Finding the Cause of Kawasaki Disease: A Pediatric Infectious Diseases Research Priority

though intravenous gammaglobulin (IVIG) with aspirin is effective therapy for most children with acute KD, its mechanism of action is unknown, and some children do not respond. In the present era of sophisticated medicine, this conversation, with all its unknowns, is very unsettling both to me and to the family. In addition, when I diagnose acute KD in a child during the first week of fever and promptly administer IVIG and aspirin therapy but the child fails to respond and coronary aneurysms develop and worsen despite additional therapies, I ponder the sobering reality that even those of us who have devoted a great deal of our careers to the study of KD cannot always stop this process. All of this leads directly to the question: what is the cause of this disease? Finding the cause of KD is a pediatric infectious diseases research priority. Identification of the causative agent(s) would be the most promising step toward developing a diagnostic test and specific therapy and, ultimately, preventing the disease. Therefore, a study by Esper et al. [1] from Yale, published in the Journal of Infectious Diseases in February 2005, that implicated an association between the new human coronavirus (HCoV) NL-63 and KD, was met with great interest. Those investigators reported detection of the virus in respiratory samples from 8 of 11 patients with KD and 1 of 22 control subjects by reverse transcription-polymerase chain reaction (RT-PCR). As a result of that article, laboratories around the world performed additional studies to determine whether an association between KD and HCoV NL-63 could be confirmed. This