrangelo, Cimaz and Calabri6} In a similar way, Salgado’s study showed that babies younger than 6 months had a much higher rate of dilated or aneurysmal coronary arteries (43.4%) than babies older than 6 months (19.5%), despite initiating medication during the initial 10 days of fever onset. ^{Reference Salgado, Ashouri and Berry7}

East Asia has the highest rates of Kawasaki disease. In Japan, Taiwan, and Korea between 67.3 and 243.1 out of every 100,000 children aged under 5 years get the disease every year. ^{Reference Uehara and Belay8} Children of East Asian descent have a significantly higher likelihood, ranging from 10 to 20 times, of developing Kawasaki disease compared to children of other racial backgrounds, even if they live in the West. The rates of Kawasaki disease are much lower in North America and Europe (4.9 to 26.2 per 100,000).

A lot of people in Indonesia do not know they have this disease because health workers are not used to finding it. At the 8^th International Kawasaki Disease Symposium in San Diego, USA, in 2005, Advani et al. presented the first group of cases of Kawasaki disease from Indonesia. Indonesia has been added to the World Kawasaki Disease Map since then. Based on estimates of the rates of occurrence in different countries, it is thought that at least 5,000 new cases happen every year in Indonesia. The rate is thought to be 20 per 100,000 non-Chinese-Indonesian children aged under 5 per year, and 50 per 100,000 Chinese-Indonesian children aged under 5 per year. There are 5,000 new cases a year, but only about 100 to 200 are found and handled. That is only about 2 to 4 percent. This means that more than 95% of people in Indonesia who have Kawasaki disease have not been identified. ^{Reference Advani, Sukardi, Satroasmoro, Lukito and Liando10}

The 4 month old child has been diagnosed with incomplete Kawasaki disease after suffering from a fever for more than five consecutive days. One week later, erythematous patches appeared all over the body, along with bilateral conjunctival injection and desquamation on the patient’s hands and feet. The diagnosis was confirmed by laboratory tests and additional examinations, which included leukocytosis, thrombocytosis, and elevated inflammation markers. Echocardiographic evaluations revealed coronary artery dilation, which is indicative of a coronary artery aneurysm, and the child also had facial nerve palsy.

Facial nerve palsy may indicate a substantial level of inflammation, which leads to a high incidence of coronary artery aneurysms. ^{Reference Stowe11} Over 50% of the individuals diagnosed with facial nerve palsy, as recorded by Poon, acquired coronary artery aneurysms. ^{Reference Poon, Lun and Ng12} Z scores enable the assessment of the extent of coronary artery dilatation by facilitating comparisons across different populations and time periods, while taking into account body surface area. ^{Reference McCrindle, Rowley and Newburger13} The latest suggestions propose a classification scheme for Kawasaki disease that relies exclusively on Z scores. Coronary artery aneurysms are classified as small if their Z scores range from 2.5 to less than 5. Medium-sized coronary artery aneurysms have a Z score range of 5 to less than 10. Coronary artery aneurysms are considered large or giant if their Z values exceed 10 or their diameter exceeds 8 mm. ^{Reference McCrindle, Rowley and Newburger13}

Several ideas have been put forward about how facial nerve palsy in Kawasaki disease affects the body’s functions. Ischaemic vasculitis probably causes facial nerve palsy. This condition affects the arteries that feed the facial nerve and also causes inflammation in the nerve itself. ^{Reference Stowe11,Reference Bushara, Wilson and Rust14,Reference Zhang, Hao, Zhang, Yang, Li and Liang15} It is thought that intravenous immunoglobulin’s reported positive effect on facial nerve palsy is because it can change the production and release of cytokines that cause inflammation. ^{Reference Burns and Franco16} A new study found that facial nerve palsy was found in 44.4% of patients, even when intravenous immunoglobulin was given. ^{Reference Chen, Liu, Hu, Xu and Deng17} It looks like the facial nerve palsy might go away faster if intravenous immunoglobulin is used as part of a faster treatment intervention. It is important to keep in mind, though, that this treatment method does not have the power to lower the increased inflammatory process seen in the individuals. ^{Reference Poon, Lun and Ng12}

The present course of therapy strategy Kawasaki disease involves administering a high dose of intravenous immunoglobulin (2 g per kg) within the initial decennary following the commencement of the illness. Aside from intravenous immunoglobulin, the American Heart Association recommends administering high-dose aspirin. ^{Reference Salgado, Ashouri and Berry7} A good number of people get better quickly with intravenous immunoglobulin therapy. It is important to note, though, that between 10 and 20% of patients have a poor reaction or get a fever again within 36 to 48 hours of intravenous immunoglobulin administration. Many times, a second dose of intravenous immunoglobulin is suggested, especially for people who have shown some improvement. Additionally, antibiotics and Warfarin should be used when large aneurysms are found. There are two numbers in the text: 2 and 7. Infliximab, a tumour necrosis factor-alpha inhibitor, cyclosporine, a calcineurin inhibitor, and statins are some of the second-line medicines. But more study is needed to find out how well they work. The given text has a number range, or more accurately an interval. ^{Reference Poon, Lun and Ng12}