Kawasaki Disease: Laboratory Findings and an Immunopathogenesis on the Premise of a ""Protein Homeostasis System

Lee, Kyung-Yil; Rhim, Jung-Woo; Kang, Jin-Han

The etiology of KD still remains unknown, despite great efforts to identify the cause for nearly a half a century. The epidemiological characteristics of KD are so unique that it is difficult to find a similar model among acute infectious disease, including newly introduced infectious diseases such as retrovirus infections (acquired immunodeficiency syndrome) or conventional infectious diseases. Although many putative bacterial agents including superantigen producing bacteria, viral agents such as Epstein-Barr virus, retroviruses and coronaviruses, and other agents have been suggested, there was no proven single agent for KD. [44] [45] [46] [47] [48] [49] [50] Given the epidemiological and clinical characteristics of KD, we previously postulated that etiologic agents were variants of normal flora produced by environmental changes. 13 The microscopic structures and genomic materials between a pathogen and its related flora are nearly identical except for tiny genetic variations, and some pathogens can change to normal flora after infection in a host. It has been reported that the intestinal microflora in infants are different according to ethnic groups and environments. 51, 52 Therefore, environment factors and possibly genetic factors can affect the distribution of microflora and induce the variants of normal flora. the possibility of changing epidemiological and clinical features, including treatment response highlighting the need for enhanced surveillance.