Iden­ti­fied syn­drome now linked to COVID-19

TOMISAKU KAWASAKI 1925-2020

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Tomisaku Kawasaki, who has died aged 95, was a Ja­panese physi­cian who gave his name to a rare in­flam­ma­tory dis­or­der that tends to oc­cur in young peo­ple — and that has symp­toms strik­ingly sim­i­lar to those ob­served in some chil­dren who test pos­i­tive for COVID-19.

Kawasaki did not in­tend for the ill­ness he iden­ti­fied in 1961 to bear his name.

Out­ward symp­toms in­clude a pro­longed high fever, a patchy all-over rash, blood­shot eyes and a straw­berry-red tongue. These oc­cur pre­dom­i­nantly in chil­dren un­der the age of five, and tend to re­solve them­selves within a few weeks. How­ever, sub­se­quent re­search has sug­gested that cor­rect di­ag­no­sis and early treat­ment are cru­cial in or­der to re­duce the risk of more se­ri­ous com­pli­ca­tions, in­clud­ing po­ten­tially fa­tal heart dam­age.

The treat­ment pro­to­col for KD, which cured most pa­tients and re­duced the risk of long-term car­diac prob­lems from 20 per cent to two per cent, was de­vised amid an in­ter­na­tional re­sponse to an English-lan­guage ver­sion of Kawasaki’s find­ings pub­lished in 1974.

Cases were soon found out­side Ja­pan, prompt­ing a slew of the­o­ries as to the syn­drome’s un­der­ly­ing cause. At one time a type of car­pet sham­poo was — wrongly — held re­spon­si­ble; at an­other, the cause was thought to be vi­ral or bac­te­rial. What was not in dis­pute was the im­por­tance of that orig­i­nal pa­per.

Grate­ful par­ents whose chil­dren had been suc­cess­fully treated for KD would be­siege Kawasaki at med­i­cal con­fer­ences, ask­ing him for au­to­graphs.

Kawasaki went on to found a dis­ease re­search cen­tre in Tokyo, serv­ing first as its chair­man and then hon­orary chair­man. The Ja­pan Kawasaki Dis­ease Re­search Cen­tre has re­ceived re­newed at­ten­tion in light of the pan­demic.

Ten­ta­tive find­ings pub­lished in the past few months sug­gest that chil­dren who test pos­i­tive for COVID-19 may de­velop a dis­or­der — “multi-sys­tem in­flam­ma­tory syn­drome of chil­dren,” or MIS-C — af­fect­ing their blood ves­sels. The symp­toms closely mir­ror Kawasaki dis­ease, though as with KD there is as yet no spe­cific di­ag­nos­tic test for MIS-C.

Tomisaku Kawasaki was born into an im­pov­er­ished fam­ily in Tokyo on Feb. 7, 1925. He turned to medicine at his mother’s sug­ges­tion, grad­u­at­ing from the in­sti­tu­tion now known as Chiba Univer­sity. In 1950 he be­gan work at Tokyo’s Ja­pan Red Cross Med­i­cal Cen­tre.

In later life, Kawasaki would stress the im­por­tance of care­ful and steady labour. Though he treated his first pa­tient show­ing symp­toms of KD in 1961, it took years — dur­ing which time he doc­u­mented 50 sim­i­lar cases — be­fore he had a med­i­cal ar­ti­cle that would hold up to public scru­tiny.

Tomisaku Kawasaki’s wife died in 2019.

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