Tuberculin Skin Test Reactivity in Kawasaki Disease

Abstract

A strongly positive tuberculin skin reaction (> 1.5 cm2) was observed during the acute phase of the illness in 11 children with Kawasaki disease (KD), but not in control pediatric patients with other febrile infections (41 patients) or diseases similar to KD (9 patients). The cutaneous sensitivity to intermediate strength [5 tuberculin units (TU)] purified protein derivative (PPD) inoculation had completely disappeared by the second monthly checkup. Peripheral blood T lymphocytes from KD subjects proliferated vigorously and produced significant amounts of IL-2 in response to the stimulation elicited by 0.05 TU/mL of PPD. In contrast, the proliferative response of, and IL-2 release by, control T cells was within background values. Mounting laboratory evidence suggests that heat shock proteins (HSP) may be involved in the pathogenesis of KD. Our clinical and experimental data may, therefore, have been due to immunologic cross-reactivity between mycobacterial derived HSP65 and its human homologue HPS63 (self P1 antigen). Despite the low number of patients investigated, our findings suggest that the tuberculin skin test and its in vitro correlates (T cell mitogenesis and IL-2 production) could provide simple and reliable diagnostic tools for identifying atypical forms of KD, or vice versa, in subjects not vaccinated against tuberculosis.

Kawasaki disease and subsequent risk of allergic diseases: a population-based matched cohort study

“…The immune system is highly activated during KD with a myriad of immunoregulatory changes including Th1 immune related response (such as IFN-gamma, TNF-alpha, IL-1, and IL-10) [27-29] and Th2 immune related response (such as eosinophil, IL-4, IL-5 [30,31]. There is evidence that the scar from prior BCG vaccination and the tuberculin skin test becomes inflated in patients during acute KD and is a marker of Th1-mediated delayed hypersensitivity reaction [32]. Thus, if KD is indeed a strong Th1 trigger and Th1 is associated with a reduced risk of allergic diseases, we would expect that children with KD will have a lower risk of developing allergic diseases.…”

The effect of Kawasaki disease on childhood allergies – a sibling control study

“…Cytokines raised during KD include both Th1 and Th2 cytokines, such as TNF‐α, IFN‐γ, IL‐2, IL‐4 and IL‐10 (10), but clinical observation suggests that the immunological slant is in the Th1 direction. The scar from prior BCG vaccination and the tuberculin skin test (11) often becomes inflamed in patients during acute KD and is a marker of Th1‐mediated delayed hypersensitivity reaction.…”

Soluble CD30 serum antigen in Kawasaki disease

“…To the best of our knowledge, however, no investigations have ever been carried out on IL-12 production by KD T cells or other cell types of the KD immune system. Our KD serum findings may, therefore, be in some way related to immune reactions which take place at the level of the lymphoid organs under the induction of as yet unknown stimulating agents, perhaps superantigens (15) or heat shock proteins (16)(17)(18), that elicit a strong polyclonal T cell activation process.…”