Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan

Abstract

Evidence indicates that the densely cultivated region of northeastern China acts as a source for the wind-borne agent of Kawasaki disease (KD). KD is an acute, coronary artery vasculitis of young children, and still a medical mystery after more than 40 y. We used residence times from simulations with the flexible particle dispersion model to pinpoint the source region for KD. Simulations were generated from locations spanning Japan from days with either high or low KD incidence. The postepidemic interval and the extreme epidemics (1979, 1982, and 1986) pointed to the same source region. Results suggest a very short incubation period (<24 h) from exposure, thus making an infectious agent unlikely. Sampling campaigns over Japan during the KD season detected major differences in the microbiota of the tropospheric aerosols compared with ground aerosols, with the unexpected finding of the Candida species as the dominant fungus from aloft samples (54% of all fungal strains). These results, consistent with the Candida animal model for KD, provide support for the concept and feasibility of a windborne pathogen. A fungal toxin could be pursued as a possible etiologic agent of KD, consistent with an agricultural source, a short incubation time and synchronized outbreaks. Our study suggests that the causative agent of KD is a preformed toxin or environmental agent rather than an organism requiring replication. We propose a new paradigm whereby an idiosyncratic immune response, influenced by host genetics triggered by an environmental exposure carried on winds, results in the clinical syndrome known as acute KD.northeastern China source | agriculture | heart disease | FLEXPART | cereal croplands

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

“…47 Epidemiological analyses have correlated the incidence of KD cases in Japan, Hawaii, and San Diego with tropospheric wind currents originating in northeastern China, which suggests that a wind-borne agent could trigger the illness. 48,49 The case fatality rate in KD in Japan is 0.015% (4 deaths in 26 691 patients from 2011 to 2012). 22,50 The standardized mortality ratio (SMR; the observed number of deaths divided by the expected number of deaths based on vital statistics in Japan) in patients diagnosed between 1982 and 1992 was higher than normal only for males with coronary artery aneurysms (SMR, 2.55; 95% confidence interval, 1.…”

The epidemiology of Kawasaki disease: a global update

“…It is suggested that this putative trigger is blown to various geographical regions of the world in the troposphere and by entering the upper respiratory tract results in KD. Air-sampling of the troposphere has shown a high density of spores from Candida albicans ,36 although whether this is necessary or sufficient to cause KD is unclear. Interestingly a C. albicans cell wall extract is used as a stimulus in some animal models of KD.…”

Association of Kawasaki disease with tropospheric winds in Central Chile: Is wind-borne desert dust a risk factor?

“…When air trajectories change -wind blowing to Japan from the southern ocean -KD incidence rates show a strong decrease there. Further research by this group has suggested that tropospheric winds from northeastern China carry a putative etiologic agent of KD to Japan (Rodo et al, 2014). These authors have postulated the hypothesis of a wind-borne aerosolized infectious agent, possibly a fungus of the Candida species, as a potential etiology of KD.…”