Yersinia pseudotuberculosis infection in Kawasaki disease and its clinical characteristics.

Tomoko Horinouchi,Hiroshi Nakajima,Jun Abe,Kandai Nozu,Kazumoto Iijima,Yosuke Inaguma,Masaaki Kugo,Kiyoshi Hamahira

doi:10.1186/s12887-015-0497-2

Abstract

BackgroundThe etiology of Kawasaki disease (KD) is unknown. Reportedly, there is an association between KD and Yersinia pseudotuberculosis (YPT). Steroid therapy for KD patients with high risk of cardiac sequelae (CS) has been reported; however, the number of reports is limited.MethodsWe conducted a prospective study of 108 patients with newly diagnosed KD in one year to determine how many KD patients have positive anti-YPT antibody titers and/or positive anti-YPT-derived mitogen (YPM) antibody titers. In addition, we tried to identify clinical differences between KD patients in whom YPT infection was or not a contributing factor. We also compared clinical characteristics of patients treated with the protocol of the Randomized controlled trial to Assess Immunoglobulin plus Steroid Efficacy for Kawasaki disease (RAISE) study (RAISE group) and with the conventional Intravenous immunoglobulin (IVIG) protocol (conventional group).ResultsEleven patients (10 %) were positive for anti-YPT and/or anti-YPM antibodies (positive group) and 97 (90 %) were negative (negative group). Cardiac sequelae (CS) occurred significantly more frequently in the positive than the negative group (two patients, 18 % vs one patient, 1 %, p = 0.027). Forty patients were in the RAISE group. Two of 40 (5 %) in the RAISE group and one of 68 (1.47 %) in the conventional group had CS (p = 0.55).ConclusionsKD patients with YPT infection had CS significantly more frequently and treatment with RAISE protocol did not decrease the frequency of CS in our cohort, nor did YPT infection affect risk scores of no response to IVIG. However, our sample size was overly small to draw such conclusions. Further investigation in a larger cohort is necessary to confirm our findings. Additionally, further research is needed to determine whether early diagnosis of YPT can prevent KD from developing and reduce the incidence of CS.

Highlights

The etiology of Kawasaki disease (KD) is unknown
Acute- and convalescent-phase sera were obtained from participants, who were divided into two groups: a positive group and a negative group
We documented that 10 % of our KD patients had positive anti-Yersinia pseudotuberculosis (YPT) and/or anti-YPT-derived mitogen (YPM) antibody titers and 18 % of serologically positive patients had cardiac sequelae (CS), meaning that YPT infection is associated with a very high-risk of CS in patients with KD

Summary

Introduction

The etiology of Kawasaki disease (KD) is unknown. There is an association between KD and Yersinia pseudotuberculosis (YPT). Kawasaki disease (KD), a febrile vasculitis of unknown origin, can cause coronary artery dilation and is increasing in incidence worldwide [1,2,3]. Yersinia pseudotuberculosis (YPT), an enteric pathogen, causes a variety of clinical symptoms such as fever, rash, desquamation, strawberry tongue, lymphadenopathy, and conjunctivitis that sometimes satisfy the clinical criteria for KD. Some research groups have reported an association between YPT and KD [4,5,6,7]. Few reports concerning the relationship between KD and YPT infection are available. The present study was designed to determine how often KD patients have associated YPT infection by assessing anti-YPT and antiYPM antibody titers and to identify clinical differences between KD patients with and without YPT infection

Methods

Results

Conclusion