Kawasaki Disease: The Debate Continues Till Date

Abstract

Tomisaku Kawasaki, a pediatrician saw a 4 years old child in 1961 with features of an unknown disease later known as Kawasaki disease (KD) in his honor. He presented his findings in a clinical conference at the Red Cross Hospital in Hiroo, Tokyo. A year later he came across yet another child with similar presentation. In the following years he happened to see about 50 more such patients. He published his findings in 1967 in a local medical journal in Japanese language [1]. The English version of the disease was published only in 1974 [2]. Despite the disease having been reported from almost all parts of the world ever since 1970s and the extensive advancement in the medical field, the debate on the etiology, clinical presentation, epidemiology and treatment of KD continues till date. KD is an acute febrile illness with multi organ vasculitis primarily affecting infants and young children under 5 years of age. It is also known as Mucocutaneous Lymph Node Syndrome (MLNS), infantile vasculitis, Kawasaki syndrome and immune vasculitis. Usually small to medium sized blood vessels are affected in KD. The male children are affected one and a half times more than female ones. The disease also sometimes affects children over 5 years of age and is rarely encountered in adults. Most of the patients are of Japanese and pacific islanders origin and is reported more often from developed world including USA in particular. The disease has now been increasingly reported from all over the world including the developing countries [3-8]. It may have some seasonal variations. Genetic constitution may be responsible for increased susceptibility in some patients. Clinical features and epidemiological findings suggest that KD may be caused by an infectious agent. Various agents like rug shampoo, bacteria, viruses, parasites, fungi and their super antigens have been incriminated in the pathogenesis of the disease. Recently a number of reports associate the streptococci with the KD [9-12]. A more recent report concludes that our knowledge of the infectious agent (s) involved and the genetic characteristics of susceptible children remain only partial [13].