Yersinia pseudotuberculosis infection in Kawasaki disease and its clinical characteristics

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.

Aetiological Significance of Infectious Stimuli in Kawasaki Disease

“…Consistent with the increased prevalence of KD in Far East countries, YPM-positive pathogenic YP are also predominantly distributed in these countries and are less frequent in western countries (64). However, in a recent clinical study involving 108 Japanese KD patients, it was found that 90% of patients were negative for antibodies to YP and YPM (65). Vβ2-bearing Tcell subsets be preferentially activated in KD, whereas Vβ3, Vβ9, Vβ13.1, or Vβ13.2-bearing T-cell subsets are activated in YP infection (66).…”

“…Except Y. pseudotuberculosis infection (65,74,75), few cases satisfy the six diagnostic criteria for Kawasaki disease (KD) among the infectious diseases caused by the aforementioned agents. Considering that genetic background is closely associated with the susceptibility to KD (see section Influence of Genetic Background Affecting Response to Infectious Stimuli), polymorphisms in some specific genes of infected children might affect the clinical futures of the infectious diseases (76).…”

Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

“…The incubation period for intestinal Y. pseudotuberculosis infection is approximately 3 to 7 days [ 7 ]. Cases of Y. pseudotuberculosis infection, including gastroenteritis, pseudoappendicitis, bacteremia, pharyngitis, erythema nodosum, reactive arthritis, and syndromes mimicking Kawasaki disease, have been reported [ 2 , 5 , 8 ]. Risk factors for Y. pseudotuberculosis infection are exposure to contaminated food or water, as well as underlying medical conditions such as hepatic cirrhosis, HIV infection, malignancy, anaplastic anemia, thalassemia, iron overload, and diabetes mellitus [ 9 , 10 ].…”

Kawasaki-betegség gyermekkortól a felnőttkorig. Multimodális képalkotók szerepe a hosszú távú nyomonkövetésben

“…A betegség klinikai jelentőségét főleg a gyulladás következtében létrejövő kardiovaszkuláris léziók adják, ma már az akut reumás lázat is megelőzve ez vált a gyermekkori szerzett szívbetegségek leggyakoribb okává (10). A betegség etiológiája a mai napig sem tisztázott, az elmúlt 50 évben különböző elméleteket állítottak fel a szindróma eredetére (11)(12)(13)(14)(15)(16)(17)(18). Felmerült a betegség infekciózus eredete is, ahol vizsgál-ták többek között a Mycobacterium tuberculosis (19), Mycoplasma pneumoniae (20) Kawasaki Kontroll…”