Kawasaki disease with a concomitant primary Epstein - Barr virus infection

Abstract

Background: Kwasaki disease (KD) is the leading cause of acquired heart disease in children in most developed countries. The cause of KD remains unknown. The presumed theory is that KD occurs due to one or more infectious agents who evoke an abnormal immunological response in susceptible individuals. Epstein-Barr virus (EBV) infection has been considered as a suspected causative agent because of the potential effect on the immune system. Case presentation: A previously healthy 19 month old boy presented with a 6 day history of fever accompanied by a diffuse macular erythematous rash that appeared 1 day after. The physical examination on admission revealed bilateral non-suppurative conjunctivitis, dry fissured and injected lips without "strawberry" tongue, diffuse macular rash on the trunk, face and limbs, swelling of the hands and feet, and right cervical lymphadenopathy (2 cm in diameter). Following fulfillment of all the clinical criteria, the diagnosis of KD was made and treatment with IVIG 2 g/Kg was administered along with oral aspirin (80 mg/ kg/day). However, despite the treatment, he remained febrile for an additional 2 days with persistent clinical manifestations. Therefore, he received a second 2 g/kg IVIG course with a favorable response. On the 14th day of illness the patient became febrile again and was readmitted. Blood examinations revealed remarkable leukocytosis up to 35.7 X 10 9 /L with 87.3% lymphocytes and the blood smear revealed atypical lymphocytes and monocytes. The liver enzymes were elevated. The serology for infectious mononucleosis from his first admission revealed: IgM CMV (+), IgG CMV (−); IgM VCA EBV (+) IgG VCA EBV (−), IgG EBNA (−). To confirm infectious mononucleosis following the administration of 2 doses of IVIG, serum EBV PCR was performed and was positive (1.6X 10 3 cp/ml). Conclusions: We describe here a case of KD with a concomitant primary EBV infection. To the best of our knowledge, this is the first case in western country that describes KD with acute EBV infection as confirmed by PCR. The case we described stands as a contribution in favor of the possible role of EBV in the development of KD.

Utilizing single-cell RNA sequencing for analyzing the characteristics of PBMC in patients with Kawasaki disease

“…It has been associated with a variety of infectious diseases and involved in the removal of virus such as varicella zoster and Epstein-Barr virus (EBV). One case report demonstrated that EBV infection could be considered as a suspected causative agent because of the potential effect on the immune system in KD [ 27 ]. GZMB represents a serine proteinase and plays a central role in killing human tumor cell lines, which can induce cell death, apoptosis [ 28 ].…”

Myocardial damage in multisystem inflammatory syndrome associated with COVID-19 in children and adolescents

“…However, both viruses could be associated with KD in children under the age of 5, because most adolescents and adults have developed protective immunity on EBV and CMV. [ 10 11 12 ] In addition, HIV is the most frequently reported infectious disease associated with KD in adults' rare cases. [ 12 ] Although MIS-C has overlapping features with KD, our patients with MIS-C were adolescents with frequent gastrointestinal and cardiovascular symptoms.…”

Features of Epstain – Barr Virus Infection in Children

“…Более 80% случаев заболевания приходится на возраст от 6 месяцев до 4 лет. Низкая частота БК в течение первых 6 месяцев свидетельствует об иммунитете, обусловленном материнскими антителами [25]. Инфекционные агенты, которые связаны с БК, включают такие бактерии, как Propionibacterium, Staphylococcus aureus, Streptococcus pyogenes и Chlamydia, а также вирусы, такие как ВЭБ, парвовирус В19, ретровирус и другие.…”

“…Инфекционные агенты, которые связаны с БК, включают такие бактерии, как Propionibacterium, Staphylococcus aureus, Streptococcus pyogenes и Chlamydia, а также вирусы, такие как ВЭБ, парвовирус В19, ретровирус и другие. Генетическая значимость в патогенезе БК подчеркивается тем фактом, что существует более высокий риск у детей из Северо-Восточной Азии, братьев, сестер и детей, переболевших БК в анамнезе [25]. Одна из теорий предполагает, что инфекционные агенты вызывают неадекватный иммунологический ответ на антиген у генетически восприимчивых индивидуумов [25].…”