title: Association of toxic shock syndrome toxin-secreting and exfoliative toxin-secreting Staphylococcus aureus with Kawasaki syndrome complicated by coronary artery disease.
abstract: Kawasaki syndrome (KS) has been reported to be associated with selective expansion of Vbeta2+ T cells and either staphylococcal toxic shock syndrome toxin-1 or streptococcal pyrogenic exotoxin C in uncomplicated cases. However, there have been no previous studies on the role of superantigens in KS associated with coronary artery disease, the major complication of this illness. The present study characterized bacteria isolated from three acute KS patients who developed coronary artery disease. Staphylococcus aureus secreting either TSST-1 (n = 3) or exfoliative toxin A (n = 1), both known to stimulate expansion of Vbeta2+ T cells, were isolated from all three patients. The percent Vbeta2+ T cells was determined in three patients with coronary artery disease. On presentation, one patient demonstrated reduction, whereas the other two showed expansion, of Vbeta2+ T cells. Repeat analyses of the latter two children showed their percent Vbeta2+ T cells to decrease toward normal. These observations suggest that coronary artery disease in KS may result from superantigenic stimulation of Vbeta2+ T cells. This is also the first demonstration of an association of staphylococcal exfoliative toxin with acute KS. The observation that three different bacterial toxins associated with KS are potent activators of Vbeta2+ T cells suggests an important role for this T cell subset in the pathogenesis of this autoimmune disease.
authors.affiliation: Division of Pediatric Allergy-Immunology, The National Jewish Medical and Research Center, Denver, Colorado 80206, USA.
authors.forename: D Y
authors.initials: DY
authors.lastname: Leung
authors.forename: K E
authors.initials: KE
authors.lastname: Sullivan
authors.forename: T F
authors.initials: TF
authors.lastname: Brown-Whitehorn
authors.forename: A P
authors.initials: AP
authors.lastname: Fehringer
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.forename: T H
authors.initials: TH
authors.lastname: Finkel
authors.forename: R L
authors.initials: RL
authors.lastname: Washington
authors.forename: R
authors.initials: R
authors.lastname: Makida
authors.forename: P M
authors.initials: PM
authors.lastname: Schlievert
mesh_terms: D000783:Aneurysm / Q000382:microbiology / Q000473:pathology; D001427:Bacterial Toxins; D003327:Coronary Disease / Q000097:blood / Q000209:etiology*; D004768:Enterotoxins / Q000378:metabolism* / Q000633:toxicity; D005083:Exfoliatins / Q000378:metabolism* / Q000633:toxicity; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology; D010614:Pharynx / Q000382:microbiology / Q000473:pathology; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000032:analysis / Q000502:physiology; D012007:Rectum / Q000382:microbiology / Q000473:pathology; D013211:Staphylococcus aureus / Q000378:metabolism*; D018089:Superantigens; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000502:physiology
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D005083:Exfoliatins; D016693:Receptors, Antigen, T-Cell, alpha-beta; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal