awasaki disease (KD) is a systemic vasculitis that primarily affects small and medium-sized arteries. 1 Transient myocardial dysfunction in children with acute KD has been reported 2,3 and moreover, myocardial inflammation, including myocarditis and microvascular damage in the myocardium, has been shown to cause aberrations in cardiac function. 4 Several recent studies have discussed the usefulness of tissue Doppler imaging (TDI) to evaluate left ventricular (LV) function. [5][6][7][8][9][10][11][12][13][14] Tissue Doppler measurement of myocardial Doppler velocity can be used to measure long-axis functions, which seem to be both more sensitive to minor disturbances in LV function and relatively preload-independent. 11,[13][14] In the present study we used TDI to evaluate disturbance of myocardial function in acute KD patients. Circulation Journal Vol.71, March 2007The plasma brain natriuretic peptide (BNP) level is associated with cardiac function in adult patients with congestive heart failure. 15,16 Although elevation of BNP has been reported in acute KD patients,17 no relation between BNP and cardiac function has been found.Reports have suggested that increased systemic oxidative stress is associated with progression of cardiovascular disease, including ischemia -reperfusion injury, atherosclerosis, and heart failure. [18][19][20][21][22][23][24] The isoprostanes are a complex family of compounds produced from arachidonic acid via a free radical-catalyzed mechanism. 18,19 The level of 8-isoprostane is used as a pathophysiological marker of lipid peroxidation. We previously reported elevation of urinary 8-isoprostane levels in acute KD patients, 25 and although the exact pathological role of increased oxidative stress in acute KD is uncertain, we believe that it is associated with oxidative injury to systemic vessels. 25 We hypothesize that this combined with disturbance of myocardial microcirculation may contribute to myocardial dysfunction in acute KD. Therefore, the purpose of the present study was to investigate the relationship between abnormal myocardial performance and plasma BNP levels, and to investigate the association between abnormal myocardial performance and enhanced oxidative stress. Background The aims of this study were to evaluate myocardial mechanics using pulsed tissue Doppler imaging (TDI), and to determine the relationship between abnormal myocardial performance and plasma brain natriuretic peptide (BNP) levels and oxidative stress in acute Kawasaki disease (KD). Methods and ResultsConsecutive TDI parameters, including peak systolic velocity (Sw) and early (Ew) and late diastolic excursion of the mitral annuli were obtained in 42 patients with KD (mean age: 2.4±0.4 years) in weeks 1, 2, and 3, and during convalescence. Plasma BNP level and urinary 8-isoprostane were also examined during the acute phase. These data were then compared with TDI profiles from 62 healthy children, plasma BNP levels in 38 controls with other febrile illnesses, and urinary 8-isoprostane levels in 13 healthy chi...
BackgroundThe etiology of Kawasaki disease (KD) remains unknown. However, many studies have suggested that specific genetic factors and/or some infectious agents underlie the onset of KD. Previous studies have suggested that human adenovirus (HAdV) is one of the triggering pathogens of KD. Here, we report monozygotic twin boys who sequentially developed KD in conjunction with acute HAdV type 3 (HAdV-3) infection.Case presentationThe patients were four-year-old monozygotic twin boys. The elder brother developed a high fever and was diagnosed with HAdV infection with an immunochromatographic kit for HAdV (IC-kit). He was transferred to our institute after persistent fever for 7 days. On admission, he already fulfilled all the diagnostic criteria for KD. His laboratory data were as follows: WBC, 9700/μl; CRP, 2.42 mg/dl; IFN-γ, 99.8 pg/ml; and TNF-α, 10.9 pg/ml. He received intravenous immunoglobulin (IVIG) and aspirin and responded well, with no coronary artery abnormalities. The younger brother, who was also IC-kit-positive, was hospitalized on the same day as his elder brother after persistent fever for 3 days. His data on admission were as follows: WBC, 12,600/μl; CRP, 5.54 mg/dl; IFN-γ, 105.0 pg/ml; and TNF-α, 33.6 pg/ml. Although he developed all of the typical KD symptoms by day 4, his fever subsided spontaneously on day 6 without IVIG or aspirin. However, he developed a dilation of the coronary artery in the region of the left circumflex artery bifurcation on day 10. His coronary artery dilation had resolved 3 months after onset. HAdV-3 DNA was detected with PCR in stool samples from both patients, and HAdV3 was isolated from the younger brother’s stool sample. Serum neutralizing antibodies to AdV3 were also significantly elevated in both patients, suggesting seroconversion.ConclusionsThere have been few reports of the simultaneous development of KD in monozygotic twins. Notably, both twins had an acute HAdV-3 infection immediately before they developed KD. These cases strongly suggest that KD was triggered by HAdV-3 infection, and they indicate that specific immune responses to some pathogens (such as HAdV-3), arising from genetic susceptibility, play a critical role in the pathogenesis of KD.
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