In response to the recent attention towards ‘Anime parents syndrome‘ after the mysterious death of Tsukumi’s mother in Kuragehime, I decided to provide what medical knowledge I gathered concerning this illness that, for years, been killing off our beloved anime protagonists’ parents. Please note that this is a very serious article. If you have any additional information regarding this matter, do not hesitate to share.

Introduction

For years, numerous anime parents have suffered a slow death inflicted by mysterious illness. Their death caused immeasurable negative impact to the world of anime and also to the well-being of remaining anime characters. To date, the true nature of this disease remains illusive and no curative treatment is available. Recently, in an attempt to create universal understanding, the author have named this illness ‘Anime parents syndrome (APS)‘ and have briefly mentioned this disease in the common health problem article.

Definition

Anime parents syndrome (APS) is the chronic idiopathic and usually fatal illness defined by prolonged generalized fatigue and wasting of anime character who is the parent of the anime’s main character.

Epidemiology

APS is apparently one of the most common cause of death among anime characters next only to trauma/accident. Its prevalence is highest in female of reproductive age. All of whom already have children. Male characters are rarely affected. APS shows ethnic predominance among Asian population. There have been sporadic cases of APS inflicting more than one generation of characters which raises the possibility of underlying genetic association.

Etiology

The true cause of APS is unknown. Nevertheless, since APS is the illness of anime parents, there are some speculation regarding the association of pregnancy and this disease. Genetic cause remains a possibility but no solid evidence is yet to be found.

Clinical manifestations

Although fatigue and physical wasting are the staple of APS manifestation, patient with APS may present with extremely wide range of signs and symptoms which are mostly non-specific. The most common manifestations are listed below.

Symptoms: fatigue, malaise, nausea, vomiting, loss of appetite, chills, cough with or without bloody sputum, difficulty of breathing, exercise intolerance, fainting, weight loss, pallor, muscle pain, weakness of limbs, headache, abdominal pain, chest pain and many others

Signs:

pale skin

dark patch around the eyes

muscle atrophy or wasting most prominent in cheeks and eye sockets

epistaxis (nosebleed)

messy or tangled hair

tremors of hands on motion

weakness prominent in lower extremities resulting in walking difficulty

seizure

depressive mood, delirium or delusion

cognitive impairment, amnesia

Diagnosis and differential diagnosis

No diagnostic criteria has been set up. Diagnosis depends heavily on the doctor’s judgment and exclusion of other treatable disease must be made before diagnosis of APS. The differential diagnosis includes other systemic diseases that may manifest with similar non-specific signs and symptoms which includes chronic infectious disease such as human immunodeficiency virus(HIV) infection, Tuberculosis and other atypical bacterial or protozoan infections; malignancy common in young adult to adult population such as leukemia or lymphoma; autoimmune disorder such as systemic lupus erythematosus (SLE).

Investigation

No diagnostic test specific for APS is available. The investigation mainly aims for excluding other treatable diseases which may mimic the clinical picture of APS.

Treatment

Currently, no definite medical or surgical treatment proves to be able to slow or stop the progression of APS. The general management is mostly supportive and symptomatic. Oxygen supplement should be provided if the patient is dyspnic or develops oxygen desaturation. Blood transfusion is indicated for patient suffering from severe anemia or having anemic symptoms. Adequate pain control is advised. There are some reports suggesting that psychological support from the patient’s close relatives provide temporary improvement of symptoms. Nevertheless, a visit from a long loss love or children of the patient may lead to sudden deterioration of symptom resulting in extremely swift death.

Prevention

Since the etiology of APS is still unknown, no effective vaccination or secondary prevention is available. The only way to avoid this disease is to refrain from having any children. This method is highly recommended in high risk population.

Take home message: If you are a woman and your children are the main characters of the anime, you will die soon or you are already dead and this is all flashback scene.

Author’s note: the content of this article can be altered if new information regarding APS emerges.