Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan.
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.
Institució Catalana de Recerca i Estudis Avançats, 08010 Barcelona, Catalonia, Spain;Unitat de Dinàmica i Impacte Climàtic (UDIC), Institut Català de Ciències del Clima, 08005 Barcelona, Catalonia, Spain; xavier.rodo@ic3.cat.
Xavier
X
Rodó
Unitat de Dinàmica i Impacte Climàtic (UDIC), Institut Català de Ciències del Clima, 08005 Barcelona, Catalonia, Spain;
Roger
R
Curcoll
Unitat de Dinàmica i Impacte Climàtic (UDIC), Institut Català de Ciències del Clima, 08005 Barcelona, Catalonia, Spain;
Marguerite
M
Robinson
Unitat de Dinàmica i Impacte Climàtic (UDIC), Institut Català de Ciències del Clima, 08005 Barcelona, Catalonia, Spain;Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA 91125;
Joan
J
Ballester
Department of Pediatrics, Rady Children's Hospital-San Diego and University of California, San Diego, La Jolla, CA 92093;
Jane C
JC
Burns
Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA 92037;US Geological Survey, La Jolla, CA 92037;
Daniel R
DR
Cayan
Center for Infection and Immunity, Mailman School of Public Health of Columbia University, New York, NY 10032;
W Ian
WI
Lipkin
Center for Infection and Immunity, Mailman School of Public Health of Columbia University, New York, NY 10032;
Brent L
BL
Williams
Center for Infection and Immunity, Mailman School of Public Health of Columbia University, New York, NY 10032;
Mara
M
Couto-Rodriguez
Department of Public Health, Jichi Medical Hospital, Togichi 108-8639, Japan; and.
Yosikazu
Y
Nakamura
Department of Public Health, Jichi Medical Hospital, Togichi 108-8639, Japan; and.
Ritei
R
Uehara
Center for Global Environmental Research, National Institute for Environmental Studies, Tsukuba 305-8506, Japan.
Hiroshi
H
Tanimoto
Unitat de Dinàmica i Impacte Climàtic (UDIC), Institut Català de Ciències del Clima, 08005 Barcelona, Catalonia, Spain;
Josep-Anton
JA
Morguí
D000383:Agriculture; D000941:Antigens / Q000235:genetics / Q000633:toxicity*; D000946:Antigens, Fungal / Q000235:genetics / Q000633:toxicity; D001230:Aspergillus / Q000235:genetics; D002175:Candida / Q000235:genetics; D002681:China / Q000453:epidemiology; D002523:Edible Grain / Q000633:toxicity*; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D058872:Epidemics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D015233:Models, Statistical; D009080:Mucocutaneous Lymph Node Syndrome / Q000453:epidemiology* / Q000209:etiology*; D012337:RNA, Ribosomal, 18S / Q000235:genetics; D014657:Vasculitis / Q000453:epidemiology / Q000209:etiology; D014919:Wind
D000941:Antigens; D000946:Antigens, Fungal; D012337:RNA, Ribosomal, 18S
FLEXPART; agriculture; cereal croplands; heart disease; northeastern China source