Clinical and epidemiologic features of Kawasaki disease strongly sugge
st an infectious etiology, but conventional as well as highly sophisti
cated studies have failed to date to identify one or more causative ag
ents. As with other vasculitides, the pathogenesis of Kawasaki disease
is not clearly defined although immunopathologic mechanisms clearly a
re involved. Marked alterations in T-cells, B-cells, and monocytes/mac
rophages occur in acute Kawasaki disease and indicate generalized immu
ne activation. In addition, coronary arterial endothelial cells are ac
tivated in the acute stage of Kawasaki disease. Future efforts will be
directed towards improved understanding of the interrelationships of
these observed immune aberrations and to the identification of one or
more infectious triggers of the disease process. (C) 1997 Elsevier Sci
ence Ireland Ltd.