Post infection, 97–99% of KD patients are immune to the agent, protected against recurrence.

IVIG may include antibody against the agent. Antigen-specific IgA plasma cells and CD8 T cells respond but coronaries can be damaged. The agent persists in inclusion bodies, with intermittent respiratory shedding, entering the bloodstream via macrophages targeting coronaries.

Thus, we propose an unidentified (“new”) RNA virus infects bronchial epithelium usually causing asymptomatic infection but KD in a subset of genetically predisposed children. Recent availability of “second generation” antibodies from KD peripheral blood plasmablasts may identify a specific viral antigen. Cytoplasmic inclusion bodies in ciliated bronchial epithelium identified by monoclonal antibodies made from oligoclonal IgA heavy chains also supports a viral etiology. CD8 T cells, oligoclonal IgA, and upregulation of cytotoxic T cell and interferon pathway genes in the coronaries in fatal KD also support a viral etiology. We hypothesize KD pathogenesis involves an RNA virus that usually causes asymptomatic infection but KD in a subset of genetically predisposed children. The primarily winter-spring KD seasonality and well-documented Japanese epidemics with wave-like spread also support an infectious trigger. The age distribution of KD, highest in children < 2 yo, lower in those < 6 months, is compatible with infection by a ubiquitous agent resulting in increasing immunity with age and with transplacental immunity, as with some classic viruses. In Hawaii, KD rates are 20-fold higher in Japanese ethnics than in Caucasians, intermediate in other ethnicities. KD is worldwide, most prominently in Japan, Korea, and Taiwan, reflecting increased genetic susceptibility among Asian populations. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesĮpidemiologic and clinical features of Kawasaki Disease (KD) strongly support an infectious etiology. Department of Pediatrics, Northwestern University Feinberg School of Medicine, The Ann & Robert H.

Kd max response