ArticleProceedings of the National Academy of Sciences of the United States of America2014
Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers, 4 of them syntheses that pooled it.
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Who cites it
97 citing papers in PubMed, 4 syntheses or guidelines pooled it, 208 citations in OpenAlex.
- Guideline for the diagnosis and treatment of incomplete Kawasaki disease in children in China.BMC pediatrics · 2024Guideline
- Association of ITPKC gene polymorphisms rs28493229 and rs2290692 in North Indian children with Kawasaki disease.Pediatric research · 2022Pooled it
- MicroRNAs in Kawasaki disease: An update on diagnosis, therapy and monitoring.Frontiers in immunology · 2022Pooled it
- A Comprehensive Update on Kawasaki Disease Vasculitis and Myocarditis.Current rheumatology reports · 2020Pooled it
- Etiology Model of Kawasaki Disease and Multisystem Inflammatory Syndromes: Mast Cell Activation.Current issues in molecular biology · 2026Article
- Prenatal and postnatal risk factors associated with Kawasaki disease up to 3 years of age.Scientific reports · 2026Article
- Potential alternatives in treatment of kawasaki disease to reduce the extremely rare risk of reye syndrome.Frontiers in pediatrics · 2026Review
- Kawasaki disease and outdoor environmental stressors: a scoping review.The Lancet regional health. Western Pacific · 2026Review
- Potential Mechanisms and Hypotheses for Pathogenic Microorganisms Triggering Kawasaki Disease.Clinical reviews in allergy & immunology · 2025Review
- Swedish Nationwide Study Found That Prematurity Was Associated With Kawasaki Disease.Acta paediatrica (Oslo, Norway : 1992) · 2025Article
- Associations of infection burden with Kawasaki disease in a population-based setting during 30 years.RMD open · 2025Article
- Multisystem inflammatory syndrome in children and Kawasaki disease.Frontiers in immunology · 2025Review
- Spatiotemporal analysis of the association between Kawasaki disease incidence and PMBMJ paediatrics open · 2024Article
- Microbial richness and air chemistry in aerosols above the PBL confirm 2,000-km long-distance transport of potential human pathogens.Proceedings of the National Academy of Sciences of the United States of America · 2024Article
- The etiologies of Kawasaki disease.The Journal of clinical investigation · 2024Review
- Age-Dependent Variations in Kawasaki Disease Incidence in Japan.JAMA network open · 2024Article
- Incidence and seasonality of Kawasaki disease in children in the Philippines, and its association with ambient air temperature.Frontiers in pediatrics · 2024Article
- Giant coronary aneurysm in a toddler with Kawasaki disease: technical challenges in CT coronary angiography.BJR case reports · 2024Article
- Preliminary Evidence of the Differential Expression of Human Endogenous Retroviruses in Kawasaki Disease and SARS-CoV-2-Associated Multisystem Inflammatory Syndrome in Children.International journal of molecular sciences · 2023Article
- Kawasaki disease and the environment: an enigmatic interplay.Frontiers in immunology · 2023Review
37 more citing papers are in PubMed but not listed here.
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Authors and funding
13 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
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 (1987-2010) 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.
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