Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan
Authors: Daniel R Cayan
Joan Ballester
Yosikazu Nakamura
Jane C Burns
Brent L Williams
W Ian Lipkin
Xavier Rodó
Roger Curcoll
Hiroshi Tanimoto
Josep-Anton Morguí
Ritei Uehara
Marguerite Robinson
Mara Couto-Rodriguez
Journal: Proceedings of the National Academy of Sciences of the United States of America (2014)
Discipline: Multidisciplinary
Keywords: FLEXPART; agriculture; cereal croplands; heart disease; northeastern China source.
Affiliations: 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; ., Unitat de Dinàmica i Impacte Climàtic (UDIC), Institut Català de Ciències del Clima, 08005 Barcelona, Catalonia, Spain;, 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;, Department of Pediatrics, Rady Children's Hospital-San Diego and University of California, San Diego, La Jolla, CA 92093;, Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA 92037;US Geological Survey, La Jolla, CA 92037;, Center for Infection and Immunity, Mailman School of Public Health of Columbia University, New York, NY 10032;, Department of Public Health, Jichi Medical Hospital, Togichi 108-8639, Japan; and., Center for Global Environmental Research, National Institute for Environmental Studies, Tsukuba 305-8506, Japan.

Abstract:  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 (&lt;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. 

Retracted: No

PubPeer comments:
 I understand that seven years might seem somewhat long time to comment, but I saw your article while searching for the information to compare my results from my last project. The authors wrote in M M that they also performed microbiome analysis with pan-bacterial primers, but I could not find in the article any information pertaining to bacteriobiome in the studied samples? What happened with it? As for the surface air mycobiome, to me it seems extremely strange, erroneous and unrealistic that it consisted solely of one fungus. Are you sure about this results? What about your reviewers? Did they comment on this finding? What about your academic editor Mark H. Thiemens? I am very curious about his comments, if any, on the issue, as well as your response, if any. He was a  prearranged editor , as the pdf file of your article specifies. ,