Jane Burns looked through a microscope in the San Diego County medical examiner's office, analyzing autopsy samples from a series of mysterious deaths. This came from the heart of a 20-year-old young man.
The blood vessel tissue on the slide appeared abnormal. “I think this was probably one of mine,” Burns said.
Burns is an expert in a rare childhood condition called Kawasaki disease, the most common cause of acquired heart disease in children worldwide. It's also one of the biggest mysteries in pediatric medicine: No one knows what causes it.
And Burns, who directs research at the Kawasaki Disease Research Center at the University of California, San Diego, has dedicated his life to solving that mystery.
This condition, which typically occurs in children under five, is easy to miss: There is no diagnostic test and its symptoms—high fever, rash, red, cracked lips, and “strawberry tongue”—can look like fever. scarlet fever, measles or a tick-borne disease, despite its characteristic distinction of red eyes. Without proper treatment, about a quarter of patients develop coronary artery aneurysms, which can lead to heart attacks and death years later.
Burns and other scientists believe that children inherit a certain level of susceptibility from their parents and that the disease is then caused by something they breathe, whether a virus, bacteria or toxin.
To solve the mystery, Burns has created a network of detectives—an oceanographer, a statistician, a cardiologist, a historian, a forensic pathologist, a microbiologist, and an anthropologist.
“This is really a search, a puzzle, but Jane is very persistent,” said Daniel Cayan, a climatologist at the Scripps Institution of Oceanography in California, who is researching how climate variability might influence the disease.
The answers couldn't come at a better time. The rate of Kawasaki disease in Japan, where it is most rampant, is growing at an alarming rate.
In the early years of his research, the epidemiology of Kawasaki disease looked very similar to a classic infection transmitted between people. There were three major national epidemics in Japan in the late 1970s and 1980s. Each was followed by a period of stagnation, usually lasting several years.
But in the 1990s, the number of school-aged children with the disease in Japan continued to rise, despite a drop in the birth rate.
By 2000, a Burns student noticed that cases in San Diego increased every time it rained. Burns teamed up with Cayan and Japanese researchers to discover that cases in Japan rose and fell with seasonal rhythms and that, unlike person-to-person outbreaks, the level of cases was consistent across wide areas of the country.
Then Burns and his colleagues, including European climate scientist Xavier Rodó, discovered that the largest outbreaks in Japan occurred when large-scale wind currents blew from Central Asia. When those winds reached Hawaii and California, cases went up there too.
Burns and his colleagues began to argue that whatever was causing Kawasaki disease was possibly being blown around the world.
When the agent was anticipated to be in the air, the team sent a plane over Japan and took samples. With Ian Lipkin, a microbiologist at Columbia University in New York, they found a fungus called Candida. But it was an association, not a sure cause.
In 2020, a natural experiment arrived. The Covid-19 pandemic caused school closures, and Kawasaki disease among children in the US fell by 28 percent.
However, most common respiratory viruses transmitted among children almost completely disappeared, but Kawasaki disease did not—the number of children younger than 12 months with Kawasaki disease did not change much, suggesting that some exposure in homes continued to affect babies.
At the Kawasaki Disease Clinic at Rady Children's Hospital in San Diego, run by Burns, Kirsten Dummer, a pediatric cardiologist, was analyzing the CT scan of a 2-year-old boy with signs of an aneurysm on the right side of the heart.
“The biggest question for parents is: How did this happen? “How did my son come to this?” she declared.
By: Emily Baumgaertner
THE NEW YORK TIMES
BBC-NEWS-SRC: http://www.nytsyn.com/subscribed/stories/7143283, IMPORTING DATE: 2024-03-06 02:48:03
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