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Kim N, Choi YJ, Na JY, Oh JW. Lymph-node-first presentation of Kawasaki disease in a 12-year-old girl with cervical lymphadenitis caused by Mycoplasma pneumoniae: A case report. World J Clin Cases 2022; 10:3170-3177. [PMID: 35611136 PMCID: PMC9082695 DOI: 10.12998/wjcc.v10.i10.3170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/12/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To the best of our knowledge, cases of Kawasaki disease (KD) occurring at the age of 12 are rare, even in Asia where the incidence of KD is high. We report a case of lymph-node-first presentation of KD (NFKD) in a 12-year-old girl with Mycoplasma pneumoniae (M. pneumoniae) infection who presented with prolonged fever and lymphadenitis refractory to macrolide antibiotics.
CASE SUMMARY A previously healthy 12-year-old girl presented with fever, myalgia, sore throat, swelling, and tenderness on the right side of the neck. She was initially diagnosed with lymphadenitis caused by M. pneumoniae refractory to macrolide antibiotics. She had elevated brain natriuretic peptide (BNP) levels. Finally, the patient was diagnosed with KD. After receiving intravenous immunoglobulin, the fever resolved, and her symptoms improved.
CONCLUSION NFKD should be differentiated from adolescent lymphadenitis presenting with prolonged fever by checking the BNP level early.
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Affiliation(s)
- Nayoung Kim
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul 04763, South Korea
| | - Young-Jin Choi
- Department of Pediatrics, Hanyang University Guri Hospital, Guri-si 11923, South Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul 04763, South Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University School of Medicine, Seoul 04763, South Korea
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2
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Sharma K, Vignesh P, Srivastava P, Sharma J, Chaudhary H, Mondal S, Kaur A, Kaur H, Singh S. Epigenetics in Kawasaki Disease. Front Pediatr 2021; 9:673294. [PMID: 34249810 PMCID: PMC8266996 DOI: 10.3389/fped.2021.673294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/01/2021] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease (KD) is a common febrile multisystemic inflammatory illness in children that preferentially affects coronary arteries. Children with KD who develop coronary artery aneurysms have a life-long risk of premature coronary artery disease. Hypothesis of inherent predisposition to KD is supported by epidemiological evidence that suggests increased risk of development of disease in certain ethnicities and in children with a previous history of KD in siblings or parents. However, occurrence of cases in clusters, seasonal variation, and very low risk of recurrence suggests an acquired trigger (such as infections) for the development of illness. Epigenetic mechanisms that modulate gene expression can plausibly explain the link between genetic and acquired predisposing factors in KD. Analysis of epigenetic factors can also be used to derive biomarkers for diagnosis and prognostication in KD. Moreover, epigenetic mechanisms can also help in pharmacogenomics with the development of targeted therapies. In this review, we analysed the available literature on epigenetic factors such as methylation, micro-RNAs, and long non-coding RNAs in KD and discuss how these mechanisms can help us better understand the disease pathogenesis and advance the development of new biomarkers in KD.
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Affiliation(s)
- Kaushal Sharma
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Srivastava
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyoti Sharma
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Himanshi Chaudhary
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjib Mondal
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupriya Kaur
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harvinder Kaur
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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3
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Plebani A, Meini A, Cattalini M, Lougaris V, Bugatti A, Caccuri F, Caruso A. Mycoplasma infection may complicate the clinical course of SARS-Co-V-2 associated Kawasaki-like disease in children. Clin Immunol 2020; 221:108613. [PMID: 33069853 PMCID: PMC7561565 DOI: 10.1016/j.clim.2020.108613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Alessandro Plebani
- Pediatrics Clinic, Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Antonella Meini
- Pediatrics Clinic, Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili of Brescia, Brescia, Italy
| | - Marco Cattalini
- Pediatrics Clinic, Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vassilios Lougaris
- Pediatrics Clinic, Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonella Bugatti
- Institute of Microbiology and Virology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Caccuri
- Institute of Microbiology and Virology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- Institute of Microbiology and Virology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili of Brescia, Brescia, Italy
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Khan I, Li XA, Law B, U KI, Pan BQ, Lei C, Hsiao WLW. Correlation of gut microbial compositions to the development of Kawasaki disease vasculitis in children. Future Microbiol 2020; 15:591-600. [PMID: 32490694 DOI: 10.2217/fmb-2019-0301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Here, we hypothesize that dysbiotic gut microbiota might contribute to the development of Kawasaki disease (KD), a pediatric disease with unknown etiology. This is the second report on gut microbiota composition in KD patients. Materials & results: 16S amplicon sequencing was performed on fecal DNA samples and revealed predominance of bacterial pathogens, such as Fusobacterium, Neisseria, Shigella and Streptococcus, in the gut of KD patients, but absent or suppressed after immunoglobulin/antibiotics therapy. In addition, beneficial bacteria propagated after the therapy. Conclusion: We conclude that prevalence of Fusobacteria, Shigella and Streptococcus might contribute to KD pathogenesis.
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Affiliation(s)
- Imran Khan
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau SAR, China
| | - Xiao-ang Li
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau SAR, China
| | - Betty Law
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau SAR, China
| | - Ka In U
- Department of Pediatrics, Kiang Wu Hospital, Macau SAR, China
| | - Bao Quan Pan
- Department of Pediatrics, Kiang Wu Hospital, Macau SAR, China
| | - Cheng Lei
- Department of Pediatrics, Kiang Wu Hospital, Macau SAR, China
| | - WL Wendy Hsiao
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau SAR, China
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5
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Lan Y, Li S, Yang D, Zhou J, Wang Y, Wang J, Xu Y, Chen Z. Clinical characteristics of Kawasaki disease complicated with Mycoplasma pneumoniae pneumonia: A retrospective study. Medicine (Baltimore) 2020; 99:e19987. [PMID: 32384451 PMCID: PMC7220055 DOI: 10.1097/md.0000000000019987] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study aimed to investigate the inner linkage and mechanism of Mycoplasma pneumoniae (MP) infection and Kawasaki disease (KD), as well as the risk factors of outcome in this cohort of patients.A retrospective study was performed in 210 patients diagnosed with KD complicated with community acquired pneumonia (CAP) in Children's Hospital, Zhejiang University School of Medicine from January 2014 to December 2017. They were divided into two groups based on MP infection: MP infection group (n = 97) and non-MP infection group (n = 113). We compared the variables of these two groups based on medical records.The MP infection group had higher ESR than the non-MP infection group. During hospitalization, the non-MP infection group had higher levels of WBC during hospital, LDH, PCT, and lower HB when compared to the MP infection group. No differences were found in the hs-CRP level, N%, PLT, ALT, CKMB, and cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) between MP and non-MP infection group. Likewise, no difference was found in fever duration or hospital stays between them. Totally 19 patients in the infection group had CAA with a rate of 19.59%; and 27 (23.89%) patients had CAA in the non-MP infection group. Unfortunately, no difference was found in CAA rate between the two groups.MP infection may occur simultaneously in children with Kawasaki disease. KD patients with MP infection tended to occur in older population. MP infection may not increase the risk of CAA, which still needs further large-scaled studies to confirm. Clinicians should be alert to KD patients with high level of ESR. MP should be screened and early treatment with macrolides should be given timely.
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Affiliation(s)
- Yinle Lan
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Shuxian Li
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Dehua Yang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Junfen Zhou
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
- Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China
| | - Yingshuo Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Jianhua Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Yingchun Xu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Zhimin Chen
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
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Abstract
Kawasaki disease (KD) is a multisystem vasculitis that primarily affects the coronary arteries of young children. The causes of KD remain a mystery. It is suspected that some sort of infectious agent is involved because KD has epidemicity and seasonality. That said, the incidence of the disease is high among Japanese people, so it can be speculated that the hosts may have some sort of genetic characteristic that leaves them susceptible to KD. Various theories regarding the etiology have been asserted, such as the infectious vasculitis theory, autoantigen theory, superantigen theory, and RNA virus theory; however, none of them have been able to overcome this epidemicity. Taking into consideration the knowledge gained from previous reports, the best scenario explaining the pathogenesis is "individuals with certain genetic backgrounds are affected by microorganisms which trigger KD." In this article, the pathogenesis of KD is discussed with a focus on the microorganisms mentioned above, along with the previous and current hypotheses as well as my own opinion.
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Affiliation(s)
- Satoru Nagata
- Departments of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
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7
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Association of early social environment with the onset of pediatric Kawasaki disease. Ann Epidemiol 2019; 29:74-80. [DOI: 10.1016/j.annepidem.2018.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022]
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8
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Kogularasu S, Akilarasan M, Chen SM, Elaiyappillai E, Johnson PM, Chen TW, Al-Hemaid FM, Ali MA, Elshikh MS. A comparative study on conventionally prepared MnFe2O4 nanospheres and template-synthesized novel MnFe2O4 nano-agglomerates as the electrodes for biosensing of mercury contaminations and supercapacitor applications. Electrochim Acta 2018. [DOI: 10.1016/j.electacta.2018.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Nanishi E, Nishio H, Takada H, Yamamura K, Fukazawa M, Furuno K, Mizuno Y, Saigo K, Kadoya R, Ohbuchi N, Onoe Y, Yamashita H, Nakayama H, Hara T, Ohno T, Takahashi Y, Hatae K, Harada T, Shimose T, Kishimoto J, Ohga S, Hara T. Clarithromycin Plus Intravenous Immunoglobulin Therapy Can Reduce the Relapse Rate of Kawasaki Disease: A Phase 2, Open-Label, Randomized Control Study. J Am Heart Assoc 2017; 6:JAHA.116.005370. [PMID: 28684643 PMCID: PMC5586277 DOI: 10.1161/jaha.116.005370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background We previously reported that biofilms and innate immunity contribute to the pathogenesis of Kawasaki disease. Therefore, we aimed to assess the efficacy of clarithromycin, an antibiofilm agent, in patients with Kawasaki disease. Methods and Results We conducted an open‐label, multicenter, randomized, phase 2 trial at 8 hospitals in Japan. Eligible patients included children aged between 4 months and 5 years who were enrolled between days 4 and 8 of illness. Participants were randomly allocated to receive either intravenous immunoglobulin (IVIG) or IVIG plus clarithromycin. The primary end point was the duration of fever after the initiation of IVIG treatment. Eighty‐one eligible patients were randomized. The duration of the fever did not differ between the 2 groups (mean±SD, 34.3±32.4 and 31.1±31.1 hours in the IVIG plus clarithromycin group and the IVIG group, respectively [P=0.66]). The relapse rate of patients in the IVIG plus clarithromycin group was significantly lower than that in the IVIG group (12.5% versus 30.8%, P=0.046). No serious adverse events occurred during the study period. In a post hoc analysis, the patients in the IVIG plus clarithromycin group required significantly shorter mean lengths of hospital stays than those in the IVIG group (8.9 days versus 10.3 days, P=0.049). Conclusions Although IVIG plus clarithromycin therapy failed to shorten the duration of fever, it reduced the relapse rate and shortened the duration of hospitalization in patients with Kawasaki disease. Clinical Trial Registration URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000015437.
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Affiliation(s)
- Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisanori Nishio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan .,Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Kenji Furuno
- Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yumi Mizuno
- Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenjiro Saigo
- Department of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Ryo Kadoya
- Department of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Noriko Ohbuchi
- Department of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Yasuhiro Onoe
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Hironori Yamashita
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Hideki Nakayama
- Department of Pediatrics, Fukuoka Higashi Medical Center, Koga, Japan
| | - Takuya Hara
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Takuro Ohno
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Yasuhiko Takahashi
- Department of Pediatrics, Japan Community Healthcare Organization (JCHO) Kyushu Hospital, Kitakyushu, Japan
| | - Ken Hatae
- Department of Pediatrics, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Tatsuo Harada
- Department of Pediatrics, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - Junji Kishimoto
- Department of Research and Development of Next Generation Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiro Hara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Fukuoka Children's Hospital, Fukuoka, Japan
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Moon JW, Lee SH, Oh YK, Choi DY, Yu ST. Autoimmune Hemolytic Anemia after Intravenous Immunoglobulin Therapy in a Child with Kawasaki Disease. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.2.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joung Whan Moon
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Seung Hyun Lee
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Yeon Kyun Oh
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Du Young Choi
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Seung Taek Yu
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
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11
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Tang Y, Yan W, Sun L, Huang J, Qian W, Hou M, Lv H. Kawasaki disease associated with Mycoplasma pneumoniae. Ital J Pediatr 2016; 42:83. [PMID: 27609267 PMCID: PMC5016862 DOI: 10.1186/s13052-016-0292-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/02/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an illness of unknown etiology that mostly occurs in children under 5 years of age and is the leading cause of acquired heart disease all over the world. Mycoplasma pneumoniae (MP) was one of the likely causative agents of KD. However, the etiologic effect of MP in KD has not been fully recognized. METHODS We prospectively analyzed the clinical records of 450 patients with KD hospitalized in Children's Hospital of Soochow University from 2012 to 2014. Using medical records, we retrospectively identified patients with low respiratory tract infection (non-KD group). RESULTS Of the 450 KD patients, MP was positive in 62 (13.8 %). The median age of the MP + KD+ group was significantly older than the MP-KD+ group (25 vs 14.5 months, P < 0.01). MP + KD+ group had higher levels of ESR, N% and CRP than the MP-KD+ group. MP + KD+ group were more frequent in respiratory disorders than MP-KD+ group with a P < 0.05. No statistical difference of non-responders or coronary artery lesion was found between the groups. CONCLUSIONS MP infections are found in an important proportion of the KD patients (13.8 % in our series). MP infection tended to occur in older populations and with a higher rate of respiratory tract involvement in patients with KD. No statistical difference of non-responders or coronary artery lesion was found between the MP+ and MP- KD patients.
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Affiliation(s)
- Yunjia Tang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Wenhua Yan
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Ling Sun
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Jie Huang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Weiguo Qian
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Miao Hou
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China.
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12
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Teng GG, Chatham WW. Vasculitis related to viral and other microbial agents. Best Pract Res Clin Rheumatol 2015; 29:226-43. [PMID: 26362741 DOI: 10.1016/j.berh.2015.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/08/2015] [Indexed: 12/11/2022]
Abstract
Vasculitis due to infection may occur as a consequence of the inflammation of vessel walls due to direct or contiguous infection, type II or immune complex-mediated reaction, cell-mediated hypersensitivity, or inflammation due to immune dysregulation triggered by bacterial toxin and/or superantigen production. As immunosuppressive therapy administered in the absence of antimicrobial therapy may increase morbidity and fail to effect the resolution of infection-associated vascular inflammation, it is important to consider infectious entities as potential inciting factors in vasculitis syndromes. The causality between infection and vasculitis has been established in hepatitis B-associated polyarteritis nodosa (HBV-PAN) and hepatitis C-associated (cryoglobulinemic) vasculitis (HCV-CV). The review summarizes the recent literature on the pathophysiological mechanisms and the approaches to the management of HBV-PAN and HCV-CV. Roles of other viral and microbial infections, which either manifest as vasculitic syndromes or are implicated in the pathogenesis of primary vasculitides, are also discussed.
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Affiliation(s)
- Gim Gee Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - W Winn Chatham
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
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13
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Rigante D, Cantarini L, Piastra M, Angelone DF, Valentini P, Pardeo M, Buonsenso D, Delogu AB, Serranti D, De Nisco A, Compagnone A, De Rosa G. Kawasaki syndrome and concurrent Coxsackie virus B3 infection. Rheumatol Int 2012; 32:4037-40. [PMID: 21052673 PMCID: PMC7080020 DOI: 10.1007/s00296-010-1613-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 10/13/2010] [Indexed: 12/30/2022]
Abstract
We describe two previously healthy children who were hospitalized in the same period in different departments of our University with clinical signs of Kawasaki syndrome, which were treated with intravenous immunoglobulins and acetylsalicylic acid: in both cases, Coxsackie virus infection was concurrently demonstrated by enzyme-linked immunosorbent assay, and complement fixation test identified antibodies to serotype B3. In the acute phase, both patients presented hyperechogenic coronary arteries, but no cardiologic sequels in the mid term. The etiological relationship between Kawasaki syndrome and Coxsackie viruses is only hypothetical; however, the eventual identification of ad hoc environmental triggers is advisable in front of children with Kawasaki syndrome, with the aim of optimizing epidemiological surveillance and understanding the intimate biological events of this condition.
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Affiliation(s)
- Donato Rigante
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
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14
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Huang FL, Chang TK, Jan SL, Tsai CR, Wang LC, Lai MC, Chen PY. Co-morbidity of Kawasaki disease. Indian J Pediatr 2012; 79:815-7. [PMID: 22057395 DOI: 10.1007/s12098-011-0589-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 10/03/2011] [Indexed: 11/25/2022]
Abstract
Despite more than four decades of investigation, the etiology of Kawasaki disease remains obscure, and none of the proposed etiologic theories for the disease have achieved independent confirmation. Clinical and epidemiologic features support an infectious cause, but the etiology remains unclear. The authors present a case of Kawasaki disease associated with Epstein-Barr virus and Mycoplasma pneumoniae infection in a 3.5-y-old boy. He received two doses of intravenous immunoglobulin due to prolonged course of Kawasaki disease but later had complicated autoimmune haemolytic anaemia. His prolonged fever subsided after azithromycin administration. Epstein-Barr virus infection was confirmed by molecular microbiological pathology of cervical lymph node and serological tests. The serological tests for Mycoplasma pneumoniae also revealed a positive result. Thus, it is concluded that Mycoplasma pneumoniae and Epstein-Barr virus infections may occur simultaneously in a child with Kawasaki disease. In addition, autoimmune hemolytic anaemia may be noted in Kawasaki disease patients after high-dose IVIG administration. To the authors' knowledge, this is the first report of Kawasaki disease with Epstein-Barr virus and Mycoplasma pneumoniae in the English-language literature.
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Affiliation(s)
- Fang-Liang Huang
- Department of Pediatrics, Taichung Veterans General Hospital, No. 160, Sec. 3, Chung-Kang Rd., Taichung, 407, Taiwan
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15
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[Kawasaki disease and Mycoplasma pneumoniae infection]. Med Mal Infect 2010; 40:717-9. [PMID: 20650584 DOI: 10.1016/j.medmal.2010.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/07/2010] [Accepted: 06/07/2010] [Indexed: 11/21/2022]
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16
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Nagata S, Yamashiro Y, Ohtsuka Y, Shimizu T, Sakurai Y, Misawa S, Ito T. Heat shock proteins and superantigenic properties of bacteria from the gastrointestinal tract of patients with Kawasaki disease. Immunology 2010; 128:511-20. [PMID: 19950419 PMCID: PMC2792135 DOI: 10.1111/j.1365-2567.2009.03135.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Satoru Nagata
- Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
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Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010; 16:162-9. [DOI: 10.1007/s10156-010-0044-x] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Indexed: 12/30/2022]
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18
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Affiliation(s)
- Peter C Schalock
- Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Falcini F, Cimaz R. Chapter 11 Kawasaki Disease. HANDBOOK OF SYSTEMIC AUTOIMMUNE DISEASES 2007. [PMCID: PMC7148694 DOI: 10.1016/s1571-5078(07)06015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kawasaki disease (KD) is an acute febrile systemic vasculitis usually occurring in children younger than five years, and rarely reported in neonates and adults. This chapter discusses the epidemiology, etiology, pathogenesis, clinical manifestations, and treatments of KD. The etiology still remains unknown, although epidemiological and clinical features strongly suggest an infectious cause. Immunological abnormalities in the acute phase of the disease reflect activation of immune system and marked production of cytokines by activated cells. KD has some similarities to toxin-mediated diseases, both from a clinical and an immunological point of view. The role of one or more superantigens competent of stimulating large numbers of T cells produced by certain strains of Staphylococcus or Streptococcus is discussed in the chapter, in the context of the etiology of KD. Atypical cases are those with fever, acute surgical symptoms, or neurological manifestations as presenting signs. Medical history, physical examination, and laboratory tests including elevated white-blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and low hemoglobin, sodium and albumin levels may help to rule out illnesses mimicking KD. Oral or pulsed corticosteroids in children refractory to intravenous immunoglobulins (IVIG) are an alternative and safe treatment.
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Benseler SM, McCrindle BW, Silverman ED, Tyrrell PN, Wong J, Yeung RSM. Infections and Kawasaki disease: implications for coronary artery outcome. Pediatrics 2005; 116:e760-6. [PMID: 16322132 DOI: 10.1542/peds.2005-0559] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to determine the effect of coincident infection, at time of diagnosis of Kawasaki disease (KD), on treatment response and coronary artery outcome. METHODS A single-center, retrospective study of 129 consecutive patients diagnosed with typical KD between January 1997 and December 1998 was performed. Standardized clinical assessments, laboratory, microbiology, and imaging test results plus treatment regimens were reviewed. Coronary arteries were visualized by using echocardiography, and coronary artery lesions (CALs) were reported as body surface area-adjusted z scores. Infection-positive and -negative groups were identified, and clinical, laboratory, and treatment data were analyzed. The effect of infections and other outcome variables on CAL development was determined by multivariate regression analysis. RESULTS (1) Concurrent infections: 33% of children with typical KD had > or =1 confirmed infection at KD diagnosis. (2) Treatment response: the presence of infection did not alter the response to treatment with intravenous immunoglobulin, with resolution of fever in 83% of children after 1 dose of intravenous immunoglobulin together with aspirin administration regardless of presence or absence of infection. (3) Coronary outcome: in total, 31% of the patients developed CALs. Both the proven-infection and no-proven-infection groups had a similar CAL frequency. (4) Multivariate regression analysis: proven infection did not increase the risk of coronary artery involvement even after adjusting for other factors impacting on coronary artery outcomes. CONCLUSIONS Infections are common at diagnosis of KD. A broad spectrum of infectious agents was found. Infections at diagnosis of KD did not affect the patients' response to treatment and coronary artery outcome when compared with those patients without infections.
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Affiliation(s)
- Susanne M Benseler
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Abstract
OBJECTIVES To describe the epidemiology, clinical features and outcome of Mycoplasma pneumoniae infection in children presenting to a tertiary children's hospital. METHODS Sixty-three month retrospective review of serologically diagnosed M. pneumoniae infections. RESULTS There were 76 children, 42 boys and 34 girls, mean age 6.3 +/- 3.5 years. The age group most commonly affected was 5-9 years, followed by children 1-5 years. More than half of the patients had failed to respond to antibiotics before referral. The commonest presentation was with cough and fever. Coryza, diarrhoea, vomiting, tachypnoea and recession were significantly more common in children less than 5 years than in children 5-15 years. Hospitalized patients were more likely than non-hospitalized patients to have respiratory distress with recession and wheeze. Radiographic findings were non-specific. Thrombocytosis was found in 29 (41.4%) of 70 children studied. CONCLUSION The clinical features of M. pneumoniae infection were different in children less than 5 years than in children aged 5-9 years. The presence of thrombocytosis in 40% of the cases has not previously been reported in children.
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Affiliation(s)
- N Othman
- Department of Virology and Microbiology, The Children's Hospital at Westmead, New South Wales, Australia
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Abstract
Kawasaki disease is an acute multisystem vasculitic syndrome of unknown etiology occurring mostly in infants and children younger than 5 years of age. In developed countries, Kawasaki disease is currently the leading cause of acquired heart diseases in children. However, it is still a mysterious disease. In this article, we reviewed and summarized from the aspects based on infection agents, host immune dysregulation and genetic background intended to establish a feasible infection-immunogenetic pathogenesis for this mysterious disease and also provided the rational strategy to explore optimal treatment of this disease.
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Affiliation(s)
- Chih-Lu Wang
- Division of Pediatric Immunology, Chang-Gung Children's Hospital at Kaohsiung, 123 Ta-Pei Road, Niau-Sung, Kaohsiung 833, Taiwan
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Schalock PC, Dinulos JGH. Mycoplasma pneumoniae-induced Stevens-Johnson syndrome without skin lesions: fact or fiction? J Am Acad Dermatol 2005; 52:312-5. [PMID: 15692479 DOI: 10.1016/j.jaad.2004.07.044] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Peter C Schalock
- Department of Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USA
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Merlin E, Al Fatuhi H, Crost P. Syndrome de Kawasaki et infection à Mycoplasma pneumoniae. Arch Pediatr 2004; 11:972-3. [PMID: 15288092 DOI: 10.1016/j.arcped.2004.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2004] [Accepted: 04/09/2004] [Indexed: 11/20/2022]
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