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Yersinia pseudotuberculosis infection in Kawasaki disease and its clinical characteristics.

Horinouchi T, Nozu K, Hamahira K, Inaguma Y, Abe J, Nakajima H, Kugo M, Iijima K - BMC Pediatr (2015)

Bottom Line: KD 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.Additionally, further research is needed to determine whether early diagnosis of YPT can prevent KD from developing and reduce the incidence of CS.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan. tomoko.hatono@gmail.com.

ABSTRACT

Background: The 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.

Methods: We 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).

Results: Eleven 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).

Conclusions: KD 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.

No MeSH data available.


Related in: MedlinePlus

Flow chart showing the distribution of study subjects and medications used for KD in the RAISE group. The numbers in parentheses denote the overall number of patients in the RAISE group, and the number in the RAISE group who received PSL because of risk scores ≥5 points, respectively. IVIG: intravenous immunoglobulin, IFX: infliximab, CyA: cyclosporin, mPSL: methylprednisolone
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Fig3: Flow chart showing the distribution of study subjects and medications used for KD in the RAISE group. The numbers in parentheses denote the overall number of patients in the RAISE group, and the number in the RAISE group who received PSL because of risk scores ≥5 points, respectively. IVIG: intravenous immunoglobulin, IFX: infliximab, CyA: cyclosporin, mPSL: methylprednisolone

Mentions: Figures 2 and 3 show the medications and the number of patients overall, whose risk scores were ≥5 points, in the conventional group and the RAISE group, respectively. Forty of 108 patients were treated according to the RAISE study protocol [15] (RAISE group). Ten patients in the RAISE group had positive risk scores and received IVIG + PSL therapy (Fig. 3). As shown in Table 3, there were no significant differences in clinical characteristics between patients in the RAISE and conventional groups. Two of 40 patients (5 %) in the RAISE group and one of 68 (1.47 %) in the conventional group had CS (p = 0.55). Further, two of 10 patients (20 %) with positive risk scores in the RAISE group (one YPT positive and one YPT negative) and one of 19 patients (5.26 %) with positive risk scores in the conventional group (YPT positive) had CS (p = 0.27).Fig. 2


Yersinia pseudotuberculosis infection in Kawasaki disease and its clinical characteristics.

Horinouchi T, Nozu K, Hamahira K, Inaguma Y, Abe J, Nakajima H, Kugo M, Iijima K - BMC Pediatr (2015)

Flow chart showing the distribution of study subjects and medications used for KD in the RAISE group. The numbers in parentheses denote the overall number of patients in the RAISE group, and the number in the RAISE group who received PSL because of risk scores ≥5 points, respectively. IVIG: intravenous immunoglobulin, IFX: infliximab, CyA: cyclosporin, mPSL: methylprednisolone
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4642785&req=5

Fig3: Flow chart showing the distribution of study subjects and medications used for KD in the RAISE group. The numbers in parentheses denote the overall number of patients in the RAISE group, and the number in the RAISE group who received PSL because of risk scores ≥5 points, respectively. IVIG: intravenous immunoglobulin, IFX: infliximab, CyA: cyclosporin, mPSL: methylprednisolone
Mentions: Figures 2 and 3 show the medications and the number of patients overall, whose risk scores were ≥5 points, in the conventional group and the RAISE group, respectively. Forty of 108 patients were treated according to the RAISE study protocol [15] (RAISE group). Ten patients in the RAISE group had positive risk scores and received IVIG + PSL therapy (Fig. 3). As shown in Table 3, there were no significant differences in clinical characteristics between patients in the RAISE and conventional groups. Two of 40 patients (5 %) in the RAISE group and one of 68 (1.47 %) in the conventional group had CS (p = 0.55). Further, two of 10 patients (20 %) with positive risk scores in the RAISE group (one YPT positive and one YPT negative) and one of 19 patients (5.26 %) with positive risk scores in the conventional group (YPT positive) had CS (p = 0.27).Fig. 2

Bottom Line: KD 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.Additionally, further research is needed to determine whether early diagnosis of YPT can prevent KD from developing and reduce the incidence of CS.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan. tomoko.hatono@gmail.com.

ABSTRACT

Background: The 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.

Methods: We 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).

Results: Eleven 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).

Conclusions: KD 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.

No MeSH data available.


Related in: MedlinePlus