Well-controlled proinflammatory cytokine responses of Peyer's patch cells to probiotic Lactobacillus casei

SUMMARY

In order to clarify the probiotic features of immunomodulation, cytokine production by murine spleen and Peyer's patch (PP) cells was examined in response to probiotic and pathogenic bacteria. In spleen cells, probiotic Lactobacillus casei induced interleukin (IL)-12 production by CD11b(+) cells more strongly than pathogenic Gram-positive and Gram-negative bacteria and effectively promoted the development of T helper (Th) type 1 cells followed by high levels of secretion of interferon (IFN)-gamma. Although the levels of IL-12 secreted by PP cells in response to L. casei were lower in comparison with spleen cells, Th1 cells developed as a result of this low-level induction of IL-12. However, IFN-gamma secretion by the L. casei-induced Th1 cells stimulated with a specific antigen was down-regulated in PP cells. Development of IL-17-producing Th17 cells was efficiently induced in PP cells by antigen stimulation. Lactobacillus casei slightly, but significantly, inhibited the antigen-induced secretion of IL-17 without a decrease in the proportion of Th17 cells. No bacteria tested induced the development of IL-10-producing, transforming growth factor-beta-producing or Foxp3-expressing regulatory T cells, thus suggesting that certain probiotics might regulate proinflammatory responses through as yet unidentified mechanisms in PP cells. These data show probiotic L. casei to have considerable potential to induce IL-12 production and promote Th1 cell development, but the secretion of proinflammatory cytokines such as IL-12 and IL-17 may be well controlled in PP cells.

Efficacy of bacterial ribosomal RNA-targeted reverse transcription-quantitative PCR for detecting neonatal sepsis: a case control study

Background

Neonatal sepsis is difficult to diagnose and pathogens cannot be detected from blood cultures in many cases. Development of a rapid and accurate method for detecting pathogens is thus essential. The main purpose of this study was to identify etiological agents in clinically diagnosed neonatal sepsis using bacterial ribosomal RNA-targeted reverse transcription-quantitative PCR (BrRNA-RT-qPCR) and to conduct comparisons with the results of conventional blood culture. Since BrRNA-RT-qPCR targets bacterial ribosomal RNA, detection rates using this approach may exceed those using conventional PCR.

Methods

Subjects comprised 36 patients with 39 episodes of suspected neonatal sepsis who underwent BrRNA-RT-qPCR and conventional blood culture to diagnose sepsis. Blood samples were collected aseptically for BrRNA-RT-qPCR and blood culture at the time of initial sepsis evaluation by arterial puncture. BrRNA-RT-qPCR and blood culture were undertaken using identical blood samples, and BrRNA-RT-qPCR was performed using 12 primer sets.

Results

Positive rate was significantly higher for BrRNA-RT-qPCR (15/39, 38.5%) than for blood culture (6/39, 15.4%; p = 0.0039). BrRNA-RT-qPCR was able to identify all pathogens detected by blood culture. Furthermore, this method detected pathogens from neonates with clinical sepsis in whom pathogens was not detected by culture methods.

Conclusions

This RT-PCR technique is useful for sensitive detection of pathogens causing neonatal sepsis, even in cases with negative results by blood culture.

Contribution of B7RP-1/ICOS co-stimulation to lethal acute GVHD

Co-stimulatory molecules expressed on T cells critically regulate donor T-cell activation and are implicated in acute GVHD after allogeneic BMT. We here investigated the role of interaction between B7-related protein-1 (B7RP-1) and ICOS in murine acute GVHD model that received T cell-depleted BM cells and splenocytes. Administration of blocking anti-B7RP-1 mAb significantly reduced the lethality and symptoms in acute GVHD. A significant hypo-responsiveness of splenocytes to host alloantigen was observed in the recipient mice treated with anti-B7RP-1 mAb. Moreover, acute GVHD was significantly reduced in the recipients of T cells composed of ICOS-deficient CD8 T cells and WT CD4 T cells compared with that in the recipients of T cells composed of WT CD8 T cells and ICOS-deficient CD4 T cells. These results suggested that B7RP-1/ICOS co-stimulatory signal plays a role in the activation of alloantigen-reactive donor T cells, particularly in CD8 T cells, in murine acute GVHD model, and that the blockade of B7RP-1/ICOS interaction may be useful for selectively manipulating allo-reactive T cells in the recipients with acute GVHD.

Heat shock proteins and superantigenic properties of bacteria from the gastrointestinal tract of patients with Kawasaki disease

We previously suggested that gut bacteria may be involved in the onset of Kawasaki disease (KD). In this study, we evaluated the production of heat shock proteins (hsps) and superantigens (sAgs) by microorganisms isolated from the jejunal mucosa of 19 children with KD in the acute phase and from 15 age-matched control children. We identified 13 strains of Gram-negative microbes from patients with KD; these microbes produced large amounts of hsp60 and induced pro-inflammatory cytokine production by peripheral blood mononuclear cells. The Gram-negative microbes also elicited endogenous hsp60 production, leading to the secretion of anti-inflammatory intereukin-10 (IL-10). We also identified 18 strains of Gram-positive cocci that had superantigenic properties and which induced the expansion of Vβ2 T cells in vitro. All bacteria identified in this study were antibiotic resistant. These data suggest that sAg and hsps produced by gut bacteria might be involved in KD.

Overfeeding can cause NEC-like enterocolitis in premature rat pups

BACKGROUND

Neonatal necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in premature infants. The mortality rate associated with NEC is quite high and in most reports ranges from 20 to 30%. Despite extensive studies, the pathogenesis of NEC remains poorly understood.

OBJECTIVES

To investigate the mechanisms of NEC in terms of inflammatory signaling in the intestine.

METHODS

A new enterocolitis model was established and examined the expression of inflammatory and anti-inflammatory signals in the intestines of rat pups. The premature rat pups, delivered by abdominal incision on day 20 of gestation (day 21 is considered as full term), were divided into three groups, and they were given a single administration of 0.05, 0.1, and 0.15 ml of formula milk via an orogastric catheter. After 24 h, the development of enterocolitis was evaluated by the presence of hemorrhagic enterocolitis, and the expression of signaling molecules, inhibitor of nuclear factor-kappaB (IkappaB)-alpha/beta and peroxisome proliferator-activated receptor (PPAR)-gamma mRNA was examined by reverse transcription-polymerase chain reaction from inflamed and non-inflamed intestinal samples.

RESULTS

The incidence of enterocolitis increased with the volume of milk, and 50% of rat pups showed enterocolitis with a volume of 0.15 ml of milk. Expression of IkappaB-alpha/beta and PPAR-gamma mRNA increased in inflamed intestine.

CONCLUSIONS

Increased expression of IkappaB-alpha/beta suggested that the inflammatory mediator nuclear factor-kappaB is deeply involved in the pathogenesis of enterocolitis that can be easily introduced by overfeeding of milk ingestion in premature rat pups which mimic those seen in NEC. Increased expression of PPAR-gamma may possibly regulate further development of enterocolitis in this system.

Fatty acid composition of the brain of intrauterine growth retardation rats and the effect of maternal docosahexaenoic acid enriched diet

AIM

To determine whether the intrauterine environment affects lipid metabolism, we measured the fatty acid composition of the brain in rats with intrauterine growth retardation (IUGR) induced by synthetic thromboxane A2 (STA2). Additionally, we evaluated the effect of maternal docosahexaenoic acid (DHA)-enriched diet.

METHODS

Two experimental diets were provided: soy bean oil and DHA-enriched diets. Maternal rats were divided randomly into three groups, STA2-/Soy (Sham), STA2+/Soy (IUGR), and STA2+/DHA (DHA) groups. The Sham and IUGR groups were fed the soy diet, and the DHA group received the DHA-enriched diet from embryonic day 7 until delivery. On postnatal days 1 and 7, the pups were weighed and their brains were removed for lipid analysis.

RESULTS

The body weight of the IUGR and DHA groups was significantly less than that of the Sham group both on the postnatal days 1 and 7, whereas it was not significantly different between the IUGR and DHA groups either on postnatal day 1 or day 7. There was no significant difference in the percentage of DHA between the Sham and IUGR groups either on postnatal day 1 or 7. On the other hand, the percentage of DHA was higher in the DHA group than in the IUGR group both on the postnatal days 1 and 7.

CONCLUSIONS

The fatty acid composition in the brain was not altered in the STA2-induced IUGR rat model. Increased DHA percentage was observed in the maternal DHA-enriched diet group, although no beneficial effect on body weight gain was observed.

Depressive tendency in children with growth hormone deficiency

AIM

This study assessed changes in depressive tendency of children with growth hormone deficiency.

METHODS

The 41 children with growth hormone deficiency were assessed using the Depression Self-Rating Scale for Children. A score of 16 or more indicated a depressive tendency. The first assessment was carried out before growth hormone treatment, and the second one was carried out at 6 months or longer after the beginning of growth hormone treatment.

RESULTS

The Depression Self-Rating Scale for Children improved significantly from 9.7 +/- 6.1 points before treatment to 6.9 +/- 4.6 points after treatment (P= 0.0013). A depressive tendency was observed in six patients (15%) before growth hormone treatment, and in two patients (5%) after treatment. No significant relationship was observed between the decrease in the score and the length of the treatment. A significant improvement was observed for 6 of the 18 items in the Depression Self-Rating Scale for Children.

CONCLUSION

A depressive tendency was relatively common in children with growth hormone deficiency, and the Depression Self-Rating Scale for Children was decreased after growth hormone treatment. These results suggest that growth hormone treatment may have positive effects on the psychosocial aspects in children with growth hormone deficiency.

Studies of anti-inflammatory effects of Rooibos tea in rats

BACKGROUND

Rooibos tea is known to be caffeine free with abundant flavonoids. Aspalathin and nothofagin, the main flavonoids contained in Rooibos tea, have stronger anti-oxidative activity than other flavonoids. As oxidative stress can induce inflammation, the anti-inflammatory effects of Rooibos tea were investigated using a rat colitis model.

METHODS

Seven-week-old Wister rats were divided into two groups: one group given Rooibos tea, and one given water. After four weeks of breeding, serum superoxide dismutase (SOD) levels were determined using the Electron Spin Resonance analysis. Urine 8-hydroxy-2'-deoxyguanosine (8-OHdG) concentrations were also determined as reflections of DNA damage using enzyme-linked immunosorbent assay. Furthermore, rats were administrated dextran sodium sulfate (DSS), which is known to induce colitis in rodents, with or without Rooibos tea to evaluate its anti-inflammatory activity. Clinical symptoms, hemoglobin, serum iron and SOD levels were compared between the groups.

RESULTS

There were no significant differences in bodyweight gain or laboratory data between the groups. The serum SOD levels were significantly increased, and urine 8-hydroxy-2'-deoxyguanosine levels were significantly decreased in the Rooibos group compared with the controls (P < 0.05 in each). After DSS administration, the serum SOD levels were significantly higher in the Rooibos group compared to the controls (P < 0.05). As a result, a decreased hemoglobin level, observed in the control group, was prevented in the Rooibos group after the DSS challenge.

CONCLUSION

Rooibos tea may prevent DNA damage and inflammation by its anti-oxidative activity in vivo. As Rooibos tea is free from caffeine, routine intake may be safe and useful in reducing oxidative stress in children.

Effect of suplatast tosilate on antileukotriene non-responders with mild-to-moderate persistent asthma

BACKGROUND

Immunomodulatory therapy has been recently introduced for the management of asthma. Suplatast tosilate (ST), a new immune-modifying drug, is known to improve the airway function by inhibiting the release of Th-2 cytokines. However, its efficacy as a controller listed in the guideline, Global Initiative for Asthma 2005 has not been established. In this study we investigated the role of ST in leukotriene receptor antagonist (LTRA) non-responders with mild-to-moderate persistent asthma before initiating corticosteroids inhalation therapy.

METHODS

This was a prospective open-level clinical trial. LTRAs was given to 41 patients with asthma for 4 weeks and clinical efficacy was assessed using daily symptom scores. The 10 patients, aged 2.5-8.5 years, who failed to show clinical improvement, were defined as LTRA non-responders. After a 1-week washout period, the efficacy of ST was investigated and compared with LTRA non-responders for the following 4 weeks.

RESULTS

LTRA non-responders showed a significant improvement in the average symptom score, peak expiratory flow, use of rescue medication and the proportion of symptom-free days with ST therapy.

CONCLUSIONS

ST is a good choice for patients who have failed to respond to LTRAs. ST should therefore be added to the list of treatment options for such patients.

Effects of the enteral administration of Bifidobacterium breve on patients undergoing chemotherapy for pediatric malignancies

PURPOSE

Probiotics are expected to be effective in prophylaxis of infection in cancer patient, since infections in neutropenics are mainly caused by endogenous flora through the intestinal mucosa. However, the experience with the use of probiotics in immunocompromised patients is limited, and precise fecal bacteria analysis has not been reported. The aim of the study was to evaluate the effects of the enteral administration of the probiotic, Bifidobacterium breve strain Yakult, on its ability to prevent infection, fecal micro flora, and intestinal environments in cancer patients on chemotherapy.

METHODS

A placebo-controlled trial was performed at Juntendo University Hospital. Patients with malignancies admitted for chemotherapy (n = 42) were randomized into two groups receiving probiotic or placebo. The effects on infectious complications, natural killer cells, fecal micro flora, fecal organic acid concentrations, and fecal pH were studied.

RESULTS

The frequency of fever and the use of intravenous antibiotics were lower in the probiotic group than the placebo group. The probiotic administration enhanced the habitation of anaerobes. Disruption of the intestinal microbiota after chemotherapy such as the increase in the population levels of Enterobacteriaceae was observed at more pronounced manner in the placebo group in comparison to the probiotic group. The concentrations of total organic acids were maintained most of the time at the normal level, which constantly maintained the pH below 7.0 only in the probiotic group.

CONCLUSION

These data, although based on a limited number of patients and samples, suggest that administration of B. breve strain Yakult could be an effective approach for achieving clinical benefits in immunocompromised hosts by improving their intestinal environments.

Use of a sensitive chemiluminescence-based assay to evaluate the metabolic suppression activity of linezolid on methicillin-resistant Staphylococcus aureus showing reduced susceptibility to vancomycin

Recently, strains of methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin (VCM) have been clinically isolated. The antibacterial activity of a new drug, linezolid (LZD), in such a strain was evaluated by measuring bacterial metabolic activity. A total of 73 MRSA strains having various susceptibilities to VCM were subjected to a novel and highly sensitive chemiluminescence-based assay. LZD MIC in the tested strains, measured by the microbroth dilution method, was within the range 1-4 mg/l (mostly </=2 mg/l), except for one LZD-resistant strain (NRS127; MIC=7 mg/l), and showed no correlation with VCM resistance. The chemiluminescence assay demonstrated that bacterial metabolic activity was strongly suppressed with increasing LZD concentration. The chemiluminescence intensity curve had a low baseline activity without tailing in most strains. The present results suggest that LZD has strong antibacterial activity against MRSA strain, and would be effective for treatment of infections that are poorly responsive to VCM. The chemiluminescence assay facilitated sensitive and discriminative susceptibility testing within a relatively short time.

Quantitative reverse transcription-PCR assay for the rapid detection of methicillin-resistant Staphylococcus aureus

AIM

To evaluate a new quantitative reverse transcription-PCR (qRT-PCR) assay for the rapid detection of methicillin-resistant Staphylococcus aureus (MRSA).

METHODS AND RESULTS

Primers for Staphylococcus-specific regions of 16S rRNA gene, spa gene and mecA gene were newly designed. RNAs extracted from broth-cultured strains were tested by qRT-PCR targeting each primer, and the bacterial counts obtained correlated well with those counted by the plating method with detection limits of 10(0), 10(1) and 10(2) CFU. The qRT-PCR assay targeting the 16S rRNA was 6430-fold or more sensitive than qPCR assay. All Staph. aureus strains tested were detected and none of the other Staphylococcus species and genus strains tested cross-reacted with the assay targeting the spa gene. All MRSAs tested were detected by the assay targeting the mecA gene. Clinical samples, faecal material and bronchial washout solutions were tested by our assay, and MRSAs were detected with a high sensitivity within 6 h.

CONCLUSION

Our qRT-PCR assay targeting three new primers to the target genes is a rapid and sensitive tool for the detection of MRSA directly from clinical samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

Because of its sensitivity and rapidity, our qRT-PCR assay is considered to be a valuable tool for clinical management.

[Effect of continuous probiotic fermented milk intake containing Lactobacillus casei strain Shirota on fever in mass infectious gastroenteritis rest home outbreak]

As part of medical risk management in a long-term stay facility for the elderly, we introduced probiotic fermented milk containing Lactobacillus casei strain Shirota (LcS-fermented milk) in an open case-control study of its effect of (1 bottle a day) on winter-time norovirus gastroenteritis. During the 1 month from December 1 to 31, 2006, norovirus gastroenteritis occurred in 21 (55%) of 38 cases in the nonmilk group, and in 27 (64%) of 39 cases in the milk group, showing no statistically significant difference. The mean duration of >37 degrees C fever after disease onset, however, was 2.9+/-2.3 days in the non-milk group and 1.5+/-1.7 days in the milk group, showing significant shortening (p<0.05). The duration of > 38 degrees C fever after disease onset also tended to be shorter. No significant differences were seen in age, gender, days of antipyretic use, or stool-free days. These results suggested that continuous intake of LcS-fermented milk could aggravate fever duration in elderly long-term rest home residents although it probably did not prevent noroviral gastroenteritis onset.

Possible role of local hypoxia in the de novo formation of dural and osteodural arteriovenous fistulas after encephalitis. A case report

A rare case of de novo formation of dural and osteodural arteriovenous fistulas after encephalitis is presented. We review and discuss the etiological angiogenetic factors and processes in intracranial dural arteriovenous fistulas formation. Local tissue hypoxia may have played a role in the initial step causing sprouting angiogenesis as the main pathogenesis of DAVFs formation.

Effect of hypoxic-ischemic injury on serine palmitoyltransferase activity in the developing rat brain

BACKGROUND

Sphingolipid metabolism is strongly associated with central nervous system myelination. Ceramide is the most active of the sphingolipid metabolites. On the basis of ceramide biosynthesis indicated by serine palmitoyltransferase activity and cerebroside generated by ceramide, the evaluation of serine palmitoyltransferase activity in developing brains or hypoxic-ischemic damaged brains is worthwhile.

METHODS

Using a scintillation counter, we assessed serine palmitoyltransferase activity, a rate-limiting enzyme of sphingolipid metabolism, in the brains of developing rats and compared the activity with hypoxic-ischemic brains, using the method of Rice on postnatal day 7 (P7).

RESULTS

In the control groups, serine palmitoyltransferase activity was detected in the microsomal fraction of whole brain homogenates from P4, which was earlier than the initial expression of myelin-specific proteins such as myelin basic protein and proteolipid protein on immunochemistry. Serine palmitoyltransferase activity increased along with development on P8, P10, P14 and P21. However, hypoxic-ischemic brains showed lower serine palmitoyltransferase activity than control brains on P8, P10, P14 and P21.

CONCLUSIONS

These results suggest that increase in serine palmitoyltransferase activity before myelin-specific protein expression may be an initial step in myelinogenesis and a decline in serine palmitoyltransferase activity in hypoxic-ischemic brains may be one of the major causes of delayed myelination.

Effect of dietary Lorenzo's oil and docosahexaenoic acid treatment for Zellweger syndrome

We investigated the possible therapeutic effect of decreasing plasma levels of very-long-chain fatty acids (C26:0) with a synthetic oil containing trioleate and trielucate (Lorenzo's oil) as well as increasing docosahexaenoic acid (DHA) in red blood cells (RBC) with DHA ethyl ester in four patients with Zellweger syndrome. We investigated serial changes of plasma C26:0 levels and DHA levels in RBC membranes by gas-liquid chromatography/mass spectrometry (GC/MS). After death, the fatty acid composition of each patient's cerebrum and liver was studied. Dietary administration of Lorenzo's oil diminished plasma C26:0 levels. Earlier administration of Lorenzo's oil was more effective and the response did not depend on the duration of administration. DHA was incorporated into RBC membrane lipids when administrated orally, and its level increased for several months. The final DHA level was correlated with the duration of administration and was not related to the timing of initiation of treatment. DHA levels in the brains and livers of treated patients were higher than in untreated patients. Early initiation of Lorenzo's oil and the long-term administration of DHA may be useful for patients with Zellweger syndrome.

Human osteoblasts support hematopoietic cell development in vitro

BACKGROUND/AIM

Although osteoblasts are thought to be the major component of the hematopoietic stem cell niche in the bone marrow microenvironment, the role of osteoblasts in hematopoiesis is still unclear. The ability of human osteoblasts to support early hematopoiesis was investigated.

METHODS AND RESULTS

Human CD34+ bone marrow cells cultured on human osteoblasts were capable of surviving without addition of cytokines and differentiated into myeloid cells with slight proliferation. The results of immunohistochemical experiments suggested activation of FAK and AKT in hematopoietic cells attached to osteoblasts. When stem cell factor, Flt3-L, and IL-3 were added to the coculture system, each cytokine distinctively enhanced proliferation and differentiation of CD34+ bone marrow cells.

CONCLUSION

The results suggest that human osteoblasts have the ability to support hematopoietic cell development in vitro.

Sepsis associated encephalopathy in an infant with biliary atresia

We describe a girl with sepsis-associated encephalopathy complicating biliary atresia. At 4 months of age, decreased consciousness and repetitive seizures of the left upper and lower extremities occurred in association with fever. Pseudomonas aeruginosa was cultured from blood, while bacterial culture was negative and cell counts were normal in cerebrospinal fluid. The interleukin-6 level in the cerebrospinal fluid was markedly elevated. MRI revealed unilateral subcortical white matter lesions in the right hemisphere. She was diagnosed as having sepsis-associated encephalopathy and was treated with dexamethasone and midazolam. She achieved normal psychomotor development until the last follow-up at 19 months of age, whereas mild atrophic changes were observed in the right hemisphere.

Urolithiasis in an acute lymphoblastic leukemia child during induction chemotherapy

An 11-year-old acute lymphoblastic leukemia patient suddenly developed severe abdominal flank pain and hematuria caused by renal stone during induction chemotherapy. The patient was treated with forced hydration, and the pain was relieved after the renal stone passed through. The renal stone was composed of calcium phosphate. The patient is currently in continuous complete remission, has had no recurrence of the urolithiasis, and is on consolidation chemotherapy. Although urolithiasis is extremely rare in childhood acute lymphoblastic leukemia, it should be considered in patients who complain of abdominal flank pain or back pain during chemotherapy.

Expression of COX-1, COX-2, and PPAR-gamma in the gastric mucosa of children with Helicobacter pylori infection

BACKGROUND

Gastric inflammation in patients with Helicobacter pylori infection is considered to be regulated by many kinds of inflammatory and cytoprotective factors. The present study examined the effects of cyclo-oxygenase (COX)-1, -2, and peroxisome proliferator-activated receptor-gamma (PPAR-gamma) on gastric mucosal injury in children with H. pylori infection.

METHODS

The subjects were 24 children who underwent endoscopy for the evaluation of anemia or gastrointestinal symptoms, and they were divided into two groups: a H. pylori-positive group and -negative group. The numbers of neutrophils in the gastric mucosa of children with and without H. pylori infection and expression of COX-1, -2, and PPAR-gamma were examined, using reverse transcription-polymerase chain reaction.

RESULTS

The numbers of neutrophils were significantly higher in the H. pylori-positive group than in the H. pylori-negative group. The ratio of COX-1 mRNA to COX-2 mRNA in the H. pylori-positive group was significantly lower than that in the H. pylori-negative group. The ratio of PPAR-gamma m-RNA to beta-actin mRNA was significantly higher in the H. pylori-positive group than the H. pylori-negative group.

CONCLUSIONS

Enhanced production of COX-2 and PPAR-gamma in the gastric mucosa has cytoprotective and anti-inflammatory effects, although the relationship to the carcinogenic activity of COX-2 and PPAR-gamma should be clarified.

Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease

BACKGROUND

The use of intravenous immunoglobulin (IVIG) is well established as an initial therapy for Kawasaki disease (KD), but treatment for IVIG-resistant KD remains uncertain

AIM

To analyse the effects of intravenous methylprednisolone (IVMP) pulse therapy compared with additional IVIG in IVIG-resistant patients.

METHODS

IVMP was administered to patients with KD who had persistent or recurrent fever after a single dose of IVIG, at Juntendo University Hospital and affiliated medical institutions between May 2003 and March 2006. The effectiveness of the treatment and the incidence of coronary lesions in patients who received IVMP and those who received additional IVIG were retrospectively analysed and compared by chart review.

RESULTS

411 patients with KD were treated with a single dose of IVIG. Of the 63 IVIG-resistant patients, 44 were then given IVMP and 19 were given additional IVIG. Treatment was successful in 34 (77%) of the patients who received IVMP and 12 (63%) who received additional IVIG. Five of the 10 patients who did not respond to IVMP and two of the seven who did not respond to additional IVIG developed coronary artery aneurysms. Although fever initially resolved faster in the IVMP-resistant group, there was a delay in fever recurrence, which ultimately delayed the final resolution of fever.

CONCLUSIONS

The findings suggest that IVMP is an effective additional treatment for IVIG-resistant KD. However, there was a tendency for fever to recur later in IVMP-resistant patients, which could potentially delay the therapeutic decision-making process.