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Kawasaki disease (KD) is an acute systemic vasculitis syndrome of infants and young children. Although its etiology is largely unknown, epidemiological findings suggest that genetic factors play a role in the pathogenesis of KD. To identify genetic factors, affected sib-pair analysis has been performed. One of the identified peaks was located on the Xq26 region. A recent report of elevated expression of CD40 ligand (CD40L), which maps to Xq26, during the acute-phase KD, and its relationship to the development of coronary artery lesions (CAL) prompted us to screen for polymorphism of CD40L and to study the association of the gene to KD. A newly identified SNP in intron 4 (IVS4 þ 121 A4G) is marginally overrepresented in KD patients as compared to controls (109/602, 18.1 vs 111/737, 15.1%). When male KD patients with CAL were analyzed as a patient group, the SNP was significantly more frequent than in controls (15/58, 25.9%, vs 111/737, 15.1%, OR ¼ 2.0, 95% CI ¼ 1.07 -3.66; P ¼ 0.030). Interestingly, this variation was extremely rare in a control Caucasian population (1/145, 0.7%). Our results suggest a role of CD40L in the pathogenesis of CAL and might explain the excess of males affected with KD.

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Out of 175 pneumococcal isolates from middle ear fluids, 26.3% were penicillin-resistant S. pneumoniae (PRSP). Serotypes 19F and 23F occurred most frequently among PRSP strains. The 7-valent pneumococcal conjugate vaccine (PCV) showed better coverage of PRSP strains (87.0%). The 7-valent PCV may reduce the prevalence of PRSP in Japan.Acute otitis media (AOM) is one of the leading infectious diseases caused by Streptococcus pneumoniae (3, 9). In recent decades, penicillin-resistant S. pneumoniae (PRSP) has evolved into a global problem, especially with AOM (7,12,18,21). The 7-valent pneumococcal conjugate vaccine (PCV) introduced in the United States and Europe has reduced the incidences of invasive pneumococcal disease and AOM (8,13,17,25,26). Nasopharyngeal carriage and transmission in children were also reduced (24). However, in Japan, use of the 7-valent PCV has not yet been licensed, and little is known about the distribution of pneumococcal serotypes. Prior to the introduction of 7-valent PCV in Japan, it is important to determine the distribution of pneumococcal serotypes in Japan as well as the prevalence of antimicrobial-resistant pneumococci associated with AOM. In this study, we evaluated the distribution of pneumococcal serotypes among children with AOM and determined the serotype coverage of pneumococcal vaccine formulas in Japan.(This paper was presented at the 108th General Meeting of the American Society for Microbiology, Boston, MA, 1 to 5 June 2008.)One hundred seventy-five pneumococcal isolates were collected randomly from middle ear fluids of 175 children with AOM at outpatient clinics in different regions of Japan during nationwide surveillance from February 2006 to June 2007. The range and quartiles of the ages of the subjects were 1 to 127, 12.8 (25th percentile), 17.0 (median), and 42.3 (75th percentile) months. Susceptibilities to penicillin G (PCG) were tested, and breakpoints were defined according to the Clinical and Laboratory Standards Institute (CLSI) (6). All isolates were serotyped or serogrouped by the capsular quelling method with pneumococcal capsule-specific antisera (Statens Serum Institut, Copenhagen, Denmark) as recommended by the manufacturer. The chi-square test and Fisher's exact test were used for categorical variables to test for significant differences between groups with Prism 4 (GraphPad Software, Inc.). A P value of Ͻ0.05 was considered statistically significant.Out of 175 pneumococcal isolates, 63 (36.0%), 66 (37.7%), and 46 (26.3%) were penicillin-susceptible S. pneumoniae (PSSP), penicillin-intermediate-resistant S. pneumoniae (PISP), and PRSP, respectively (Table 1). The predominant serotype was 19F (19.4%), followed by 23F (14.9%), 14 (11.4%), 6B (11.4%), 6A (9.1%), and 3 (9.1%). The distribution of S. pneumoniae serotypes among PCGsusceptible strains was significantly different from that among PCG-resistant strains (P Ͻ 0.01). Serotype 3 was the most prevalent PSSP serotype (odds ratio [OR], 78.2; 95% confidence interval [CI], 4.6 to 1,330; P Ͻ 0.01), while s...

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