Advances in Kawasaki disease.
Recent studies have increased our understanding of the etiopathogenesis of Kawasaki disease (KD). The inflammatory infiltrate in KD coronary artery aneurysms has been shown to consist of CD8 T lymphocytes, macrophages, and IgA plasma cells, consistent with an immune response to an intracellular pathogen with a mucosal portal of entry. The identification of an oligoclonal IgA response in the vascular wall and the detection of a KD-associated antigen in inflamed KD tissues using a synthetic antibody derived from KD oligoclonal IgA antibodies have provided new approaches to identification of the etiologic agent. Highly effective therapy has evolved for KD, even in the absence of identification of the etiologic agent. The existence of incomplete KD cases remains a significant diagnostic dilemma for the clinician.


CONCLUSIONS
The development of a diagnostic test, more specific therapy, and ultimate prevention of this potentially fatal illness of childhood are dependent upon continued advances in determining the etiopathogenesis of this fascinating disorder.
Shulman
Stanford T
ST
Division of Infectious Diseases, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, 2300 Children's Plaza, Box 20, Chicago, IL 60614, USA. sshulman@northwestern.edu
Rowley
Anne H
AH
D006801:Humans; D009080:Mucocutaneous Lymph Node Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy